while working, sharing info, sharing process relevant to who at what time? this text is based on what my friend Luksia told me today when i asked her about it. she was kind enough to share the numbers too.
Neoliberal healthcare crisis and budget cuts NL context
The Corona virus has exposed the neoliberal crisis of this country’s healthcare system after 10 years of its economization under Rutte’s command. Different measures have caused the public health care system to crumble and succumb to profit motivated health care and market forces.
Profit oriented hospitals
Public health care is one of the largest cost items in the national budget, for which the Dutch government pays from tax money. New policies allow hospitals to make profit and has turned it into the sole strategy for them to survive. Many smaller hospitals that were providing essential neighborhood care went bankrupt in the face of competition. Another factor is the bureaucratization that results from the government constantly giving more rules, increasingly demanding to account for the work people have been doing in the buildings, allowing them to have little time for doing the ground work they were supposed to be doing. This while most of the money that the remaining hospitals make disappears into it's managerial layers, pharmaceutical and ICT companies, while doctors become their own companies. With small hospitals disappearing, access to healthcare becomes a problem, showing itself in the evident lack of IC beds in the times of Corona.
Own risk
On an individual level, citizens are obligated to make a contract with health care insurance companies, for which they pay monthly to access service packages ranging from basics to special, from budget to premium. Under those contracts, citizens are financially responsible for our ‘own risk’, which is the max amount of money you have to pay from your own pocket to get care outside the general practitioner. This money is essentially profit that health care insurance companies make, that they put on a bank with no other designation than to be used to invest. The ‘own risk’ has increased over the years from 200 to over 350 euros and in practice takes its toll especially from our already vulnerable groups and the people on the bottom of our society, many of whom are working in conditions that require heavy physical or affective labor. Considering that they run a higher risk to get sick or injured and they are more often forced to pay the full sum, it’s generally the poor adding to that pile of money that insurance companies already raked in.
Measures in home care
Budget cuts on staff hit the people working in the ‘thuiszorg’ or home care hardest. In this line of work, 75.000 people lost their jobs. Home care has been minimalized and, in many ways, completely eliminated, leaving responsibility for our elderly largely with the family and depending on informal care, true to the vision of the participation society, the Dutch version of the UK's big society. It has led to the neglect, isolation and increased vulnerability of the elderly and disabled.
The homecarers in the Netherlands are amongst the current front liners, the people that take care of the elderly and disabled in their homes, washing them, keeping an eye on how they are doing, physical and mental health wise and who are in direct contact with the general practitioner. Initially, keeping track of eating and drinking habits and support in domestic work fell under home care as well, but these were split off from specified and controlled health care activities. Health care and domestic workers, although caring for the same patients are no longer formally or institutionally facilitated to keep in touch with each other. The company makes them change patients constantly and does not let them sustain long term relationships.
In 2015, the responsibility for organizing home care was moved from a national and public level to the level of the municipality, under the WMO law for ‘societal support’. The government insists the municipalities enable people to live at home on their own as long as possible and that they take on the administration of this type of healthcare too. If you need the home care, you apply with the municipal authorities to get a health worker assigned to you. Since the municipality is no expert on how to organize professional care at home, they buy care from companies that in turn run it on the neighborhood level.
These companies compete with each other, because the municipalities want cheap care. Health and domestic care professionals who were previously contracted and working for a national public health care system are forced into precarity, into becoming freelancers working for companies and care institutions, stripped from their rights, pension and sick leave. These changes affects the quality of the work they are able to do to its core. Home care is a type of essential work for a minimum wage under a government that continues to add on regulations and control, playing blind to the moral and ethical dilemmas accompanying the weight of carrying the responsibility for another person’s life.
Insufficient places for education also contributed to a dire shortage in health care staff. In 2019, 140 000 unfulfilled job offers was the highest amount since 20 years. It has led to a level of work pressure that is through the roof, causing stress, anxiety and depression. People in the health care sector run high risk to become sick, performing under impossible time constraints and control. Meanwhile the cuts ate up 200 million from the mental healthcare in between 2011 and 2017. With 6,7%, absence from work due to sickness, it is highest among those caring for the eldery.
11 april 2020, Utrecht #dontpanic #unionize











