Patients who face long waits for medical treatment may, from this year onwards, be proactively approached by their health insurer for so-called waiting list mediation. The idea is simple: those who are willing to travel a little further may be able to receive treatment more quickly. The topic recently received attention in NRC. In that context, Martin Buijsen, Professor of Health Law at Erasmus School of Law, reflected on the legal and societal significance of this development. Buijsen emphasises that waiting list mediation is not a miracle cure, but that it can contribute to greater insight into a persistent problem. “It is not a panacea for long waiting lists, but it does help insurers gain a better picture of waiting lists in their region. At present, no one really knows how long they are,” he said in NRC.
Waiting times and the legal duty to provide timely care
According to Buijsen, the debate on waiting times should not be seen merely as a practical or organisational issue. Waiting times directly affect the right to healthcare. “From a legal perspective, good care is also timely care,” he stresses. The so-called Treek norms, which have existed since 2005, indicate for various types of care what is considered a maximum acceptable waiting time. In practice, however, these standards have proved to be of limited effectiveness. “Unfortunately, these norms only become effective when someone actually takes action when they are breached: the client or patient, the health insurer, or the Dutch Healthcare Authority,” Buijsen explains. “That still happens far too rarely.”
This is all the more problematic given that waiting times have increased across the board in recent years. “Compared with other European countries, the Netherlands does not perform badly at all in terms of waiting times,” Buijsen adds by way of nuance. “When it comes to elective care, such as knee, hip and cataract surgery, waiting times in the Netherlands are in fact very short compared to those elsewhere in Europe. But waiting times have been increasing in recent years. That is a sign that access to healthcare is under pressure.” Mental healthcare is the most striking outlier in this respect: “Here, waiting times have been far too long in all regions for many years.”
An active role for health insurers: A solution?
What is new is that health insurers are now permitted to actively approach their insured clients about waiting list mediation. Buijsen considers this a logical step. “This could have been arranged years ago,” he says. “For too long, health insurers have had too little reliable information about waiting lists.” Since the beginning of this year, healthcare providers are therefore required to supply more data, enabling insurers to gain a clearer picture of actual waiting times. According to Buijsen, this is a necessary precondition for mediation to be possible at all. At the same time, he points out in NRC that healthcare providers do not always benefit from short waiting lists. “It is not in their interest; people on waiting lists also represent a kind of work stock for healthcare providers,” he notes.
What is waiting list mediation?
Waiting list mediation is a statutory task of health insurers aimed at assisting insured persons who have to wait too long for care. The health insurer then examines whether the patient can be treated more quickly by another healthcare provider. This may involve a different hospital, another clinic, or a provider in a different region. The patient is not obliged to accept an alternative. Waiting list mediation does not change the content of the treatment, only the location where it is provided. In doing so, the insurer may use only limited information, such as the type of care and the waiting time, and not the medical diagnosis. The aim is to make the most efficient possible use of available healthcare capacity.
Although waiting list mediation may help individual patients to receive care more quickly, Buijsen cautions against excessive expectations. Asked whether mediation offers a structural solution to long waiting lists, he is clear: “Hardly, but it is a means of making better use of the available healthcare capacity.” Mediation therefore does not change the size of the healthcare supply, but merely redistributes patients within the existing system.
Access to healthcare
According to Buijsen, the discussion about waiting times touches upon fundamental questions about patients’ rights. He states: “The right to healthcare for health is an internationally recognised human right.” That right concerns not only the availability of care, but also its accessibility. “Healthcare must be accessible in various respects: geographically, physically and financially. Timeliness is also an aspect of accessibility.” In practice, however, many patients appear to be insufficiently aware of their rights and options. “Waiting list mediation has always been a statutory task of health insurers,” Buijsen says. “Unfortunately, many people are unaware of this.” According to him, healthcare providers also fall short in drawing attention to this possibility. “Healthcare providers have a duty to inform their patients or clients about waiting list mediation by their health insurer. In practice, they generally do not do so.”
Buijsen’s conclusion is a sober one. Waiting list mediation can help, but it does not solve the structural problems in healthcare. As he previously stated in NRC: “It does not create additional healthcare capacity, but it does allow us to use the existing capacity more efficiently.”
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The NRC article can be read via this link (in Dutch).
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