-
01 January 2023 | Country Update
Compulsory waiting time of five days for abortion abolished
5.4. Specialized ambulatory care / inpatient care
Secondary care encompasses those forms of care that are only accessible upon referral from a primary care health provider, such as a GP, dentist or midwife. These forms of care are mainly provided by hospitals and mental health care providers. Hospitals have both inpatient and outpatient departments, as well as 24-hour emergency wards. Outpatient departments are also used for pre- or post-hospitalization diagnosis.
There are six types of institutions that provide hospital or medical specialist care:
- general hospitals
- academic (university) hospitals
- specialized hospitals (providing care for one type of condition only, such as cancer hospitals, eye hospitals, rehabilitation centres)
- independent treatment centres, providing day care only
- top clinical centres (providing both general hospital care and complex care)
- trauma centres.
In 2014 there were 85 general hospitals (of which 28 were top clinical centres) in 131 different locations, 8 university hospitals and 65 specialized hospitals. These hospitals provide practically all forms of outpatient care as well as inpatient secondary care. Most hospitals also have 24-hour emergency wards. Except in cases of emergency, patients only consult a specialist upon referral from a GP or by referral from another medical specialist. The specialized hospitals concentrate on specific forms of care or on specific illnesses (such as revalidation, asthma, epilepsy or dialysis). In 2014 there were 268 independent treatment centres. The care provided by independent treatment centres is limited to day care in the so-called free segment. This is non-acute, freely negotiable care that can be provided in an outpatient setting or as one-day admissions. Most top clinical centres are part of a university hospital or are operated by a number of hospitals working cooperatively. Examples are the nine cancer clinics and the clinics for organ transplantation (including 10 for kidney transplants, three for lung transplants, and three for heart transplants in 2013). In 2011 there were 11 trauma centres, most of them related to a university hospital (National Institute for Public Health and the Environment, 2014a).
Most hospitals are foundations. Hospitals are non-profit institutions as a for-profit motive is not allowed. Whether or not hospitals should be allowed to generate profit and to have shareholders is still a topic of political debate. A bill submitted by the Minister of Health in the summer of 2014 and proposing to allow profit-making under certain conditions was withdrawn in December 2014 because of the fierce opposition in the First Chamber. It is not yet known when it will be submitted again (van Dorresteijn, 2014).
Within hospitals, approximately 60% of medical specialists are self-employed and used to be organized in partnerships per specialty (Rabobank, 2014/2015). In a few hospitals, especially university hospitals, all specialists are employed by the hospital. Furthermore, all paediatricians are in salaried service in hospitals. In 2014 there were 24 584 registered medical specialists.[5] The largest categories were psychiatrists (3416), internists (2170) and anaesthesiologists (1821) (KNMG, 2015). In 2015 the position of the medical specialist partnerships changed. Medical specialists no longer negotiate with insurers on prices for their services, but instead negotiate directly with the hospital on their remuneration. As a result, some medical specialists became employees of the hospital, but most united in a medical specialist company per hospital. It is not clear whether the National Tax Office will acknowledge these companies as independent entrepreneurs. This may have financial consequences for the medical specialists.
In 2012 there were 257 hospital admissions per 1000 population. Of all hospital admissions, approximately 54% were one-day admissions. Clinical admissions lasted on average 5.2 days in 2014. The average length of stay has been steadily decreasing over the years, dropping down from 10.7 days in 1990 (Centraal Bureau voor de Statistiek, 2014) (see Fig5.3).
Fig5.3
The government aims to replace medical specialist care with GP care whenever possible. This relates mainly to low complex and non-acute care. Chronic care for conditions such as COPD and diabetes is considered to be suitable for substitution. For diabetes care, extra consultations in the GP practice can lead to less medical specialist care.
Since the early 1980s the number of people receiving hospital care has been rising. In the same period the proportion of one-day admissions has risen considerably. Fig5.3 shows that in a period of 12 years (2000 – 2012) the number of one-day admissions has almost tripled, while the number of clinical admissions grew only slowly. In this same period the average length of stay decreased by 40% (Centraal Bureau voor de Statistiek, 2014). This trend is mainly the result of developments in non-invasive surgery.
- 5. The list of registered medical specialists includes GPs, profile physicians (such as addiction physicians and forensic physicians) and occupational and insurance physicians. These are not included in the number provided here. ↰
In the Netherlands, abortion services are part of insured care. Until now, women who were seeking an abortion had to go through a compulsory waiting period of minimum five days in which she was meant to consider whether to proceed with the procedure. As of 1 January 2023, this waiting period no longer has a five-day minimum and is instead determined in discussion with physicians.
References
Verplichte minimale bedenktermijn bij abortus vervalt | Nieuwsbericht | Rijksoverheid.nl: https://www.rijksoverheid.nl/actueel/nieuws/2022/07/08/verplichte-minimale-bedenktermijn-bij-abortus-vervalt