A placebo is a medicine that does not contain an active substance, but of which the user is convinced that it works. The word placebo comes from Latin and means ‘I will please’. Placebos are sometimes used by doctors, but nowadays also by politicians and administrators. The placebo ‘appropriate care’ has been used for some time in health care policy. Appropriate care should ensure that the shortage of staff and the rapidly rising costs of care are reduced.
The users of ‘appropriate care’ firmly believe that this placebo works. Both the chairman of the board of the Dutch Healthcare Authority (NZa), Marjan Kaljouw, and the chairman of the board of the Zorginstituut (ZiN), Sjaak Wijma, believe that only appropriate care can ensure that care is available for everyone who needs it in the future. and the accessibility and solidarity of the healthcare system is guaranteed. A lot is expected of appropriate care. Even King Willem Alexander visited the NZa this week to hear about its effectiveness.
High mountain treatment
What is appropriate care? And why would it work? When you ask these questions it suddenly becomes very vague and unclear. Just like with a placebo. The Zorginstituut has a website about appropriate care that will not make you any wiser. Appropriate care works, is stated with great aplomb on the website. Appropriate care is about people’s functioning and contributes to the quality of life.
Healthcare providers work together and decide together with the patient on appropriate care. Appropriate care is about health instead of illness, as can be read on the website. Do you now understand what appropriate care is? And why, according to the chairman of the NZa, it is the only way to keep healthcare affordable, accessible and of a high quality? Not me.
The only concrete thing about appropriate care is that, according to the Zorginstituut, treatments that do not work must be removed from the health insurance package. That turns out not to be easy, by the way. In 2019, the Zorginstituut advised the minister to remove high mountain treatment in Davos for patients with severe asthma from the insured package because the effectiveness of the treatment had not been proven. According to the Zorginstituut, it was not appropriate care.
The House of Representatives saw it differently and put a stop to it. Patients felt that they benefited from a stay in Davos and that is why it should remain in the package, a majority in the House of Representatives thought. That is often the case. Administrators come up with a rational means of saving money, politicians mainly listen to interest groups that do not agree.
Defibrillator placed too easily
So with appropriate care, expenditure is limited by only including care that works in the package? Well no, you can’t say it like that, said the chairman of the Zorginstituut in the trade magazine Care vision: ‘Appropriate care is not a cutback. Appropriate care is more person-oriented, sustainable and sustainable.’ For example, the NZa and the ZiN deal in vagueness and generalities in an attempt to please everyone.
What is sensible is that the Care Institute wants to clarify for which patients this care really works for the care that is already included in the package. The Healthcare Institute recently did this for defibrillators. The study by the Zorginstituut showed that an internal defibrillator is placed preventively in 83% of patients without there being a cardiac arrhythmia. According to the Healthcare Institute, there should be better guidelines for placing and replacing defibrillators and patients should be better informed about the negative consequences of having a defibrillator.
What if an elderly person does want a new hip?
Nevertheless, the question is whether such well-intentioned advice from the Zorginstituut will have much effect. The practice of the consultation room does not always follow the advice of the Zorginstituut. Or the strict requirements we set in the Netherlands. For example, the European guidelines for placing internal defibrillators are much broader and almost everything that happens in our country complies with European regulations.
The discussion about appropriate care is often narrowed down to care for the elderly. In an interview in Care vision ZiN chairman Sjaak Wijma, for example, wonders: ‘From the perspective of patients and society, is two months of life extension for a grueling and costly course of chemotherapy really worth it?
Should frail elderly people with a broken hip get a new hip?’ The rhetorical character of this discussion about care for the elderly is striking. The only answer seems to be: no, we shouldn’t do that. But what if an elderly person with a broken hip is in tremendous pain and wants a new hip?
Foreign countries often find our care poor
The suggestion is invariably raised that Dutch doctors continue to treat for too long regardless of the consequences and without taking the wishes of patients into account. That is incorrect. Compared to doctors in other countries, Dutch doctors are very reluctant to treat for longer. Most doctors also make treatment decisions together with the patient.
There is often a lack of understanding abroad about the restraint of Dutch doctors. Patients with cancer who have been told here that they have finished treatment sometimes go to Germany or Belgium because more is being done there to treat cancer patients.
On a number of occasions, the Turkish government has transported patients of Turkish origin who had finished their treatment here in the Netherlands by plane to Turkey for further treatment there. The attention that Dutch doctors pay to the quality of life in the event of a ‘debilitating chemotherapy’ is seen as bad care in Turkey and many other countries.
Costs also rise with appropriate care
Compared to most other European countries, we have had appropriate care for a long time. Appropriate care does not always mean less care, as the NZa and the Care Institute believe. If doctor and patient decide together, appropriate care will mean more treatment for some patients, not less.
Research by the Dutch Federation of Cancer Patient Organizations also shows that in many hospitals patients with cancer do not receive the treatment prescribed in accordance with Dutch guidelines. Better compliance with the treatment guidelines, as the Zorginstituut rightly advocates, will also lead to more treatment, not less.
This week, the Central Planning Bureau published its economic forecasts for the period 2023-2031. The CPB expects the health care premium to rise from an average of €138 per month this year to €175 in 2027. The placebo policy of appropriate care will make little difference to this cost increase.
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