In Friesland, BuurtzorgT is one of the few mental health service providers with sufficient space for clients. But since they have reached their limit, according to insurer Zilveren Kruis, they have to introduce new customers. Then they end up on a long waiting list.
It was agreed that BuurtzorgT could grow by 2 million euros in turnover, but it has become 4 million euros. Zilveren Kruis believes this was not the deal and will not repay the extra 2 million. This is why BuurtzorgT has now had to set a shutdown for customers until the end of January.
Stick to budgets
“BuurtzorgT focuses mainly on severe psychiatric problems,” says director Bas van Riet Paap. “We conclude contracts with the health insurers and unfortunately now have a discussion with Zilveren Kruis.”
“Zilveren Kruis means: keep the contract,” explains economist Wim Groot. “Around 2012, it was agreed that budgets would be determined in advance. Then you wouldn’t have just approved doubling it now, any more than you would have said right away for a renovation on your home, ‘It doesn’t matter that it’s become twice as expensive.” According to him, BuurtZorgT should have started negotiations with Zilveren Kruis or other insurers first.
Come on patients
But as a result, many patients with vulnerable mental health problems cannot be helped directly and must be referred to other health professionals. Many, if not all, healthcare workers in the region have long wait times, ranging from a few months to even 9 months.
“I understand that a limit has to be set,” says Van Riep Paap of BuurtZorgT. “But now we’re having an ethics discussion. We have the capacity to deal, but Zilveren Kruis says, ‘Let people be on the waiting list.’ It seems crazy for practitioners, but also for those who pay the premium. Do we find it acceptable?”
Watch here as mental health sufferer Charlotte de Jong now ends up on a waiting list.
Duty of care of the insurer
Doesn’t this also affect the insurer’s duty of care Zilveren Kruis? A health insurer has a duty to get people treated within a reasonable time frame. “The waiting lists are very high, much higher than agreed. While instead the entire mental health budget has not been spent: 300 million euros remain a year”, says Groot.
“That’s a realistic question,” says health economist Zilveren Kruis’ duty of care. “Waiting time averages over 20 weeks. Health insurers fail to fulfill their duty of care and have to buy back care, but you shouldn’t have to do it later. It’s not a case for the care provider to determine the amount of care can be provided”.
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In diep from MS port
Charlotte de Jong (31) is one of the patients who is now on the waiting list. In 2019 she was diagnosed with MS, after which she fell into “a deep valley” and developed psychological problems. “Such a chronic disease turns your whole life upside down. I had to abandon my studies, I lost my job and my home”.
“I stopped taking care of myself, I didn’t want anything anymore. Those are all red flags,” she says. “I haven’t seen him myself, but he was referred to me. I’m grateful for that.” Charlotte was diagnosed with a mood disorder, for which she now takes antidepressants daily.
Sad and insecure
“I find that quite troubling and hard to accept,” Charlotte says about the fact that now she can’t be helped at BuurtzorgT. “I don’t know what’s going to happen, and I live with it every day. I’m sad and insecure about it.”
Bas van Riet Paap, director of the mental health institution, hopes the discussion with insurer Zilveren Kruis over the size of the budgets will be resolved quickly. “So that people like Charlotte can come back to us in February.”
