Many hospitals have a tight budget

1 How are things with staff and patients?

The MC Slotervaart is closed on Friday afternoon at 15 hours. This means that all patients still hospitalized, estimated at about fifty, were transferred to hospitals in Amsterdam or its surroundings. Only outpatient clinics will remain open for the time being with the support of the health insurers, so that the agreements already scheduled can continue. In the longer term, hospitals in the Amsterdam area are expected to face the loss of MC Slotervaart.

For the approximately 1,300 employees, many remain uncertain. They have lost their jobs, but doctors and nurses expect to be able to move quickly to another hospital because of the labor market shortage. Other hospitals are approaching "released" employees.

The situation seems different in Flevoland. Health insurers have raised funds to temporarily continue providing care, while working towards a "gradual and controlled reduction" that should last a month or two. Meanwhile, Zilveren Kruis, the party with by far the most secure in the region, has asked hospitals in Zwolle, Sneek, Harderwijk and Almere, among others, to help and strengthen its capabilities. The approximately 900 employees are still working and are paid by the UWV

2.

Many Dutch hospitals have a tight budget. BDO's advisory office warned this week against a "health care infarction": declining revenues, increasing staff shortages and "grabbing" deals – national agreements by hospitals with the ministry and insurers to reduce the costs. The bankruptcies this week will certainly not be the last.

According to BDO, in addition to the IJsselmeer and Slotervaart hospitals, twelve hospitals still have financial problems. The LangeLand Hospital (Zoetermeer) and the Zuyderland (Sittard-Geleen and Heerlen) are known as weak brothers.

The problem is that banks want to lend money to hospitals, but their growth is reduced – a political choice. Health care costs may not increase too quickly. Nevertheless, hospital turnover is generally higher than previously agreed. This gives rise to discussions between the insurer and the hospital that has to pay the bill.

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3. Who is really guilty of bankruptcy?

It is clear to the management and staff: the insurer Zilveren Kruis. As the party with by far the most secure regions of Amsterdam and Flevoland, it has the fate of hospitals. They can not do without a contract with Zilveren Kruis. With the refusal to grant an emergency loan available earlier this month, the health insurer signed the hospital death sentence.

Nevertheless, the question is whether Silver Cross is to blame. Hospitals had structural financial problems and constant turmoil. It is no coincidence that MC IJsselmeer hospitals have been under strict supervision of the inspection since this summer. In addition, said Zilveren Kruis, it is not up to the insurer to fund structurally deficit hospitals. This can not be explained to taxpayers. Health insurers are obliged to guarantee quality and accessible care. According to Zilveren Kruis, this is also guaranteed without these hospitals.

4. What is the consequence for the Flevoland region?

At the closing of the IJsselmeer hospitals, the approximately 180,000 inhabitants of East and North-East Flevoland depend on the hospitals of Sneek, Zwolle, Harderwijk, Hoorn and Almere. According to municipalities and provinces, this is "unacceptable" and leads to "life-threatening situations". CEO Georgette Fijneman of Zilveren Kruiszei said earlier this week against the NRC that there were "sufficient alternatives" for MC Slotervaart and IJsselmeer hospitals.

5 Health insurers should not keep hospitals open

Health insurers are legally obliged to ensure that their insureds have access to all basic health care within reasonable time and distance. The supervisor of the Dutch Health Authority (NZa) is now asking health insurers to prepare a plan in which they explain how they ensure this duty of care in Flevoland and the Amsterdam region. The legal principle is that emergency care must be accessible in less than 45 minutes. This is a very important lower limit, which theoretically allows for the removal of half or more of the Dutch hospitals.