Hospitals Medisch Spectrum Twente (MST) and Hospital Group Twente (ZGT) are going to work together intensively and a merger in the long run do not exclude. “We want to organize as much care in our own region as possible. Our patients have to travel to an academic hospital for one and a half hours,” says Joyce Berger, MST board member. “Doing everything in -house is becoming increasingly difficult due to the shortage on the labor market and the rising demand for care. That is why we are joining forces.”
Emergency scenarios
Emergency care that is open 24 hours a day in particular and the Obstetrics department are becoming increasingly a stumbling block for hospitals. They also see that in Twente.
“Every year there are emergency scenarios, especially in the summer period, due to a shortage of nurses. We then look at per day or weekend where people can still give birth. Home reclements are often not possible,” says Berger.
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Twente is not the only region where this plays. In recent years, many hospitals have entered into intensive collaborations. How that collaboration should take shape is often a puzzle. For example, an advanced merger plan suddenly spoke in Friesland at the end of May because a director of one of the hospitals saw too great risks.
Negotiating position
“By merging, as a hospital you get a better negotiating position against health insurers who provide care for their insured persons annually,” explains Ron Kemp, job title at the Consumer and Market Authority. “Because there are few other hospitals left in a region, health insurers almost have to conclude a contract and it is therefore easier for hospitals to request a higher price for their treatments.”
He continues: “For a hospital board of a merger hospital it is also easier to push on certain decisions, such as moving the emergency department to one location, than when it concerns two cooperating hospitals.”
But a merger between two hospitals must first be approved by the ACM. And he looks at whether the new hospital is not getting too large a market position. “We look at the competition, among other things. There is something to choose for the health insurer. And also at the patient perspective,” says Kemp. Even when hospitals start working together intimately, the market watchdog is watching. “Hospitals are competitors, so agreements about distributing patients is not allowed just like that. But when there is a problem in the region, for example in midwifery, and good agreements are made, we will not soon act against it,” says Kemp.
New construction plans
With a merger in the background also often play new construction plans and that means a cost increase. Hospitals have lost themselves more often in the past, says Marco Varkevisser, professor of market regulation in health care at Erasmus University Rotterdam. “Although keeping care in a region is usually the reason for a merger, growth ambitions, new construction plans often arise. And they can later hang around the neck like a millstone.”
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Merging, but also working together means making concessions. “Many hospitals want to remain a ‘fully -fledged’ hospital. But hospitals should wonder much more: what care can and want to offer, what profile should our hospital have,” says Varkevisser.
Maastricht UMC received permission from the ACM a year ago to take over the St. Jans Gasthuis in Weert. “Weert does not want to impoverish an elderly person who does one and a half merorial care if ZBC does,” said Gertjan Kamps director of the St. Jans Gasthuis in April of this year to trade magazine Zorgvisie.
Sharp choices
“A rather derogatory statement,” says Varkevisser. “Not every hospital
Need to offer everything. You also need hospitals that focus primarily on cooperation with the first line in the region. It is inevitable that sharper profile choices must be made. “
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So -called volume standards were already agreed for complicated cancer treatments last May. Only hospitals where these interventions are carried out often enough may continue to do these treatments. In the coming years, agreements will be made for more complex operations.
By choosing a merger, as a hospital you can keep care in your own home more easily and thereby avoid painful choices. Varkevisser: “It takes courage from drivers to say to specialists” In the coming years we are going to reduce this care, this is no longer the path we want to follow. ”
Although the collaboration plans in Twente are widely supported, Berger also sees that not all medical specialists are eager for changes in their working area. “Some doctors are more enthusiastic than others. If you say: this intervention will happen to the neighbors from now on, that affects their practice and position.”
Financially
In addition, shifting with care is financially risky, says Berger. Hospitals have to deal with fixed costs, and moving treatments also means moving income and costs. “The margins in the hospital world are small. You can’t just shift sales without having to influence the financial health of both organizations.”
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That is why the involvement of health insurers is crucial, says the driver. “Menzis has been closely involved in the process from the start and VGZ and Zilveren Kruis also endorse the plans. Without the consent of the insurers, a collaboration will not get off the ground legally.”
In my village
Kemp confirms that the ACM always looks at whether ‘the triangle’ is involved in the plans: “It is very important for us that care providers, health insurers and patients support the plans.”
Conversations with people from Twente are particularly the importance of proximity to care. Berger: “They actually say: just merge if necessary, as long as I can be helped in the neighborhood.”