Hospitals can go bankrupt. That is one of the fundamental principles of the Dutch healthcare system. At the same time, the patient must be able to trust the system to provide him or her with safe healthcare whenever necessary. The investigation of the Dutch Safety Board into the bankruptcies of MC Slotervaart and MC IJsselmeerziekenhuizen revealed that the bankruptcies took place in a disorderly manner, leading to increased risks for patient safety. The Dutch Safety Board observes that insufficient arrangements are in place regarding the manner in which hospital bankruptcies should be carried out. This is an omission in the current Dutch healthcare system.
Increased risks for patient safety
The investigation of the Dutch Safety Board has revealed that various patient safety risks became manifest during the winding down and/or relaunch of healthcare activities at MC Slotervaart and MC IJsselmeerziekenhuizen. No ‘calamities’ are known to have occurred. However, during the course and aftermath of the bankruptcies a number of risks occurred simultaneously, causing patient safety risk to increase in comparison to the situation of a hospital operating as normal.
Some patient safety risks can be specifically traced back to events surrounding the bankruptcies, such as the collapse of the organizational structure and the uncontrolled termination of healthcare functions. Other risks can be traced back to more generic issues that may also occur in other hospitals. The bankruptcies made these generic issues even more pressing as they had to be resolved under high time pressure. Examples are the backlogs in updating patients’ medical records and the challenges in finding accommodation for urgent patients at a regional level. It is the combination of and interplay between these specific and generic circumstances – and the ensuing risks – that jeopardized the continuity of good and safe care. According to the Dutch Safety Board, such risks can be controlled and possibly avoided if bankruptcy is appropriately prepared for.
To the Minister for Medical Care and Sport:
1. Ensure that the resolution of hospital bankruptcies always takes place in an orderly manner. To this end, the Board considers the following measures important:
- Recalibrate the duty to provide care requirements for health insurers in such a manner that the continuity of individual diagnosis and treatment processes is guaranteed in the event of a hospital bankruptcy.
- Oblige health insurers, on the grounds of their duty to provide care, to collectively guarantee sufficient financial resources for the orderly winding down and/or transfer of care in the event of a hospital bankruptcy. This can be done, for instance, through the formation of a collective fund or a collective guarantee scheme.
To the Minister for Legal Protection:
2. Adjust the bankruptcy laws in relation to hospital bankruptcies in such a manner that:
- A hospital can only go bankrupt after a period of ‘silent administration’ during which adequate preparations are made for an orderly resolution of the hospital bankruptcy.
- When weighing up conflicting interests, the trustee shall give priority to the public interest (i.e. patient safety during the winding down operation and/or continuation of healthcare activities) over the interests of creditors.
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