BuurtzorgT is one of the few mental health providers in Friesland with enough space for clients. But because they have reached the limit, according to insurer Zilveren Kruis, they have to refer new clients. They then end up on a long waiting list.
It was agreed that BuurtzorgT could grow 2 million euros in turnover, but it has become 4 million euros. Zilveren Kruis believes that this was not the agreement and will not reimburse the extra 2 million. That is why BuurtzorgT has now had to impose a client stop until the end of January.
Stick to budgets
“BuurtzorgT focuses primarily on serious psychiatric problems,” says director Bas van Riet Paap. “We conclude contracts with health insurers and unfortunately now have a discussion with Zilveren Kruis.”
“Zilveren Kruis wants to indicate: stick to the contract,” explains care economist Wim Groot. “Around 2012, it was agreed that budgets would be determined in advance. Then you wouldn’t just approve the double now, as you wouldn’t immediately say for a renovation to your house: ‘It doesn’t matter that it has become twice as expensive.’ According to him, BuurtZorgT should have entered into discussions with Zilveren Kruis or other insurers earlier.
Forward patients
But as a result, many vulnerable mental health patients cannot be helped directly and they have to be forwarded to other care providers. Many – if not all – healthcare providers in the region have long waiting times, ranging from a few months to even 9 months.
“I understand that a limit must be set,” says Van Riep Paap of BuurtZorgT. “But we are now having an ethical discussion. We have the treatment capacity, but Zilveren Kruis says: ‘Let people be on a waiting list.’ That feels crazy for practitioners, but also for the premium payer. Do we find that acceptable?”
See here how mental health patient Charlotte de Jong now ends up on a waiting list.
Insurer’s duty of care
Does this not also jeopardize the duty of care of insurer Zilveren Kruis? A health insurer has a duty to have people treated within a reasonable period of time. “The waiting lists are extremely high, much higher than agreed. While on the other hand, the entire mental health care budget has not been spent: there is 300 million euros left over annually,” says Groot.
“It is a realistic question,” says the care economist about the duty of care that Zilveren Kruis has. “The waiting time is on average more than 20 weeks. Health insurers do not comply with their duty of care and have to buy care again, but you should not do that afterwards. It is not the case that the care provider determines how much care can be provided.”
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In diep dal door MS
Charlotte de Jong (31) is one of the patients who is now on a waiting list. In 2019 she was diagnosed with MS, after which she fell into ‘a deep valley’ and developed psychological problems. “Such a chronic illness turns your whole life upside down. I had to quit my education, lost my job and my home.”
“I stopped taking care of myself, I didn’t want anything anymore. Those are all alarm bells,” she says. “I didn’t see it myself, but I was referred. I’m grateful for that.” Charlotte was diagnosed with a mood disorder, for which she now takes antidepressants daily.
Sad and unsure
“I find it quite worrying and difficult to accept,” says Charlotte about the fact that she cannot be helped at BuurtzorgT now. “I don’t know what will happen, and I live with that every day. I’m sad and unsure about that.”
Bas van Riet Paap, director of the mental health institution, hopes that the discussion with insurer Zilveren Kruis about the size of the budgets will be resolved quickly. “So that people like Charlotte can come to us again in February.”