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In late January 1998, the Dutch social partners reconsidered their jointly agreed position to give priority to employees in the use of healthcare facilities, soon after reaching it, following opposition from some member trade unions of the FNV confederation. The proposal was also rejected, following consideration, by the Government. This issue has sparked heated debate in political circles and in the healthcare sector.
In late January 1998, the social partners represented on the bipartite Labour Foundation (Stichting van de Arbeid, STAR) reconsidered their jointly agreed position to give priority to employees at healthcare facilities, only 10 days after reaching it. After much hesitation, in mid-January the Dutch Trade Union Federation (Federatie Nederlandse Vakbeweging, FNV) had endorsed the employers' stance that, in view of long waiting lists, employees should be given priority at healthcare facilities such as hospitals. However, opposition from the largest trade unions within the FNV caused the federation quickly to take a few steps back and revise its standpoint. Priority treatment for employees has also sparked heated debate in political circles as well as within the healthcare sector itself. From discussions conducted between the parties directly involved, it has become clear that the opinion of the recalcitrant unions will be supported. Moreover, after some consideration, the employers' proposal was finally rejected by the Government.
Following its "privatisation" under the Sickness Benefits Act in the spring of 1996 (NL9710138F), employers have become more overtly and publicly active in the organisation of healthcare. Now that the financial consequences have begun to affect their companies directly, the long waiting lists for psychological treatment and at hospitals have become a thorn in their side. Employers feel that the inadequate organisation of healthcare is exemplified by the fact that the long waiting times for diagnosis and therapy have not decreased in recent years. Because the related costs - employees remain off work as they wait for a diagnosis - are partly at the expense of employers, they feel justified in arguing that priority be given to employees.
Divisions in society
In supporting a position for priority treatment, the social partners on the Labour Foundation pointed mainly to the lack of effective initiatives originating from healthcare organisations to deal with the waiting lists. In mid-January 1998, the FNV attached two conditions to its short-lived argument for employee priority. First, non-working patients must not be disadvantaged by the accelerated help given to employees. Second, waiting lists must be structurally adapted in the long term to eliminate the need for priority treatment in the future. In short, this would be a temporary measure, and not a permanent solution, and it should never be allowed to create a two-tier healthcare system.
Within 10 days, the letter containing the healthcare recommendation from the Labour Foundation to the Second Chamber of the Dutch Parliament was swept from the table because the largest union within the FNV had turned completely against the federation's proposal. The FNV had originally justified its standpoint for granting priority to employees on the grounds of keeping pace with the times. Now, however, the decisive factor was that this policy would contribute to divisions in society which would be in conflict with the very principles of the FNV. And it was these principles, established in the Dutch Constitution and separate legislation as the "equal treatment of citizens", which made both a majority in the Second Chamber as well as the relevant Minister fundamental opponents of priority treatment.
Constitutional equality
These same fundamental objections were predominant among the arguments of the responsible parties and those involved in the healthcare system who were invited by the Second Chamber to participate in a "round-table discussion" on the issue. For them, equal treatment in healthcare should remain the point of departure, and sick employees should have no priority over other patients. The various parties involved - hospitals and insurers, doctors and patients, employers and employees - decided to draw up an action plan for the short term to do away with waiting lists. However, this will mean that they have to act fast, because the current situation in healthcare is becoming less and less clear with each passing day.
A few examples: in addition to already existing private initiatives, or "company policies", hospitals also conclude contracts with insurers to introduce consulting hours for specific companies. This initiative was suspended at the request of the Minister until the Second Chamber issues its final decision on the matter in the spring of 1998. Healthcare insurers complain that although enough money exists, the current system of finances has been set up in such a way that it punishes them for shortening their waiting lists with a tighter budget the following year. Moreover, the extra funds allocated for combating the long waiting lists are available for such a brief period, and are so encumbered by rules and regulations, that the 1997 budget has not even yet been spent. To make matters worse, the lack of space at nursing homes, where follow-up care is provided, frustrates the efforts of hospitals to conduct more operations. Finally, although efficiency in various healthcare sectors can still be improved, it is also clear that more funds are needed to meet the continually increasing demand for healthcare resulting from a demographically ageing society.
Commentary
In the many comments that have recently appeared in the press, an important distinction is drawn between healthcare priority for those who work above those who do not on the one hand, and occupational illnesses which have received too little attention in the current healthcare system on the other. Employees with, for example, carpal tunnel syndrome or those plagued by job-related stress should indeed be able to count on receiving additional specialised treatment. This is already the case for hairdressers whose common complaint of eczema can be included in a separate policy. After all, separate facilities already exist for certain segments of the population in the form of infant and toddler care, support for drug addicts and, for example, for haemodialysis. Precisely because regular care is or has been so one-sided with regard to curative care, medical experts feel that it is high time to invest extra time and effort in the long-neglected occupational illnesses. Until now, it has been unclear whether the employers include this kind of care in their proposal for employee priority.
Both the government and healthcare insurers will be approached for additional funds to increase attention for occupational illnesses within the healthcare system. Some political parties have recently shown their involvement - with the elections in sight - by proposing to make extra funds available, including funds to deal with the waiting lists. Moreover, it has been clearly understood that the system of financing should be reversed completely: the elimination of waiting lists must be rewarded, not punished. On the other hand, the politicians have also addressed the continued lack of efficiency and sub-optimal working methods. Why are operating rooms not used during the evenings or weekends? And why are outpatient clinics closed at that time as well? It has even been proposed to have employers pay extra so that their employees can receive help during these hours, and to use this extra income to shorten the waiting lists for non-workers. This would also lead to a fair solution, and would finally reintroduce the issue of involving employers in reducing the sick leave of their employees. In retrospect, it has been pointed out that the privatisation of the Sickness Benefits Act not only invites employers to provide better healthcare protection for their employees, as was intended, but also stimulates them to do everything they can to shorten the amount of sick leave. (Marianne Grünell, HSI)