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Dutch hospital patient figures show great differences in treatment28 January 2014, by Alexandra Gowling
For the first time, health insurers have publicly released treatment figures for a medical condition, showing large differences in treatment and results for surgery patients in hospitals in the Netherlands.
The Dutch Patient and Consumer Federation (NPCF) requested access to data specifically on the treatment of herniated discs and has published it in an infographic on its website.
The figures show that some regions operate on patients much sooner than others, while the quality of the treatment varies considerably between hospitals.
NPCF director Wilna Wind said that the federation requested the information because patients and GPs in the Netherlands need it in order to choose the right treatment and practitioner.
She also said that getting the information had proved difficult, as Dutch health insurers still have to adjust to the openness of providing treatment figures to the public.
She concluded, however, that, "The time of 'we know what is best' is over."
Differences between Dutch hospitals
The figures show that hernia patients in one region are five times as likely to have surgery as in another. Also, while in one hospital a patient had only a 10 per cent chance of post-surgery complications, in another hospital that chance rose to 42 per cent.
In another example, one hospital recommended surgery for 68 per cent of hernia patients, whereas in another that figure was only 10 per cent.
It is also clear from the figures that recovery times vary greatly, from six up to 18 weeks for most (90 per cent) patients, with around 22 per cent suffering from post-surgery complications.
According to NPCF, herniated discs do not always need to be operated on, and surgery that is not required is stressful, expensive and causes unnecessary risks.
Freedom of information on health
While general information concerning differences in hernia treatment is now available, the NPCF says they do not know to which hospitals the figures refer.
"So we know that the differences are great," said Wilna Wind, "but which hospitals perform well and which don't is only known to the insurance companies. This is the information we want."
She also said that patients want to know how the decision to operate is made. "If a hospital does a comparatively large amount of surgery, is that a good sign? Or do they opt for surgery when it is not really necessary? And if a hospital conducts relatively few operations, does that mean a particular doctor also works in other hospitals or that he is inexperienced?"
Wind claimed that this hernia surgery comparison was only the beginning. "Ultimately, we want to make it clear for many conditions where the differences are in quality, cost and treatment. We also call on hospitals and health insurers to make the information that exists available to patients."
This information is especially important for people who have taken out minimum cover health insurance, as these policies limit the number of hospitals patients can go to where their full costs are covered.
Healthcare in the Netherlands
Professor Gert Westert, director of IQ Healthcare, a scientific department focusing on quality improvement in healthcare in Radboud University Medical Centre, agrees with the NPCF.
He said that transparency of quality, cost and (regional) differences are a prerequisite for the proper functioning of the healthcare system in the Netherlands.
"It’s really amazing how little insight the Netherlands has on healthcare use, related costs and results achieved in patients," he said. "For me, this [information on herniated discs] is only a first step. The next step in the development of our healthcare system is that clear information on the quality, cost and variables among institutions be made available."