Political Courage Required

I have to say, that what he was facing was difficult, the Minister of Health was to tell us our DWV, Dushi Wasteful Vida is over, and that from now on we had to be frugal and calculated, instead of acting like Rockefellers.

When he appeared on the screen, he discussed a few things, mostly outlining what we already knew, that we had saved the last three months, because not a single patient was sent to Colombia for treatment.

While the MinPres took A LONG TIME to apologize and explain that transportation costs have been cut for 155 hemodialysis patients and 35 peritoneal dialysis patients, and that some cash-allowance were slashed, the MinHealth presentation was underwhelming.

At the end of his presentation he MENTIONED the Zorgaanbieders, the caretakers’ fees were slashed. And that is how we found out that AZV will cut everyone, and everything. For example: If the hospital has a 150M budget, then a 5.5% reduction means a good chunk of change, saved.

And if they do this across the board every specialist, every house doctor, every nurse, they will manage to save 35M until the end of the year.

But the minister just skimmed over the plan, I later saw a press release by AZV, clearly conceived by its leader Ruben Goedhoop, with a fancy name: AZV 5 Wave Model.

The AZV 5 Wave Model is much-needed, but the question remains: WILL THEY INTRODUCE STRUCTURAL CHANGES OR JUST CUT SERVICES.

The same question also applies to the hospital workers, will they accept the salary reduction, or will they maintain their salaries intact, and just eliminate services to the public.

So far, we didn’t hear much about the restructuring of total care expenses, and this is a big issue, but very solvable.

There is a huge amount of waste right now in the hospital, caused by the way it is run. Just think about it. The fixed costs are the fixed costs, you can’t touch them, but the operating room for example runs at a productivity of less than 25%. We have a building with facilities, fixed costs – airco, trash removal, mortgage – but it only gets used for one shift of 8hrs a day, so at 30% efficiency.

In that 30% there are a bunch of issues causing actual touch time, net operating time, of less than 25%. And the list of patient-patients is long, and getting longer.

Imagine if we had two shifts? And used the facilities more efficiently, it will cut the cost of care significantly, because it isn ‘t the facility that defines the bottleneck, it’s the personnel. The operating crews are limited so that only one shift can be staffed.

BOTTOM LINE: Our cost per operation is 3 times higher than it needs to be. If we would utilize the existing resources better, we would deliver more value to our clients.

In general, in Aruba, we don’t look at the total cost of care, we look at the accounting. But accounting is hocus pocus, they move things around, and tada…. we’re in the clear.

Why not try to lower the total cost??

And you do that by prevention, education, promotion.

AZV, by nature of its name is a sickness insurance. Their business is sickness.

We should change the name of that organization to GCP, General Care Plan.

Right now, with more sickness, doctors make more money.

We should turn things upside down, and on their heads.

If you show us less sickness, we pay you more money.

Pay physicians by how efficiently they manage our well-being and how much progress we made towards total health. How much we improved, and that will lower the cost of care.

Right now, no one “cares.”

As a public we should talk about actual care delivery and how to prevent the need for care, longer term, and use the existing assets and services for the betterment of our community.

It’s the same illusive goal: More Value for Less Money

Back to the minister, he DID NOT TALK ABOUT ANY OF THESE, he allowed a press release to tell us about the AZV 5 Wave Model.

Political courage expresses itself in the understanding of the risks and pressures that elected officials face when having to make difficult choices. There was little here.

On the other hand, he had the courage to tell us that he is rebuilding the pier at Roger’s Beach. Why don’t you put these people whom you must employ to cleaning, we must clean the island before the first visitors arrive, we don’t need a pier at Roger’s Beach.   


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June 16, 2020
Rona Coster