Experiences on an MHA study trip

Inspirational, learning to use your creativity to solve problems and sometimes having to take a step back to examine problems. These are a few of the learning outcomes that participants Hilde Hooijman and Edwin de Vaal took away from the TIAS Executive Master of Health Administration (MHA) educational tour.

Program participants departed May 9 for South Africa on a one-week study trip. They visited institutions, including a hospice and a hospital, and attended lectures on the South African health care system from Members of Parliament, insurers and other sector partners.

"In South Africa. problems are approached in innovative ways – even problems that we do not have in the Netherlands. A great deal of creativity is used to find solutions," notes De Vaal. One example is provided by the South African insurance system. The country has two types of insurance coverage: a state insurance plan and an additional private insurance sector in which policies are much more expensive. "In practice, this means that patients with state insurance have to wait longer before seeing the GP. A visit to the family doctor takes an entire day and cannot occur if you have to go to work. First-line care is at a different level than what we are accustomed to. These issues have led to two innovations: supplementary insurance for the extremely poor paid by the employer and company doctors who also fulfill GP tasks. The result is better and more affordable care without long waiting times."

Getting more for the money

Hooijman also recognizes similar creativity. "South Africa obtains much more for its money than we do. It is as if we, in the Netherlands, have lost the flexibility to look at problems from different points of view." Hooijman also noted that South Africans make much clearer choices. "The problems there are so great that they are forced to make tough decisions. The state has decided to first properly organize primary care. Long-term care therefore receives less attention. Often, 90% of such organizations are preoccupied with fund raising. This is inconceivable to us. It may be ethically irresponsible,but it is certainly clear."

The view repeatedly mentioned by Hooijman was that participation cannot be forced. "The government wants citizens to participate, as they do in South Africa, but that must occur for intrinsic reasons. The social conception of "what is valuable" varies enormously. But there are increasingly more people here in the Netherlands who believe that our value system has become too one-sided in recent years. The answer to our "social crisis" can partially be found by examining the sense of community in South Africa.

Looking at problems from a distance

What De Vaal realizes is that a problem may be more easily solved if examine them from a distance. Sometimes, you need to take a step back and start again. "Do you know the story of the frog in boiling water. If the water is heated gradually, the frog does not ever jump out of the pan and cooks to death. If you put the frog in water that is already boiling, it will jump immediately out.The frog becomes accustomed to the problem and does not react. It is better if you examine a problem after distancing yourself from it and jumping briefly out of the pan."

The example cited by him relates tothe cuts introduced by the Dutch Exceptional Medical Expenses Act. In practice, municipalities will have to operate with 25% less. "Perhaps the focus should not be on the 25% reduction but on what can be done with the remaining 75%, as if it was being received for the first time." The educational trip ended just a few days ago, but remains alive in the Hooijman's thinking. "I was ripped out of my comfort zone and am still working out the consequences. Primarily, I am considering how I can apply all my impressions back here in the Netherlands." The creativity and determination are certainly transferable. "The energy that is there and the idea of looking at challenges from a different perspective, I will certainly do something with that."