Long wait for a diagnosis? Past perfect tense!

One look at the National Atlas of Public Health – on which the government keeps track of waiting times for all kinds of healthcare research – says it all: waiting lists in the Netherlands are far from a thing of the past.

At a CT-scan It is not that bad: in most hospitals you can go for this within a maximum of three weeks. At a MRI however, this can go up to six weeks and for a gastroscopy (a visual examination in the esophagus and stomach) for up to twelve weeks. Waiting a few weeks is nothing in a human life. But if you have a sore knee, back or stomach, for example, it feels like an eternity.

In recent years, the number of diagnostic examinations has increased rapidly. For example, while 75,000 MRIs were performed in 2003, that number has now increased almost tenfold. The demand for MRIs is increasing by 10 to 12 percent every year. This has to do with the increasing number of elderly people, but also with better technology. The more physical problems doctors can detect and treat, the more demand there is for good diagnostics.

From 37 to 184 in five years

Hospitals are not always able to respond well to the growing demand for diagnostic tests, partly because of their large, complex organization. In addition, hospitals deal with emergencies. These naturally take precedence, but they do ensure that patients with less urgent complaints sometimes have to wait a long(er) period.

At an independent clinic – a private healthcare institution with a special government license to provide regular care (paid by the health insurer) – patients almost never have to wait. This is because such a clinic focuses on one task, such as conducting research. Unlike a hospital, an independent clinic never has to deal with acute patients, which means that appointments can be planned well. And if more patients arrive in a certain period than there is time for during the day, the clinic will remain open in the evenings or at the weekend.

The number of independent clinics is growing rapidly. In 2005 there were 37, in 2010 already 184. 90 percent of the care in the independent clinics is medically necessary and is reimbursed by health insurers. The remaining 10 percent mainly consists of cosmetic procedures and other uninsured care, such as a preventive total body scan. Most clinics focus on one specialism, such as orthopedics, cardiology, gynaecology, dermatology or dentistry. You can go to almost all clinics for a diagnosis, often also for treatment.

Eliminate waiting lists

You can find both at the nine DC|Groep locations. “In 1995 a number of radiologists from the Onze Lieve Vrouwen Gasthuis in Amsterdam decided to start their own clinic,” says operational director Anneke Snelder. “They thought they could answer the requests from general practitioners for, for example, a x-ray, an echo or a mammography that way they could arrange faster and better. That turned out to be the case.”

Due to the long waiting times, other surveys were added to DC|Groep’s offer over the years. An MRI scan, for example, and an endoscopy (stomach and bowel examination). With the exception of endoscopy, patients can contact DC|Groep for all examinations within 24 hours. 90 percent of them were referred by their GP.

At the four branches of another large chain of diagnostic clinics, the MRI Center, two thirds of the patients are referred by a GP and one third by a specialist. When radiologist Erik Veldhuizen started the MRI Center in 1998, he had only one goal in mind: to eliminate waiting lists for MRI examinations.

As demand continued to increase, he opened more branches in different parts of the country. And the next branches are already planned. “In our centers we now make about 25,000 MRIs a year,” says Veldhuizen. “That is almost eight times as much as the average hospital does. We offer all possible forms of MRI examination, but the most requested are MRIs of the knee, back and brain. In 2010, 94 percent of all hospitals in the Netherlands referred one or more patients to us.”

Needed: referral letter

To be able to go to an independent clinic, you need a referral letter. “We have made a conscious decision to do this,” says Veldhuizen. “You should not conduct research if it is not really necessary. Moreover: a result alone is not of much use. You need a doctor to interpret it for you and tell you if further treatment is needed.”

The procedure in the diagnostic clinics is about the same everywhere. After the examination has been performed, the images and results are sent to the doctor who requested the examination. If desired, the patient can receive a copy on CD for a small fee (usually between €10 and €25). His own doctor then discusses the results with the patient and decides whether treatment is necessary.

Usually it is the GP or specialist who takes the initiative to refer a patient to an independent clinic. But at both DC|Groep and the MRI Center they notice that patients are increasingly reference to ask. Not all doctors are aware of the possibilities for diagnostics outside the hospital.

If it is in the best interest of his patient, a doctor will generally not be bothered if someone asks for a referral to a diagnostic clinic. However, hospitals in particular are not always easy to comply with. The TweeSteden Hospital in Tilburg, for example, advises patients on the website not to have an MRI done in an independent clinic, because this would not be done according to the same protocols as in the hospital. In addition, digital files from the clinic would not fit into the hospital’s computer system. Both Erik Veldhuizen and Anneke Snelder deny that. According to them, an MRI supplied on a CD from an independent clinic can be used in any hospital in the Netherlands.

Asked about it, the Association of Hospitals says it has no opinion on the quality or usefulness of the research in independent clinics. However, according to the branch organization, more and more hospitals are starting their own independent clinics or are working closely with them.

Reimbursed or not

A health care provider’s policy can be another obstacle to a medical examination in a clinic. Health insurers often only reimburse such an examination if they have concluded a contract with the relevant clinic. Large chains of clinics often have a contract with many health insurers (DC|Groep only has no contract with Menzis; the MRI Center only not with UVIT for patients referred by the GP), but this does not apply to all independent clinics.

Even if there is a contract between the two, a health insurer sometimes imposes additional requirements. Umbrella organization Zorgverzekeraars Nederland does not have a clear policy on this. Each health insurer can therefore decide for itself whether or not to reimburse research in a particular clinic.

Additional requirements

An example of such an additional requirement from a health insurer is that you must also be treated earlier after the faster diagnosis. But that is not always the case. If your GP has requested the test, he will quickly discuss the results with you. If the specialist is the applicant, you sometimes have to wait a few weeks for an appointment where you will hear the results. What happens next depends on the diagnosis.

If it turns out that there is an urgent problem, you can of course go straight to the hospital. In the case of less urgent problems, a complaint can often be solved with medication. Sometimes surgery is required for which there is still a waiting list in the hospital. In that case, you can consult with your health insurer to see if you can go elsewhere for this. For example, in another hospital or in an independent clinic where treatments are performed. Incidentally, the investigation may of course also show that nothing is wrong. Then you’ll be ready soon. In that case, you will certainly benefit from a quick(er) diagnosis.

Quality requirements

Although independent clinics are becoming more and more common in our streets, there are still various prejudices about the care that is provided. That the doctors are mainly out to earn money quickly and therefore have less eye for quality, for example.

That is unjustified, believes Marcel Canoy, professor by special appointment of competition and regulation in healthcare at Tilburg University. “Independent clinics must meet the same legal quality requirements as hospitals,” he says. “So they are also checked by the Health Care Inspectorate.”

In addition, independent clinics compete with hospitals. “They have to rely on their good reputation,” said Canoy. “If they do bad work, no doctor will send their patients to them anymore. The clinics are therefore very keen that patients and referrers are satisfied.”

Whether diagnostics (and treatments) in independent clinics are as good or even better than in hospitals has never been investigated. “But it’s quite conceivable that clinics that specialize in one task will become very adept at it because of their experience,” Canoy says. “In addition, many specialists combine their tasks in a hospital with a job in an independent clinic.” He states that everyone should do what they are good at. “Clinics excel at organizing simple, planable care. If they take care of the hospitals, the specialists can spend more time there on what they do best: emergency and complex care. In the end, everyone benefits. expect that this division of tasks will only be expanded in the coming years.”

good coffee

Anyone who has ever been to a clinic knows that in most cases it looks very different from a hospital, with the marble corridors, soft leather armchairs and fragrant espresso coffee in the waiting room. Doesn’t all that luxury make fast care much more expensive? “On the contrary,” Canoy says. “Because clinics specialize, they can plan care better and offer it cheaper. So they have more money left over for good coffee, for example.”

How do you find a good clinic?

– Waiting time for an examination in the hospital too long? Ask your GP or specialist to refer you to an independent clinic for diagnostics.
– Not all doctors are aware of the possibilities outside the hospital. In that case, look for a suitable clinic yourself and ask your doctor for a referral letter.
– On www.zkn.nl, the website of the trade association Self-employed Clinics Netherlands (ZKN), you will find an overview of all independent clinics with the ZKN quality mark. The requirements of that independent quality mark for quality, safety and service, among other things, go further than those stipulated by law.
– By law, everyone can choose their own doctor. This also applies to conducting medical research. Does your GP or specialist not want to refer you to a quick clinic? Then contact the care mediation department of your health insurer.
– Before an examination in an independent clinic, it is wise to always ask your health insurer for permission.