Figures from the knowledge centre Kompas in de Zorg show that waiting times for some of the most common operations in the Netherlands continue to increase. Need a new knee? You'll have to wait for thirteen weeks. A new hip? Eleven weeks. These waiting times exceed the target standards for socially acceptable waiting times, the so-called Treek standards, which amount to seven weeks. This raises the question: what are the consequences of these increasing waiting times for patients, health insurers, and the healthcare system as a whole? Martin Buijsen, Professor of Health Law at Erasmus School of Law, appeared in De Telegraaf on the subject. In this article, he discusses the rising waiting times in healthcare.
Socially acceptable waiting times
Waiting times in healthcare are not arbitrarily determined. "Treek standards are target norms for socially acceptable waiting times for non-emergency care," Buijsen explains. "They are based on agreements between healthcare providers and health insurers and are named after the Den Treek estate where they were first agreed upon." Buijsen explains that waiting times for non-emergency care are inevitable but that Treek standards have been established to find a balance between the interests of healthcare providers and health insurers. For healthcare providers, care must remain effective. Excessive waiting times can lead to additional health damage and less effective treatments. On the other hand, health insurers value efficiency, as prolonged waiting times ultimately make healthcare more expensive. "The Treek standards do not differ per operation, but they are different for mental healthcare, general practitioners, specialist medical care with outpatient clinics, and so on," says Buijsen.
Why do waiting times continue to rise?
According to Buijsen, there are multiple causes for the increasing waiting times: "The growth of waiting lists is caused by increasing demand, driven partly by an ageing population but also by increasing medical possibilities, while supply is relatively lagging." The lagging supply is mainly due to healthcare budgets not growing at the same pace and a shortage of personnel. This shortage means hospitals can perform fewer operations, resulting in patients waiting longer for necessary treatments. "The healthcare system is designed so that health insurers enter into contracts with hospitals and specialists. But if there is insufficient capacity, waiting times can increase." In De Telegraaf, Buijsen also points to the role of politics: "Politicians have chosen to limit healthcare expenditure as much as possible. This directly affects the accessibility of healthcare."
Healthcare: a privilege?
De Telegraaf shows that patients are increasingly finding solutions themselves when they have to wait too long for treatment. Those who can afford it choose a private clinic or go abroad. We asked Buijsen if he fears that the Netherlands is sliding towards a healthcare system where only people with sufficient financial means will be helped. However, according to Buijsen, the risk of a division in healthcare is limited: "We collectively finance many forms of care because the costs for individual patients are truly unaffordable. Additionally, private clinics generally also really want contracts with health insurers. The market for necessary care paid entirely out of pocket is practically non-existent."
Everyone will be affected
The problem of increasing waiting times in healthcare is an issue that affects the entire society. Buijsen explains: "Sooner or later, everyone will be affected, simply because everyone sooner or later faces health problems and needs care." Although the situation is pressing, there are options for people who need care. "Contact your health insurer immediately if you need care," Buijsen advises. "Overall waiting times are increasing, but health insurers are still managing to promptly refer individual patients to a healthcare provider. Many insured do not know that the duty of care rests with their insurer and that they can and will mediate." Health insurers have the legal duty to ensure that patients receive the care they need in a timely manner.
Future challenges
The problems in healthcare do not seem to be solved anytime soon. "The scarcity will only increase because the demand for care continues to rise while personnel and resources lag behind." According to Buijsen, solutions lie partly in increasing productivity through innovations and partly in making choices about what should still be collectively financed. "But we find making such choices very difficult in the Netherlands."
One thing is clear: the current situation underscores the need for a broader societal discussion about the future of healthcare in the Netherlands.
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