ANPEA patient is reading a self-help book.
NOS Nieuws•vandaag, 06:03
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Sander Zurhake
healthcare editor
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Sander Zurhake
healthcare editor
A solution to the long waiting times in mental health care (ggz) seems even more complicated than expected. Because how long patients actually have to wait or what the waiting times are per institution or healthcare region is not properly recorded.
This is evident from unpublished research by health economists at the Vrije Universiteit, commissioned by health insurer VGZ. According to the researchers, half of mental health care providers make mistakes when providing information about waiting times to the Dutch Healthcare Authority (NZa).
Things went wrong in various ways in the period from June 2023 to July 2024, causing waiting lists of healthcare institutions to be significantly distorted and waiting times to appear longer or shorter than they actually were.
In some cases, a healthcare provider completed the NZa form incorrectly, so that the total number of people waiting was multiplied by the number of types of diseases that the institution can treat. With 100 real patients and 16 diseases, it seems as if there were 1600 patients on the waiting list.
Healthcare providers also provided waiting times for patients with conditions for which those healthcare providers did not even have treatments available.
Response from the Dutch Healthcare Authority
The NZa says it is continuously working on improving information collection, but also says that there are limits to what is possible. For example, the NZa wants to guard against additional administrative burdens for healthcare providers and the privacy of patients must also be taken into account.
Read the full response here.
Xander Koolman, professor of health economics and leader of the study, cannot assess whether there are healthcare providers who deliberately increase waiting lists to put pressure on health insurers to purchase more care.
“I attribute it more to a lack of attention and care. You see that many numbers are cut and pasted.”
A spokesperson for the Dutch GGZ trade organization says it takes the findings of the study seriously, but points out that the industry experiences that the information portal does not always function properly. And given the long wait times, “health care providers are now prioritizing the delivery of care.”
Koolman emphasizes that the long waiting times affect a significant proportion of patients. “But because much of the data is incorrect, we do not know exactly how long the waiting lists are. Or what the difference is between the waiting lists of different institutions or healthcare regions.”
Frustration among health insurers
And that lack of insight frustrates good healthcare purchasing, says Marjo Visser, chairman of VGZ. “There is a danger that in one region, for example, you try to purchase additional treatments for eating disorders, while that is not the problem at all. And in another region, people may have to wait far too long for that kind of capacity.”
In addition, health insurers are wary of the dataset with which the NZa measures waiting times. After all, the regulator also uses this information to assess whether health insurers comply with their legal duty of care by purchasing enough care.
Until recently, the NZa was not too strict in this area, but that is changing. In March, Zilveren Kruis and VGZ received a formal warning for neglecting their duty of care. CZ and Menzis were even given an instruction (penalty measure). That was the first time in the history of the NZa.
Patients and mental health care providers are also preparing a lawsuit because they believe that the duty of care is not being properly fulfilled. Health insurers fear the use of NZa data in such a case. Because then there would be almost 100,000 people waiting.
“We feel responsible for the waiting lists,” says VGZ chairman Visser. “But preferably based on good data.”
Perverse incentive
Koolman points to what he believes is a different, but more fundamental problem. “Our conclusion is that even if all data has been entered correctly, the design of the dataset is unsuitable for checking whether a health insurer complies with the duty of care.”
Because waiting times are registered per region and not per health insurer, it is impossible for the NZa to distinguish between the purchasing behavior of health insurers. Which, according to Koolman, can lead to a perverse incentive: “An insurer with the least purchased capacity is not singled out, but does have a financial advantage. It is good if the NZa enforces more strictly, but they must look critically at this source of information. “
Mental Health Waiting Times: A Comedy of Errors
So, here’s a little ditty from the world of mental health care in the Netherlands that could make a stand-up comedian weep with laughter—or perhaps cringe in disbelief. Sander Zurhake, our health care editor and accidental comedian, takes us on a wild ride through the tangled mess of waiting times in mental health care. Spoiler alert: it’s not a comedy of errors—it’s a tragedy in three acts!
The Waiting Game
Let’s set the scene. Imagine waiting months, maybe even years, to see a mental health professional—sort of like waiting for your favorite band to play that one hit song they keep ignoring. Now, you’d think there’d be records meticulously kept for something as crucial as mental health support, right? Well, think again. New research straight out of the Vrije Universiteit shows that half of all mental health care providers can’t seem to tell their waiting times from a hole in the ground!
Creating a waiting list is like baking a cake: you need the right ingredients, a dash of attention, and no bumbling cooks who mistakenly think they’ve got a soufflé when all they have is a flatbread. Turns out, the numbers these institutions are feeding into the system are so mixed up they might as well be part of a magic trick. “Ta-da! 100 real patients, multiplied by 16 diseases, and voilà! We’ve got 1,600 patients needing aid!” Someone hand these healthcare providers a calculator, and quick!
Healthcare Authorities: What’s Going On?
The Dutch Healthcare Authority (NZa) is having a bit of an existential crisis as they contemplate improving their data collection methods. They want to enforce ethics without piling on more administrative burdens—sort of like trying to fit your cat in a suitcase without upsetting it too much. A noble effort, but good luck with that!
It’s like watching a circus act that’s just a little too chaotic—sometimes it even includes juggling with incorrect data. “We’re here to ensure you have care,” they say, while the waiting patients roll their eyes and wonder if anyone’s even checking to see who’s actually got their name on the list! “But let’s not add to the paperwork!” Meanwhile, those knocking on the doors of therapy remain… you guessed it, waiting.
Boundless Frustration: Enter the Health Insurers
The health insurers are quaking in their boots, arguing it’s not just about the waiting times but the sheer ridiculousness of the data they have to work with. It’s like being handed a treasure map, only to realize the “X” marks the spot for your sofa. Marjo Visser, the chair of VGZ, screamed, “We want to provide quality care, but who’s giving us the right directions?”
And what’s even more alarming are the lawsuits brewing like a pot of overdone tea. Patients and providers are connecting over their grievances like old school friends. “We’re not being taken care of!” they cry, while insurers nervously glance at the pile of paper that suggests almost 100,000 people are twiddling their thumbs waiting for attention—before someone finally realizes that a spreadsheet is not a care plan.
A Perverse Incentive?
The situation escalates like a dramatic soap opera—with Koolman tossing in a theory that the very design of their data collection may actually create perverse incentives. “The insurers getting away with minimal purchases while actual patients suffer? I guess you could call that the ‘win-win’ situation for some!”
The dataset is organized by region, not by the specific insurer, making it harder for anyone to pinpoint who’s slacking on their responsibilities. It’s like playing a game of “Guess Who?” but without the satisfaction of unmasking the culprit as they hide away in their financial fortress.
The Road Ahead
So, what’s the endgame here? More accurate data, better care delivery, and perhaps a snappy new self-help book entitled “Waiting Times, Seriously?”. Or maybe we should just cancel the healthcare system and replace it with a friendlier neighborhood therapy session at the local pub. At least we know how long a pint takes to pour!
The reality, my dear readers, is that mental health care is no laughing matter, even when it seems like a comedy of errors. It’s high time for a shake-up in the system, or else we may find ourselves waiting not just for care but for someone—anyone—to fix the ticking time bomb of inaccuracies surrounding mental health waiting times.
Let’s hope the next time we’re on stage with this situation, we’re not just serving punchlines but also serving real solutions that restore sanity—yours and theirs!
