Bijzondere interventies aan het hart - Gezondheidsraad

surgical backup. Another benefit of the regionalisation of cardiac care is that it
enables chronic heart failure patients to be timely diagnosed and treated.
5 Maintain central control via the permit policy
Much of the care provided to patients with cardiovascular disease consists of
interventions that are both acute and highly complex in nature. These often
require extensive and costly human and material infrastructure. Such care must
be provided efficiently, with a view to obtaining the best possible results, while
preventing the associated costs from spiralling out of control. In the past, this
requirement led to a situation in which centres for cardiac surgery and interventional
cardiology were made subject to the provisions of the Special Medical
Procedures Act (WBMV). Accordingly, the provision of this type of care
requires a permit, which is granted by the government.
This instrument (the Planning Decree for special cardiac interventions)
allows central government, in the person of the Minister of Health, Welfare and
Sport, to exercise control over the quality and accessibility of such care
(VWS02). This approach was a major factor in optimising the actual care provided
to heart patients, both in terms of quality and geographical distribution.
The Minister has now asked whether it is possible, and indeed desirable, for
direct government involvement in this matter to be either restricted or terminated
completely. For each type of cardiac treatment, recommendations have been
made concerning the desirability of maintaining this type of government control,
or of dispensing with it completely. In general terms also, this question deserves
careful consideration. The conclusion is that there are strong arguments against
deregulation and in favour of maintaining the permit requirement for cardiac
centres.
In the first place, the indications for treatment are still in a phase of rapid
change, as a result of major developments in interventional cardiology, the treatment
of cardiac arrhythmias, heart valve surgery, the treatment of heart failure,
aortic surgery, and the care for adults with congenital cardiac defects.
Secondly, it is essential that there be accessible care facilities capable of
offering round-the-clock care, since patients with an acute disorder now make up
an increasing percentage of the total (especially coronary disorders, aneurysms
of the thoraco-abdominal aorta, cardiac arrhythmias and heart failure). If this is
to be achieved, regulation is indispensable.
Thirdly, there is an unequivocal and direct association between the number of
procedures performed by an institution/therapist each year, and the results
obtained. This necessitates the use of a quality policy in which a concentration of
34 Bijzondere interventies aan het hart