Review paper BMJ over staat Nederlandse gezondheidszorg

[Dr. Marc-Alexander Fluks]

REPLY TO: D66 at nic.surfnet.nl

Bron:  British Medical Journal
Datum: 16 september 2000
URL:   http://www.bmj.com/cgi/content/full/321/7262/712


REVIEWS
Press

Dutch doctors supported by media
--------------------------------

British doctors may feel all alone in the trenches as they continue
to be hit by a relentless series of scandals in the press.
Professional demoralisation, however, seems to be a much more
widespread phenomenon, currently affecting many European healthcare
settings, hinting at deeper and perhaps more common roots of
professional unease. What clearly varies, however, are professional
strategies to deal with the media.

Take the Netherlands. Here, too, healthcare provision has come under
fire. But rather than pillorying doctors, most journalists aim their
critical arrows elsewhere: at government, insurers, and hospital
administrators. In the process, professionals have become the
media's best friends, as victims of a failing system.

This peculiar state of affairs became visible again recently, when
one of the senior commentators of De Telegraaf, the most widely read
Dutch populist national morning paper, filled a column with his
personal selection of headlines on health care from the previous few
months (De Telegraaf, 29 July). These included: "Many demented
elderly without care" (Haarlems Dagblad); "Shortage of doctors to
check up on children" (Tubantia); "Too little radiotherapy available
for cancer patients" (NRC Handelsblad); "GPs sick of workload"
(Drentse Courant); "A third of GPs will stop this year" (Het
Parool); "Pregnant women without midwives" (Noordhollands Dagblad);
"Day-budget finished, patients sent home" (De Limburger); and
"Waiting lists: an outrage" (De Telegraaf). This avalanche of
negative reports allowed for only one conclusion, De Telegraaf
maintained: the pending collapse of the Dutch healthcare system.

Few of the headlines were attacking professionals directly. Doctor
bashing has not yet become a national sport in the Netherlands.
Professional organisations may be reproached for their guild-like
structure (NRC Handelsblad, 13 January), but reports of scandals
involving doctors are few and far between.

To media watchers, De Telegraaf's column - for all its alarmist
contents - merely confirmed the profound shift in public
perception of health care they have noticed for over a year now. In
the past, Dutch commentators could bore an audience to death with
barely disguised national pride about their high quality, easily
accessible healthcare system - delivered since the late 1980s at
the expenditure of a fairly constant 8.5% of the gross national
product.

Today, that mood has changed. There is mounting opposition to the
macro-budget policy and the detailed supply regulations, which only
allow for an annual volume increase of 2.3% - much too little to
keep the system up to speed, critics say.

Hundreds of critical articles have appeared since the beginning of
this year. The primary theme is waiting lists, which prove a
bottomless pit, swallowing hundreds of millions of government
guilders to no avail. "Waiting lists for hospital care grow again,"
the Dutch Press Agency ANP announced in June; a "millstone around
health minister's neck" (Financieele Dagblad, 16 June).

Another recurring worry is the loss of healthcare staff to the
private sector and the business world ("Professionals flee, but
where?" De Telegraaf, 13 May), a situation worsened by the
increasing numbers of reports on demotivation and significantly
higher sickness rates in the healthcare sector (8.7% instead of the
national average of 5.6% in 1998; Parool, 14 June). Last year MOVIR,
a healthcare personnel disability insurance company, barely escaped
bankruptcy due to the rapid increase of burnout among health
practitioners. Fellow disability insurers were reported to have
raised their annual premiums by up to 25% to cover the high
percentage of healthcare workers falling ill under growing work
pressures.


"Dead on the waiting list"

Also hitting the headlines are the shortages of staff reaching
critical levels in several disciplines: "GP shortage plagues
provinces" (Elsevier, 17 June), "Medical care no longer guaranteed,
due to lack of GPs" (Volkskrant, 26 June), "Major shortage of
gynaecologists in Alkmaar" (Reformatorisch Dagblad, 5 July).

So, while the recent World Health Report 2000 still ranks Dutch
health care in the top 20, the Dutch press has pronounced a national
crisis in health care. And the professionals? They have jumped on
that bandwagon. Many have abandoned their traditional reluctance to
spill the beans in the press. Much to their own surprise, their
coming out has been warmly embraced by most of the Dutch media.

The year had barely started when one national morning paper carried
an article by a general surgeon Ton van Engelenburg cautioning
government and health insurers against strangling the profession and
saying that one out of five doctors were dissatisfied with their
work and regretted ever having chosen medicine as a profession
(Algemeen Dagblad, 5 January).

In April and May, the weekly Vrij Nederland published a reportage
series covering the daily struggles of healthcare practitioners of
the Utrecht Academic Hospital. The prestigious evening paper NRC
Handelsblad had plastic surgeon Hans de Bruijn explain how
structural lack of funding and chaotic legislation prevented
professionals from doing their job and caused the system to grind to
a halt (22 January). His colleague Chris Plasmans, chairman of the
national organisation of orthopaedic surgeons, was given free rein
to complain about the urgent need of extra staff in his field
(Algemeen Dagblad, 15 January).

The climax of the outpouring of doctors' sorrows was a full page
interview with staff surgeon Maurits de Brauw of the Maastricht
Academic Hospital, detailing his reasons for leaving the profession
after 20 years of faithful duty: "I make people sicker, not better"
(NRC Handelsblad, 27 May).

Thus, in the Netherlands, a curious alliance has emerged which
- at least for now - holds professionals and media in an
unprecedented union. All keep their eyes firmly on the Department of
Health, where Minister Els Borst has assembled the heavy artillery,
a task force to help her produce an official plan on the future of
the Dutch healthcare system for the Cabinet by December.

In a country with coalition governments and a mixed public-private
insurance system, any change in health system legislation is bound
to be a thorny affair. Senior civil servants remember all too well
how the attempts at health reform in the early 1990s failed. Their
anxiety about the current mood of the media is understandably
mounting.

Most newspapers seem unimpressed by the government-friendly experts
who emphasise that a silent revolution is in fact already underway,
resulting in a greater convergence of private and public
arrangements and increasing flexibility.

Such experts do not convince ordinary Dutch citizens either, who
have to wait five months for a hip replacement or eight weeks for
biopsy of a breast lump. For them, tacit revolutions are simply not
good enough. And these days, they find the medical world and the
media on their side.

--------
Godelieve van Heteren, university lecturer in medical history and
freelance journalist, department of ethics.
Philosophy and History of Medicine Faculty of Medical Sciences,
University of Nijmegen, Netherlands

--------
(c) 2000 BMJ

**********
Dit bericht is verzonden via de informele D66 discussielijst (D66 at nic.surfnet.nl).
Aanmelden: stuur een email naar LISTSERV at nic.surfnet.nl met in het tekstveld alleen: SUBSCRIBE D66
Afmelden: stuur een email naar LISTSERV at nic.surfnet.nl met in het tekstveld alleen: SIGNOFF D66
Het on-line archief is te vinden op: http://listserv.surfnet.nl/archives/d66.html
**********