AZV in transition

Generally speaking, we had it good with AZV and we have been ungrateful. Itching and moaning, abusing the system in many ways, collecting prescriptions whether we need the medications or not, and deliberately visiting physicians and specialists, instead of using home remedies and maintaining good diets – which are way more effective.

Over the last decades, the established-by law AZV corrupted our old ways of stropi calbas and aloe potions, and taught us to treat symptoms, not causes.

Besides, pampering and over-indulging patients, AZV adopted a rich-kid mentality, it paid its own employees generously – check out the AZV report and the admin cost –  it overpaid its specialists, it was generous with stipends, adding perks above the law, it regularly opted for expensive fixes instead of health promotions, fussed little about the hospital’s exorbitant bills, and said nothing when the laboratory lost 4,000 pap smears, the cost went up, the value deteriorated, doctor appointments seemed harder to get than a Coca Cola in the desert, then Covid19 hit.

So now we really want to transform AZV to OZV, Optimal Zorg Verlening, and make it responsible for more care and less ziekte and in gerela convert GOA into a lean, public-service machine.

In walks a new broom, an improved Dutch model.

Apparently, all new brooms sweep cleaner.

He is thinking about a multi-year masterplan to introduce efficiency into the healthcare-systems in Aruba and in Curacao, with a three phase plan. He is right, we want less waste and more value. He is, I understand, headquartered at the hospital here.

One of the suggestions is to buy meds in bulk via a central office for medications, in collaborations with Curacao. If you are a population of 100,000 or 200,000 or 220,000; you are, and will, remain a village, as far as buying power goes.

Then with Curacao as the Dutch Caribbean medical hub, the hospitals will be grouped according to specialty, Aruba will perform certain operations, all stomach related, for example, while Curacao will specialize in others, all chest related. The two systems will then work together, which is a fantastic idea that’s logistically uber-complex. The masterplan also suggests some consolidation to fewer laboratories, all in search of efficiencies.

In the name of that cost-cutting initiative I read on the AZV website, and personally, I support self-participation, they just introduced Awg 5 per prescription, Awg 1 per lab test, Awg 5 for an office visit to the house doctor and Awg 10 to the specialist.

In reality, we have cost much better under control than Curacao. We grow at 3% a year, they reached 9%, still we must CHANGE OUR WASTEFUL WAYS, and the Ministry of Health is dictating changes in all directions to see how much the public will tolerate. They already started pedaling backward regarding transport of Dialysis patients.

They made changes without strategically thinking about consequences. The devil is in the detail.  

It is now clear that GOA should have listened a few years ago when AMC was asked to manage the hospital. I wrote about it at the time. AMC/VU (Amsterdam Medisch Centrum and Vrije Universiteit) was to take over the hospital in a Schiphol-type arrangement. GOA opted to ignore the suggestion, and now we will pay the price for this total mismanagement and start going for treatment to Curacao.

Of course, nothing is etched in stone, but it is clear that our politically-appointed minister needs all the help that he can get and our newcomer is turning all regulatory knobs at the same time.

He must also be thinking about Colombia, wanting to avoid the situation whereby that country shut the borders on our patients, in honor of the pandemic.

And perhaps if he also throws in Bonaire, as a Dutch territory, he can achieve even more savings, and utilizing his connection in the Netherlands to fly in a heart surgeon, brain surgeon, or cancer surgeon, and offer the same level of sophistication as Colombia, for much less money, right here in Aruba or Curacao!

Dear Rona: “I do share the fears of the specialists that Aruba is heading in a direction that is being forced upon us without us having much say in the matter. This could lead to Curacao becoming the center of healthcare for the Dutch Caribbean and Aruba being reduced to playing a minor part.  Our new man at HOH is representing Aruba in these talks. What, and how Aruba’s unique universal healthcare insurance will survive is a question of Hit or Miss.”

About the new broom: “I experienced him as a practical crisis manager. He is connected and is protecting the quality and accessibility of care for the patients. Up to now. Time will tell, more.”

When there is lack of leadership/vision at home, it must be imported.


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June 24, 2020
Rona Coster