“Do you trust me?” With these words, Aladdin, in the Disney film of the same name, invites his great love Jasmine to his flying carpet. After a moment of hesitation, she takes his outstretched hand and they experience a great adventure together under the starry sky. Last weekend, the Minister of Health, Welfare and Sport did the same. He begged the general practitioners to please take a seat on his flying carpet and sign the Integral Care Agreement (IZA).
This multi-year plan should tell us how the hares in healthcare will perform in the coming years. This is necessary, because the rising healthcare costs, staff shortages and waiting lists require making drastic decisions and cooperation. You will have noticed from the reports in the media that this process is anything but smooth. And that, among others, the general practitioners do not accept Kuipers’ outstretched hand for the time being.
Bland Hallmarks
How did that happen? Let’s go back to the Disney movie for a moment. For years, we caregivers have played the role of Aladdin. Despite a growing workload, we spend 40 percent of our time and energy justifying every fiber of our carpet, even if the holes are there. We jump through hoops and tick marks to get hold of baloney seals, some as meaningful as a seal from the International Society of Flying Carpets.
Not because our dress will fly better, but because we have to. And even then it’s never enough. That’s not possible either, because the magic of a flying carpet can never be fully qualified. Against this background, we are now being asked the other way around to step on the flying carpet of Minister Kuipers and the IZA with full confidence and on the basis of nothing more than promises and intentions. Is it strange that we don’t dare?
In 2022, the Netherlands increasingly has the character of a ‘low-trust society’. In public sectors such as health care, there is also a fury of mistrust. Although research by NIVEL shows that patients still confidently step on the flying medical carpet, there is a deep-lying, mutual and growing mistrust at the ‘back’ of care that affects all parties in care. Health care providers are distrusted by health insurers and, conversely, health care providers do not trust health insurers, regulators and politicians at all. And that is a problem, as the past few months have shown, because mistrust results in division, suspicion, counterproductivity, control. And even more mistrust. It stands in the way of fruitful cooperation, because you can only build on trust, as is also described in the report of the Council for Public Health & Society (RVS). Show of confidence from 2019.
Binding contract
Unfortunately, the trust of healthcare providers has been squandered. By health insurers that did not comply with agreements from previous agreements. By politicians who looked away. By supervisors who did not intervene. The general practitioners have now reached the stage that, outside their own professional association, they engage lawyers to fight for their case. They do not want a care agreement, but a binding contract with firm, concrete and (legally) enforceable agreements. For all parties. Butter-soft promises from a minister who did not even bother to appear at the Malieveld, but now swears with hand on heart to ensure that agreements are complied with, are no longer enough. You can’t blame the doctors for that. Here is reaped what has been sown for years: distrust.
The problems with the Integral Care Agreement force us to reflect. Until we take a closer look at our healthcare system. To the different roles, hats, tasks and mandates. of involved healthcare parties. Towards the trust gap between administrators, policy makers and professionals in the workplace. A reform of our health care system will be necessary to restore the necessary trust in health care. But we are not there yet.
For now, therefore, in order to get the IZA signed, it will have to take the form of a business care contract. With mutual, clearly formulated and binding obligations. Without it, the general practitioners, among others, will not dare to step on the flying IZA dress of Minister Kuipers. Even if they risk missing out on a great adventure under the stars.
Thank you is a general practitioner.