Dutch GPs strike over reforms
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《英国医生杂志》
Ninety per cent of Holland's roughly 7500 general practitioners went on strike last week over fears that plans to boost competition among health insurance companies will damage primary care.
For three days normal surgeries and home visits were cancelled, and telephone answer machines directed urgent cases to hospitals.
GPs in the Netherlands protest, hands tied, outside The Hague, at proposed changes in insurance payments
Credit: RAYMOND RUTTING/VOLKSKRANT
Exceptions were made for seriously ill patients, however, when strikers volunteered to help reduce the increasing pressure on emergency departments.
The national strike came after the collapse of months of negotiations between the health minister Hans Hoogervorst and the GPs' national association (Landelijke Huisartsen Vereniging). Negotiations, which began over pay, have grown into an ideological dispute over the benefits of competition in health care and the authority of family doctors to decide appropriate care.
From 1 January 2006 a single basic health insurance package will be introduced for everyone, allowing insurance companies to compete for patients.
For GPs this will mean a cut in the guaranteed income they get for each patient, while 6% of their budget—90m (￡62m; 113m) overall—will instead go first to insurance companies. GPs could then be reimbursed as a result of negotiations of contracts with insurers over plans to offer services such as minor surgery and specialist care for chronic patients.
But insurance companies will also be free to spend this money on other services, such as on-call centres, nurses, or specialist treatment centres.
Mr Hoogervorst believes that competition will encourage insurance companies to get the best deal for patients. But the GPs' association believes that quality and GPs' income will suffer as insurance companies seek cheaper alternatives.
The insurers' umbrella body insists that the concerns of the GPs are unwarranted. Insurers are obliged to seek good deals for their clients on quality and price, it says.
The minister has now written to all GPs to "remove any misunderstanding" and warning that patients must not become the victims of strike action. The association, of which 95% of GPs are members, has in turn accused the minister of intimidation.(Tony Sheldon)
For three days normal surgeries and home visits were cancelled, and telephone answer machines directed urgent cases to hospitals.
GPs in the Netherlands protest, hands tied, outside The Hague, at proposed changes in insurance payments
Credit: RAYMOND RUTTING/VOLKSKRANT
Exceptions were made for seriously ill patients, however, when strikers volunteered to help reduce the increasing pressure on emergency departments.
The national strike came after the collapse of months of negotiations between the health minister Hans Hoogervorst and the GPs' national association (Landelijke Huisartsen Vereniging). Negotiations, which began over pay, have grown into an ideological dispute over the benefits of competition in health care and the authority of family doctors to decide appropriate care.
From 1 January 2006 a single basic health insurance package will be introduced for everyone, allowing insurance companies to compete for patients.
For GPs this will mean a cut in the guaranteed income they get for each patient, while 6% of their budget—90m (￡62m; 113m) overall—will instead go first to insurance companies. GPs could then be reimbursed as a result of negotiations of contracts with insurers over plans to offer services such as minor surgery and specialist care for chronic patients.
But insurance companies will also be free to spend this money on other services, such as on-call centres, nurses, or specialist treatment centres.
Mr Hoogervorst believes that competition will encourage insurance companies to get the best deal for patients. But the GPs' association believes that quality and GPs' income will suffer as insurance companies seek cheaper alternatives.
The insurers' umbrella body insists that the concerns of the GPs are unwarranted. Insurers are obliged to seek good deals for their clients on quality and price, it says.
The minister has now written to all GPs to "remove any misunderstanding" and warning that patients must not become the victims of strike action. The association, of which 95% of GPs are members, has in turn accused the minister of intimidation.(Tony Sheldon)