Rising Trend: Elderly Patients with Multiple Conditions Overwhelming Hospitals in the Netherlands

• Sander Zurhake

  healthcare editor

• 

  Judith Pennarts

  Nieuwsuur investigative editorial team

There is a risk that hospital care in the Netherlands will come to a standstill in the coming years, as there are more and more patients with multiple diseases at the same time. Inadequate collaboration between medical specialists, the rapid aging of the population and the complex financing of the health care system reinforce this trend.

Doctors are now working on solutions, but they face bureaucratic hurdles in implementing them. The chaos leads to fragmented care and can cause disasters, for example due to medication errors.

This is evident from an inventory by the co-editors of the NOS and News hourwho spoke to seven scientific professional associations of medical experts, doctors and professors.

As The conclusion is that the demographic change in the population up to and including 2040 will lead to an overload of the current hospital system. Today, 5.7 million people already have two or more illnesses. By 2040 there will be 6.6 million, stilt the Scientific Council for Government Policy.

Most of these patients will be transferred to hospitals. This often applies to elderly people who have multiple diseases at the same time. Figures not yet published from the North-West Hospital Group in Alkmaar, seen by the research group, confirm the growing demand that patients with multiple diseases place on healthcare capacity.

From previous research by NOS and News hour it has already become clear that there is a structural risk to healthcare to get involved because patients come to hospital unnecessarily. The editors of the research have now investigated whether hospitals can cope with the expected flow of patients with multiple diseases who belong to the hospital. It also seems that the system is no longer equipped for this.

“Care is now focused on treating one specific disease,” says professor of internal medicine Barbara van Munster. “And the specialist is trained to provide that treatment as best as possible.”

According to Van Munster, health care funding perpetuates this way of working. The system is set up to fund treatments for one disease such as cancer, where ‘multidisciplinary consultations’ are funded, but not for patients with multiple conditions.

This is a ticking time bomb in terms of access to hospital care. Because it is precisely these patients who will become the most common hospital patients in the coming years. “The doctor treats a large number of conditions,” says Van Munster. “But if one of them has multiple conditions, and I mean three, four, five, they end up in the hospital. “

At the North-West Hospital Group in Alkmaar, the physician-researcher Ursula de Ruijter has provided an insight into the level of burden that such patients place on the overall capacity of a hospital. Of the 140,000 patients who visited the outpatient clinic in Alkmaar in 2019, only a quarter of them had multiple diseases at the same time. But almost half of all consultations went to this group. According to Professor Van Munster, this case is representative for the rest of the Netherlands.

In this video, Ursula de Ruijter shows how much capacity is required for one patient with multiple conditions.

There are not many examples of collaboration between doctors for patients with multiple problems, but they do exist. At the Jeroen Bosch Hospital in Den Bosch, interns, clinical geriatricians, pulmonologists, cardiologists and hospital doctors together create a treatment plan for complex patients in a special department every morning.

There are also financial problems here, but these have been temporarily solved because the departments of these medical specialists have taken part of their budget has been submitted. This allowed specially trained hospital doctors to get to work to examine patients more widely and monitor daily consultations between specialists.

The clinical expert Esther Cornegé shows a scientific publication with the results. “The length of stay is two days shorter and patient satisfaction is also very good. In addition, patients visit fewer doctors because the collaboration has reduced the number of mutual references.”

However, it is difficult to implement this program nationally. In her role as chair of the professional association for clinical geriatrics, Cornegé is highly trusted by health care administrators and health insurers. Financially, it is considered risky.

Funding is not the only obstacle. “You notice in everything that current thinking is still very disease-based, not enough attention is paid to the fact that a growing part of the population has more than one disease,” Robin said. Peeters, head of internal medicine at Erasmus MC and also an advocate.

This blind spot is also reflected in the Integrated Care Agreement, especially the plan for how Dutch healthcare should be organized in the future. But the patients who suffer from many diseases are mentioned only three times. Agreements on better collaboration between medical specialists are not an issue.

As chairman of the Dutch Trainers’ Association, Peeters experiences how lack of attention hinders support. For five years he has been trying to arrange funding with the Dutch Health Care Authority and Zorgverzekeraars Nederland (ZN). better cooperation between medical experts. Without reimbursements, consultations cannot be financially viable for hospitals.

Before insurers reimburse such consultations, they want to see in black and white that the discussions are useful. That’s where Peeters wants establishing pilots, but he is not willing to help from health insurers. They oppose this and argue that Peeters is responsible for creating a concrete research plan. “We haven’t got this plan yet.”

“We are all wasting precious time this way,” says Peeters. “A fully developed business case is a utopia at this point.” In light of the looming health care crisis, he emphasizes the urgency of testing now what works and what not. “We have to deal with this together now. The healthcare system is almost bursting at the seams, so we can’t wait until we have the numbers.”