Dutch efficiency savings are hitting healthcare quality

BMJ 1996; 313 doi: (Published 02 November 1996) Cite this as: BMJ 1996;313:1104

Signs are emerging in the Netherlands that the most vulnerable sections of society are suffering because of an annual drive towards increased efficiency savings.

The fourth annual report by an influential group of independent economists, led by Professor Arie van der Zwan, warns of a link between increased demands for productivity and poorer quality health care.

The report says that it is the elderly, handicapped, and psychiatric patients requiring nursing and home care who are feeling the brunt of cuts in health spending.

The report, commissioned by the Dutch Federation of Healthcare Organisations, (NZF), which represents all hospitals, nursing homes, and health institutions, has been presented to the health minister, Professor Els Borst-Eilers.

Discussion of the report formed the centrepiece of a national debate of health policy last Monday.

The federation's chairman, Dr Ton Krol, said: “We must continue to confront the politicians with the consequences of their policy.”

The report says that hard pressed staff have less time to talk and physically care for patients. Nursing home staff have to wake and feed patients at unusual hours and do not have the time to give proper information on aftercare and complications of treatment.

In addition there is a high turnover of frequently untrained and therefore cheaper staff, which hinders better care.

Waiting lists have also grown, with 35 000 patients waiting longer than the recommended times for long term care during 1995. The average waiting time for residential care for 8000 handicapped patients was 16–18 months.

In acute care orthopaedic patients wait on average nearly 15 weeks for hospital treatment. Overall the growth in the number of acute patients treated in hospitals slumped from 2.1% to 0.9% for 1995.

The report argues that healthcare institutions have been faced with an increasing demand from patients without a corresponding increase in funds.

Increases in health spending have been capped at 1.35% by the present government. But the report says this figure is a myth and argues that once the increased cost of treatment and an aging population have been taken into account, real growth has been about 0.7%.

By contrast health spending grew at an annual rate of 2.3% in the decade before the 1994 general election. The report is now calling for an extra 1.6bn guilders (£590m; $885m) to be spent between now and the year 2000 on top of the 63.3bn guilders annual budget.

Dr Krol said: “We can try to be more and more efficient, but you pay a price for that in quality.” He added: “You can do the work with fewer people, but it means fewer people caring for the elderly in nursing homes.”

The federation has now called for a national taskforce of government, health service staff, and patients to define a package of health care, including waiting times and quality standards, that would be guaranteed through the Netherlands compulsory health insurance.

Earlier this year Professor Borst-Eilers spoke of the bad example of long waiting lists in Britain's NHS, arguing that governments must ensure that all patients receive necessary care.—TONY SHELDON, medical journalist, Utrecht

View Abstract

Sign in

Log in through your institution

Free trial

Register for a free trial to to receive unlimited access to all content on for 14 days.
Sign up for a free trial