Healthcare in The Netherlands

[[be...]]

Bummer. It seems to me that it's like the fox watching the hen house.

[[li...]]

Note to previous post.

 

While there might be a theoretical possibility of visiting a specialist without a referral, not covered by insurance, but don't expect them to do anything strange or unusual.

If you have something that would be much less of a problem while not on clonazepam, the typical answers would be like ... 'taper off the clonazepam first', 'go back to the GP', 'I didn't learn my job that way'. The GP is supposed to do so much, and to know the patient well ... medieval nonsense. 'living naturally/normally' and 'normal' is about the holy grail.

 

And NOONE knows about clonazepam, only about those simple sleeping calming or sleeping tablets ... and even then ...

 

I might have better luck if a doc had a panic attack when he/she would notice that I'm on clonazepam ...

[[ba...]]

Note to previous post.

 

While there might be a theoretical possibility of visiting a specialist without a referral, not covered by insurance, but don't expect them to do anything strange or unusual.

If you have something that would be much less of a problem while not on clonazepam, the typical answers would be like ... 'taper off the clonazepam first', 'go back to the GP', 'I didn't learn my job that way'. The GP is supposed to do so much, and to know the patient well ... medieval nonsense. 'living naturally/normally' and 'normal' is about the holy grail.

 

And NOONE knows about clonazepam, only about those simple sleeping calming or sleeping tablets ... and even then ...

 

I might have better luck if a doc had a panic attack when he/she would notice that I'm on clonazepam ...

 

Hi Liberty,

 

Thank you for such a thoughtful post.  I live in the US, and the horrendous consequences of long term benzodiazepine use is overlooked (ignored) here as well.  We are bombarded daily in cable and television advertisements to take medications that have not been proven to be safe, yet the FDA continues to sanction them. 

 

When I first started my taper, I went to a doctor who was new to me after my geographical move.  When she inquired how long I had been on benzodiazepines,  (8 years), she barked a laugh into my face and told me, “It’s too late” and I would be “On them for life”.  Nice, huh? 

 

I was so very angry!  What a bitch!  But as the years have gone by, I have realized she was simply telling me the truth in an ungracious manner.  Her advice chronicled the experience she has had with past and present patients.  So while her bedside manner was abhorrent, at least she was truthful. 

 

I have found doctors that do know about the benzo danger, but most are hamstrung by bureaucrats in the hospital and health care networks in which they work.

 

So not much better here in the States.

 

 

 

 

 

[[li...]]

babyrex, I'm sorry to hear that.

 

At least you have/had (?) the option to pick your own doctors (?).

 

To clarify the procedure I started: it's a (quasi) legal procedure, it has its own part in Dutch law but it's basically the profession monitoring/judging their own members. The 'college' that makes the decisions consists of one or several members of the same profession, and one or several lawyers. It's legal, but separate from civil or criminal law. The fox guarding the henhouse, indeed.

 

 

[[ba...]]

babyrex, I'm sorry to hear that.

 

At least you have/had (?) the option to pick your own doctors (?).

 

To clarify the procedure I started: it's a (quasi) legal procedure, it has its own part in Dutch law but it's basically the profession monitoring/judging their own members. The 'college' that makes the decisions consists of one or several members of the same profession, and one or several lawyers. It's legal, but separate from civil or criminal law. The fox guarding the henhouse, indeed.

 

Hi again Liberty,

 

Yes, depending on our health insurance plan, we do have choices in doctors (General Practitioners).  But it’s kind of like choosing to buy fabric at either Kmart or Walmart.  They all seem to be cut from the same cloth.  No real distinction there.  At least we have a choice though.

 

The medical monopolies (whether private or socialized) seem intent on reducing populations at ever increasing rates.  Seems to be global.  Rumor has the NHS starting to restrict injections of insulin and B12 who have been diagnosed.  Not sure of the validity of these claims, it could be total BS.

 

 

[[be...]]

As of 2018, I will no longer need a referral from what Liberty refers to as a gatekeeper. I can pick and choose whom I like, w/o him interfering, for once. (phew). I will find the best doctors and pick them and while I'm at it, I will drop kick my internist once this colonoscopy hassle is done.

[[li...]]

Benzogirl,

 

From our conversations, I was under the impression that you could choose your own doctors ??

 

 

[[li...]]

The case has been proceeding.

 

The GP came up with some new evidence. Up to a point, a new version of my medical records. Some (or all) might even be true in the sense that he actually recorded it that way. It seems he thinks it improves his position, but from an objective point of view it only makes his position worse. Much worse. He doesn't have a clue.

 

There are two standards that are relevant, the law (mostly the WGBO) and the professional standard that applies to the profession (in this case what aplies to GPs). In my view, that he broke the law is obvious. Then again,  Ducth GP medical practice is mostly opinion based.  Would a lower standard of behavior according to professional standards trump the law ? It's not supposed to happen. But GPs are mostly above the law. Criminal law and civil law, I don't see how. Benzo's are known to be 'safe'.

 

Would anyone know of a legal defence against a possible defence that I 'just get off the drug' ? It's not exactly a panacea for serious health problems. He has been messing around with my health ... if only I were 25 years old ... What this GP did was not normal.

 

A horrible profession, the GP. They expect you to look up to them. They are so proud when they don't refer people to specialists. But they know so little ... And the less they know, the worse their behavior.

[[li...]]

It's my turn to write a reply to the GP's defense. And reacting to different medical records ...

 

Unpleasant work. I'll get it done in a few days, I guess. GPs make medical errors all the time.

[[ne...]]

Thanks, Liberty, for keeping us posted. I wish you the best of luck in your pursuit, I know it's a long, slow, and nerve-racking  process.

[[li...]]

I finished writing a reply, and sent it on its way. It has been a burden.

 

Dutch GPs base their decisions to a very high degree on opinions. Will opinions and ´I learned to do my job that way´ trump the law ? (´it is my opinion that clonazepam´ ...)

 

Anyway, it has shed a new light on what happened to me.

I just have a few (some weird) unaddressed health issues. Dutch doctors usually really want to work by the book. I´ve been wondering if I could bypass the usual restrictions. I could pay some things out of pocket and bypass the GP, in theory. Thing is, they will usually do almost anything to avoid medical treatment if it´s not strictly ´by the book´. What if a certain health problem would be much less of a problem if I had not been on clonazepam ? The last thing I want to hear is ´taper off the clonazepam first´, ´that´s work for the GP´ or lifestyle advice that won´t work !

 

I´m thinking about this, and if anyone has any ideas ...

[[ne...]]

It's very annoying, to say the least. I had my own struggles with doctors for many many years, due to chronic pain that was never property treated or even managed. I'm tapering my benzo now, and will probably heal from the horrible benzo sxs, but I'll be only returning to disabling pain. So, I understand where you are coming from, and the frustration you may feel.

 

If I were you, I would go ahead and pay from my pocket and try and find an understanding doctor, that is willing to listen and collaborate with you. No matter how long it takes. They are few and far between, but there still are decent human beings out there. I had more luck with young doctors in this regard, maybe they are not so worn out by the system yet and have more patience?

 

Wish you luck, liberty! 

[[li...]]

This country is different ...

 

16-17 million people, specialists are not used to working without a 'gatekeeper'. It's minimalistic, and restrictive. As long as something doesn't kill you first while you're on the drug ... Most likely works fine for 25 year olds. And then, in the very first place, the consequences of medical errors. I'm not going to repeat here how long I've been on the stuff ... Don't every expect a Dutch doctor to criticize another Dutch doctor.

 

Official Dutch source for medical professionals: https://www.farmacotherapeutischkompas.nl/bladeren/groepsteksten/benzodiazepine_agonisten

 

I quote (google translate) 'Benzodiazepines have qualitatively the same efficacy. Possible differences in anxiolytic, muscle relaxation, anticonvulsant and sleep-promoting properties have not been convincingly demonstrated. Due to pharmacokinetic differences, the various benzodiazepines differ in rate of onset and duration of action.' They are all the same ! (contrady to evidence)  So incredibly outdated.

 

Also, I think Dutch doctors freak out if you haven't been living normally, with everything (medicially) having happened just in/on time. 'Dutch normalcy'

[[li...]]

This is getting a bit of a blog like saga.

 

The GP in question started practicing in the early 1980s.

 

I´ve done a little reading. An article published in 1986, for healthcare professionals. Quite possibly, this is what the GP learned:

 

https://www.ntvg.nl/artikelen/afhankelijkheid-en-abstinentieverschijnselen-bij-gebruik-van-benzodiazepinen/volledig

 

Through google translate:

 

´Dependency and abstinence symptoms when using benzodiazepines Open

Situation

08-07-1986

M. van Steenkiste and J. de Roeck

 

    Fully

    Article info

    Author info

    Reactions 0

 

To print

Parts

Back upstairs

 

In 1984, 8,503,800 packages of benzodiazepine preparations were sold in Belgium, and only through the pharmacist. 1 Sales to hospitals are not included in this number. However, the figures on the number of regulations, sales and actual use appear to be incompatible with each other. 2 In the western countries, 1 in 6 adults would use benzodiazepines for a short or longer period of time in the course of a year; 2 of the population she would use chronically. 3-5 These figures show that at least a fairly large group of the population regularly occupy benzodiazepines. Even if the chance of dependence and abstinence symptoms is small, a non-small group of the population will be able to deal with these problems. Previously, several aspects of this have already been pointed out in this journal. 6 7

FREQUENCY OF DEPENDENCE ON BENZODIAZEPINES

 

The patients who become dependent on benzodiazepines can be divided into two groups, firstly those who use alcohol or other addictive substances in addition to these drugs and secondly those to whom benzodiazepines are prescribed on a strictly medical indication. According to Marks, dependency in the latter group would not occur more often than once per 50,000,000 patient months. 8 Assuming that this figure is correct, the risk of dependence on benzodiazepines is virtually negligible. Tyrer et al., On the other hand, concluded that abstinence symptoms occurred in 27 to 45 of the cases of more or less prolonged benzodiazepine use. 9 The study concerned ambulatory patients with anxiety syndromes who had taken on average 10 mg of diazepam or 4 mg of lorazepam per day for an average of 3.5 years. Murray et al. Found difficulties in stopping it at 58 of long-term users of benzodiazepines. 10 In only 1 in 5 patients this problem was discussed with the GP. From this it can be deduced that the ease with which benzodiazepines are prescribed and obtainable can lead to masking drug-seeking behavior of many patients who have dependency.

PHENOMENA

 

Stopping treatment with benzodiazepines can evoke three forms of reaction:

 

1. The complaints for which the therapy was set return. In this case, the underlying problem has not changed anything or enough and, in an attempt to gradually or completely omit the medication, the problem will inevitably have to be dealt with again.

 

2. There are 'rebound' phenomena such as 'rebound-anxiety' and 'rebound-insomnia'. This may involve an increase in anxiety or sleep disorders because homeostatic mechanisms at the receptor level can not keep up with the rate at which benzodiazepines and their active metabolites disappear from the organism. 11

 

3. The real withdrawal reactions, indicating that metabolic tolerance for the product has occurred. The first two reactions are the most common; withdrawal reactions are exceptional.

 

Dependence symptoms can be distinguished into mild and severe symptoms.

 

- Among the most common symptoms, anxiety, insomnia, irritability, nausea, palpitations, headaches, muscle tension, tremors and dysphoria are considered. 2 These symptoms fall into the category of rebound phenomena.

 

- Among the serious symptoms is: hyperesthesia (reduced perception threshold for stimuli), kinesthetic perception disorders, illusionary sensory forgeries of a primarily visual nature (stationary objects seem to move), deerealisation, depersonalization, character change, myoclony, epileptic seizures, confusion states with disorientation and real psychotic episodes with delusions and hallucinations (delirium). 2 These symptoms fall into the category of real withdrawal reactions. Its emergence presupposes a tolerance, which is rare for benzodiazepines. Of course, these symptoms never occur simultaneously and the most serious are also the rarest.

 

In the event of sudden discontinuation of benzodiazepines, these effects may occur after a latency period of 1 to 10 days, depending on the half-life of the drug, and last for 1 to 4 weeks. Then the serious symptoms disappear; however, the mild symptoms can continue to exist for a very long time (weeks or even months). 2 12

 

There are reasons to believe that prolonged benzodiazepine use undermines normal stress tolerance and the efficiency of coping mechanisms. In laboratory animals it has been shown that long-term intake of benzodiazepines can easily cause panic attacks when confronted with new stimuli. 13 Something similar could also occur in man.

FACTORS THAT PROMOTE DEVELOPMENT PHENOMENA

 

- In the first place, the origin of withdrawal symptoms is related to the duration of use. In general, the risk of withdrawal symptoms increases with the longer use of the benzodiazepines. A minimum duration of 3 months seems to be required, but in most cases it is chronic use for months or even years.

 

- In the second place, metabolic and pharmacokinetic elements play a role. The benzodiazepines are distinguished mainly by their different half-lives, on the basis of which they can be divided into 3 classes:

 

1. Long-acting benzodiazepines, with a half-life of 24 hours or longer. These are generally converted to active metabolites in the liver, the half-life of which is often very long. Some examples are diazepam (Valium), chlordiazepoxide (Librium), prazepam (Reapam), clorazepate (Tranxene) and ketazolam (Unakalm). Of all these agents desmethyldiazepam, with a half-life of more than 100 hours, is the central active metabolite.

 

2. Short-acting benzodiazepines, with a half-life of between 5 and 24 hours. These are mainly eliminated by conjugation, have virtually no active metabolites and are virtually non-accumulated. Some examples are lorazepam (Temesta), lormetazepam (Loramet), oxazepam (Seresta) and temazepam (Euhypnos, Normison).

 

3. Very short-acting benzodiazepines, with a half-life of less than 5 hours, eg triazolam (Halcion).

 

According to several researchers, mainly the benzodiazepines with a short half-life lead to the rebound and withdrawal symptoms. 2 9 11 15 Triazolam, for example, would easily give rise to rebound insomnia and lorazepam would more often give rise to withdrawal symptoms than for example clorazepate. 16 17 An explanation could be that the sooner these products are eliminated, the faster they also disappear from the benzodiazepine receptors. Moreover, the short-acting products have virtually no active metabolites. Because benzodiazepines have an α-aminobutyric acid (GABA) -ergic effect, it is assumed that after prolonged use and in rapid elimination the balance is disturbed because the GABA-ergic tone becomes too weak with an increased excitability of certain neuron groups as a result. 18

 

Not only withdrawal symptoms bring people back to their medicines, but also the so-called onset and offset phenomenon has an influence on this. 11 The onset phenomenon is the speed with which the anxiolytic effects occur after the intake of the medicament. The duration and intensity of these are directly related to the liposolubility of the product. Of diazepam, for example, it is high and oxazepam is low. The offset phenomenon is the speed at which the anxiolytic effect disappears, which is related to the half-life. In the case of drugs with a short half-life, a rapid and abrupt breakdown of sedative and anxiolytic effects is experienced. It is understandable that drugs with pronounced onset (flash) and an equally pronounced and abrupt offset effect will more likely result in the patient tending to resume their use more quickly. This can explain the commercial success of resources such as lorazepam and bromazepam.

 

- Thirdly, the personality of the patient plays a role, 19 which is just as important as that of the two aforementioned factors together. The clinic teaches us that some patients, even after very long use, can stop relatively easily, while others, even after short-term and low-dose use, still have every effort in the world to reduce or omit their use. While on the one hand the patients whose benzodiazepine levels fall the fastest in the blood relatively more problems, 9 it is also noted that some people are particularly sensitive to these changes. Especially people of the passive-dependent type, with a 'histrionic personality', or with an asthene personality, alcoholics or patients with other addictions, even if they occur in the family, patients who somatize strongly and finally depressive patients tend to form dependence or getting withdrawal symptoms. When these symptoms occur, these people also have a reduced tolerance for them.

 

However, these statements are put into perspective by Mendelson, 20 who concluded, inter alia on the basis of a study by Clift, 21 that long-term use of sedatives in an important part of the cases originated in a hospitalization, whether or not psychiatrically reasons. Often systematically, patients receive hypnotics, usually benzodiazepines, which are simply prescribed after discharge. This rule is sometimes extended for years without any criticism. Furthermore, Mendelson states that patients with clear psychiatric illnesses in their history are no more likely to become dependent than patients without a psychiatric history. However, this risk was increased in apparently normal people who clearly achieved high scores on questionnaires on the subjective experience of stress symptoms (eg the personal disturbance scale of Foulds). Ashton also describes the majority of patients who experienced major dependency problems as 'normal' before starting to use benzodiazepines. 12 Somatic complaints or symptoms were often the reason to use benzodiazepines. Possibly, however, these were anxiety equivalents. Furthermore, dependence on benzodiazepines appears to occur more frequently when they are prescribed by general practitioners, orthopedists and gynecologists to patients with insomnia of somatic origin. Patients who increase the dose themselves also form a risk group.

POLICY AND TREATMENT

 

Benzodiazepines are prescribed too easily, too often and for too long. It is advisable to prescribe benzodiazepines as a 'cure', as is the case with antibiotics. Therefore, a benzodiazepine was given in a well-defined dose for a well-defined period, under very regular control. It is difficult to draw up general rules, but preferably benzodiazepines should not be prescribed for more than 4 months. 2 If this period is to be exceeded, consideration should be given to the possibility that dependency may arise, or that there are other or underlying problems that are not adequately addressed, so that psychiatric assistance must be considered.

 

Furthermore, the previously mentioned risk categories should be kept in mind when prescribing benzodiazepines. With these people, one should be cautious about prescribing a benzodiazepine. In general it is also advisable to enter into a 'contract' with the patient, in which one clearly determines the dose, the frequency of intake and the overall duration of the treatment. In addition, frequent contact with the patient must be ensured, in which case one also tries to help in other ways through supportive conversations, advice for healthy living habits, relaxation of the type of autogenic training, insightful psychotherapy, behavioral therapy, etc. A clear agreement with the patient. patient - especially when it comes to psychopharmaceuticals - prevents and manipulates at a later stage of the therapy.

 

If it is difficult for a patient to reduce the use of medication, whether or not because rebound or withdrawal symptoms occur, one proceeds as follows: one replaces the preparation with another, long-acting benzodiazepine preparation in a comparable dose. The latter is then phased out very gradually, preferably in accordance with a predetermined schedule. Especially with long-term use of benzodiazepines 'the last few bins weigh heaviest'. For example, 50 to 100 mg of clorazepate can be administered, the dose reduced to, for example, 20 to 30 mg in the course of 1 to 2 weeks and then gradually reduced further over 2 to 4 weeks.

 

However, Ashton advocates stopping quickly - especially with hospitalized patients - in order not to stretch the process unnecessarily. 12 After replacing the agent used with a long-acting preparation (in this case diazepam), it ceases it in the course of 2 weeks. During this phase, a supportive attitude, with frequent contacts, is very important.

 

Optionally, propranolol (Inderal) can be administered in a dose of 40 to 80 mg per day. Propranolol may reduce, but not prevent, the severity of certain vegetative symptoms, such as palpitations. 9 If the patient nonetheless fails to omit his medication, or significantly reduces it in doses, hospitalization can be considered to clinically stop the withdrawal.

CONCLUSION

 

Severe addiction to benzodiazepines is likely to be rare, but rebound symptoms in discontinuing therapy are not. Taking a tranquillizer has almost become part of our culture. A very large number of people use benzodiazepine preparations every day, sometimes for years. With which stubbornness people stick to their tranquilizers, they often only see when they try to get rid of them. This task is certainly not facilitated if abstinence symptoms occur when the medication is stopped. Benzodiazepines may be easily prescribed from a sense of impotence in order to do something about the psychological suffering of patients. Furthermore, it is also true that patients come too easily to ask. However, it is our job as a physician to prevent our evolving to a sedated society through clear agreements with our patients. ´

 

Absolutely horrible. So incredibly outdated. To say the least. Still, no excuse for lying and a few other things.

I just get the feeling I really have to distrust doctors. There is that old tradition of paternalism. I wonder if any of his collegues that will be on the case will share his ´views´.

 

´Just say no´ (to doctors).

[[li...]]

Update:

 

The proceedings are in a new phase. I replied, and recently the GP responded. From the perspective of content, his response was weak. Yet, with his expensive professional legal help he managed to write up a ´decent´ response. Most likely scenerio: his colleagues will cover it up.

 

Recently I was reading a bit about this healthcare system. GPs are supposed to treat so many conditions and situations. For most common ailments, this works out fine. Most of the time.

 

Obviously this has been a disaster for me. In so many ways, the system is so primitive. And it´s the most paternalistic one compared to the USA, France, Germany, the UK.

I most certainly won´t switch to another GP, no matter what they say. They just don´t know anything, and about benzodiazepines it´s ´everybody knows´. Bunch of nitwits. Not referring to secondary care is almost their primary function. I´m not going to play their games. Obviously I should have avoided GPs at all. Btw, it is the world´s second most expensive healthcare system. Obviously, the USA ranks first.

 

´the heroes of primary care´ (GPs), ´we think we´re so great´ (Dutch doctors in general)

[[ne...]]

Thanks for updating us, liberty. I'm rooting for you, no matter what happens.

 

But, I wonder, is it possible NOT to have a GP?

[[li...]]

Legally, it is.

 

But you'll need a referral for regular appointments with a specialist. That is, 'non emergency' appointments. Sometimes you can go without a referral (but Dutch specialists are very 'by the book'), in those cases insurance doesn't cover anything.

[[li...]]

Is it realistic to expect that a broken system that got me into this mess will get  me out ?

 

Probably not. Then again, 'go natural' is rather crude ... no more healthcare till I am recovered !

 

(crazy note: GP's attitude: if you have problems with clonazepam I stop all non-critical/non-catastrophic healthcare, I'll act only if I 'see' anything and wait till you are better/ till you are off and recovered. Crazier is not possible, but this is The Netherlands. And yes, they are horrible gatekeepers. If only he had told me before he started ...)

[[li...]]

A bit blog-like: the bastard (GP) just got an extension. He'll likely wait it out till his retirement.

[[ne...]]

Sorry about that, liberty. What's next?

[[li...]]

Good question !

 

He also has the opportunity to file an appeal, so he'll likely be covered till his retirement. I suspect I'll have the opportunity to react in writing, but I shouldn't get the idea that it's going to do me any good. That whole process is for the doctors. In the NL, docs are mostly above the law.

[[ne...]]

That's outrageous and sadly, the case for most psych-med damaged patients, as these injuries are so hard to prove! 

 

I admire all your effort to shed light on this issue.

[[li...]]

In my case it was about more than ´the benzo´.

 

[[li...]]

I've been reading a bit more in preparation, and the all pervase issue in my medical 'treatment' is the lack fo informed consent (not just the benzo). 'care' without informed consent.

 

Probably unimaginable if you live in the USA. I've had my own personal dr Mengele. Doctors are above the law for the most part. Especially in primary care. The ordinary level of care is horrible, but if they mess you up and cannot get relevant medical care ... http://www.patient-safety.com/blacklisting-patients.htm

 

That doctors don't take benzo w/d seriously is a thing that happens everywhere. I have yet to see an American MD  cutting fof someone's regular medical care because 'you're addicted' or 'it's all mental'. Just getting it off my chest.

 

Oh, and for a 'detox' I must wait till I know what goes through my mind when i reach for a pill ....

 

Doctors that are above the law and don't have a fucking clue. But they (or he) has first class legal representation.

[[li...]]

Article:

 

https://www.nrc.nl/nieuws/2017/02/15/nederlandse-gezondheidszorg-is-ondermaats-6713146-a1546191

 

Dutch health care is below par

The gatekeeper function of the GP stands in the way of good care, says Frans Rampen.

 

    French Disasters

 

February 15, 2017

 

The Euro Health Consumer Index (EHCI) is often seen as the European barometer for the quality of health care. For years our country has stood proudly on top. In the report published in 2016, we are once again at the forefront.

 

A frequently heard critique of this index concerns the research methods. For the most part, patient surveys are used, a rather subjective source of information. Parameters related to the organization of the health care system are also overestimated, and the care results, expressed in mortality rates, are undervalued. With a more balanced weighting, the ranking of the countries would look completely different.

 

This discussion was based on data from the fifteen countries that formed the EU until 2004. Greece is excluded because of its deplorable care level. Added are Switzerland, Norway and Iceland. Total seventeen countries, in short EU17.

 

It appears that the Netherlands performs poorly on parts. As far as life expectancy is concerned, we score a meager 8th place in this ranking. According to the WHO, since 1980 the country has recorded the lowest growth in life expectancy since the birth of all EU-17 countries! There are indications that mortality among the elderly is particularly disproportionately high here.

 

In the case of mortality due to asthmatic disorders, the Netherlands is also somewhere below (12th place). With regard to child mortality during the first year of life, our country occupies 15th place. From several sources it appears that we achieve remarkably low survival rates over the children's period up to 5 years (OECD, WHO).

 

The EHCI gives the Netherlands a 13th place within the EU17 in the field of cancer mortality. According to a more recent bulletin from Eurostat, we are now closing the line! Our position in the rearguard applies to almost all cancers. Only for breast and cervical cancer do we perform in the middle. Let these be the tumor types, coincidental or not, for which population screening is offered and where the contribution of general practitioners is limited.

 

This brings us to the red line through the EHCI statistics: the gatekeeper function of the GP. In all countries where a strict gatekeeper system applies, we see the same disappointing results. The most fanatical gatekeeper countries within the EU17 are - in addition to the Netherlands - Denmark, the United Kingdom and Ireland. The scores of these countries in the field of life expectancy, asthmatic disorders, infant mortality and cancer mortality are correspondingly: at best in the middle, mostly in the tail. That can not be coincidental. GPs do a lot of specialized work nowadays, although they are not sufficiently trained in this.

 

At the end of 2015, Arne Björnberg, the chairman of the EHCI, paid a visit to our House of Representatives. When he was asked how we could improve our health care system, his resolute answer was: "Abolish the gatekeeper system!" Minister Schippers (Public Health, VVD) has neglected the advice carelessly.

 

The gold medal in the EHCI competition has a black border. Our total health care budget as a percentage of GDP is about the largest in Europe, despite forty years of gatekeeping. Our report figures in terms of care performance are disappointing, on the other hand. We spend too much money on an inferior product. It is important that politicians provide clarity on the discrepancy between the still high healthcare costs and the survival statistics that are meager according to European standards.

 

Frans Rampen, former dermatologist with personal interest in European health care policy