This exciting proposal is contained in a draft of the Integral Care Agreement (IZA) that has been submitted to seventeen care organisations. They can now respond to the piece and suggest adjustments. The intention is that a full agreement will be reached on Budget Day, which will be incorporated into the 2023 budget. The IZA aims to reorganize healthcare, based on the principle that healthcare providers work together more and healthcare is available close to the patient.
A patient who now goes to a healthcare provider without a contract with his health insurer will still be reimbursed part of the bill. With a so-called in-kind policy, the reimbursement is around 75 percent, with a cheaper budget policy it can be lower. Only the more expensive reimbursement policy always reimburses all care covered by the policy. Removing the obligation to reimburse in kind and budget policies is referred to as abolishing the ‘free choice of doctors’. In 2014, a bill to that effect by former minister Edith Schippers was defeated in the Senate.
The government now wants to try again to combat the use of uncontracted care. The main obstacle is ‘reducing the reimbursement of non-contracted care’, although it is not clear by how much from the Integral Care Agreement.
Reorganization of care
The proposal is politically extremely sensitive. The CDA of the coalition parties voted against Schippers’ proposal at the time. If the coalition now draws a line, it depends on the Senate whether there is a majority in favor. The Senate will change its composition next year.
The measure to prevent the free choice of doctors is part of a reorganization of healthcare. Healthcare is under tension, both due to rising costs and a shortage of staff. In addition, ‘not all care that is provided is demonstrably effective’, according to the Integral Care Agreement. ‘Appropriate’ care will be central, which means as much as to determine in consultation with the patient whether an expensive intervention increases the quality of life or not.
To make healthcare more effective, all healthcare providers in 31 regions must work together. This cooperation will be crucial when concluding contracts with health insurers and municipalities that are responsible for care for people in need of help living at home. Insured persons, in turn, should therefore primarily purchase care from those partnerships and not opt for other, non-contracted care. Restricting the free choice of doctors can help with this.
With the IZA, the cabinet also wants to reduce the pressure on general practitioners and district nurses. The workload for general practitioners and district nurses, the so-called primary care, is already high and will only increase because people continue to live at home longer with more complex care requirements. However, primary care is organized on a ‘small-scale and monodisciplinary’ basis, which means that patients often have to deal with several care providers. In their turn, they are less and less concerned with care provision and more and more with peripheral matters, is the analysis in the article.
Living independently
This has to change, for example through the use of ‘(self-)care resources’ via the computer. GPs, mental health services and municipalities – responsible for people in need of help who live independently – must also work together better. Over the next two years, an organization must be set up per region to arrange this.
GPs have long been responsible for people who are on a mental health waiting list. ‘At the same time, we see’, according to the IZA, ‘that mental health care still too often focuses on relatively minor requests for help that can (partly) also be dealt with outside mental health care.’ These patients are easier to treat and declare than heavy, complex patients.
Hospitals must specialize more and also treat people outside the hospital: ‘Close to home where possible, for simpler specialist care, a bit further from home for highly specialized complex care’. The concentration of hospital care is being accelerated. ‘We are initially looking at complex oncological care and vascular surgery. There is much to be gained there – higher volumes in specialized hospitals mean that the quality has to be improved.’ This can lead to a fuss such as earlier this year about the concentration of pediatric heart surgery, which caused the department in Groningen to close. The same goes for breast cancer treatments.