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Sander Zurhake
health care editor
Sander Zurhake
health care editor
The Professional and Interest Association of Psychiatrists says the four major health insurers withhold crucial medication and therapy from depressed patients. These are extremely depressed people for whom no treatment or medication is effective. According to the Dutch Psychiatric Association (NVvP), their hopeless situation regularly leads to them becoming suicidal.
Since September last year there is a new drug: esketamine. This is administered via a nasal spray. Scientific research shows that patients can benefit greatly from this medicine.
The problem is that health insurers do not buy enough of it, says the professional association of psychiatrists. According to the Zorginstituut, 2000 patients are eligible for care every year, while according to the psychiatrists there is only a joint capacity for 250 patients per year at the currently contracted care institutions.
Alternative is suicide or euthanasia
“If people do not receive treatment with esketamine nasal spray, or do not receive it quickly enough, they are often so desperate and depressed for a long time that they consider suicide or euthanasia as an alternative,” says Eric Ruhe, psychiatrist at Radboud UMC. He is very experienced in treating treatment resistant patients. “It is distressing, because the treatment is simply included in the basic package.”
“This is an intolerable situation for many patients and practitioners”, the NVvP, the Dutch GGZ and the Depression Association also write in a fire letter to Minister Conny Helder of VWS and the House of Representatives. “In addition, the distribution of care providers is unevenly distributed across the country. This means that the demand for care cannot be met.”
Health insurers do not recognize the problems of psychiatrists and patients. For example, the Zilveren Kruis states that the UMC Groningen has recently been contracted, which improves the geographical spread. VGZ also says it will offer extra care with the new product in Groningen.
Introduction takes some time
The major health insurers say that using the new drug takes some time. “This heavy drug has only been available for a year,” says the CZ spokesperson. “And only recently has the profession drawn up a quality framework that we can use to contract the right healthcare providers.”
Menzis states that the quality criteria of the psychiatrists hinder the broad deployment of care. “One of those criteria is the standard of a minimum number of patients per mental health care provider, for building up knowledge and skills. By contracting too many mental health care providers, you do not achieve that standard,” says the spokesperson.
There is a caveat to this: an institution must treat at least 10 patients per year in order to meet the standard. According to the Zorginstituut, more than 2000 patients are eligible for the treatment. In theory there is therefore room for 200 healthcare institutions that treat 10 patients. Even if the volume standard were to go to 20 patients, at least 100 healthcare providers could offer the drug and therapy.
But CZ also states that care providers are not always sure that they can meet the quality requirements of psychiatrists. The therapy is not just the simple administration of nasal spray. The treatment takes about two hours and there is a risk of heart and blood vessel problems. An institution must have the means to intervene in the event of complications.
Many institutions do not receive a contract
According to psychiatrist Ruhe, this is complete nonsense: “It is true that you are not just going to do these treatments. They require investments in location, expertise, personnel and logistics. But there are still 20 centers that would like to do this, but no contracts. I find this a stark contrast to the pronunciation of CZ.”
In addition, Ruhe has not heard from any of those 20 centers about difficulty with the treatment protocol. “In fact, everyone is motivated to help collect data on how this treatment of severely depressed people is working out in practice.”