The differences in the quality of care between hospitals performing a radical prostatectomy in the Netherlands are enormous. For example the probability of becoming incontinent ranges from a 7% (best case) to 40% (worst case). With an average probability of 22% this is far higher than for example Germanys best practice: The Martini Klinik (see HBS business case by Michael Porter) in Hamburg, at only an hour flying time from Amsterdam, with only a 6.5% probability. For impotence the numbers are quite shocking as well, with an average Dutch probability of 74% compared with a 34.7% outcome at the Martini Klinik. Severe complications count for 2.7% patients in the Netherlands and 0.14% in the Martini Klinik.
Prostate cancer occurs in the life of 1 out of 10 men in the Netherlands. It is the most common form of cancer under men. Due to an aging society the total number of men needing a radical prostatectomy is expected to rise in the near future. The chance of survival is quite high, though the quality of life after the operation is a significant aspect considering the chance on becoming incontinent or impotent. The possibility of becoming impotent or incontinent drops drastically with the experience of the urologist preforming the procedure.
The Martini Klinik performs 2,225 procedures a year. The minimum number of operations by an individual urologist a year is 250. 2,582 radical prostatectomies were performed in the Netherlands in 2015 by 37 hospitals. The lowest number of operations performed by a hospital is 5 the highest 272. It is not likely that any of the urologists performing this procedure in the Netherlands will reach the minimum standard of 250 operations a year. It seems that poor quality is the outcome of far too low volumes and with that, lack of experience by the urologists. Urologists are well aware of these facts but due to competition between hospitals and healthcare insurers nothing is happening.
As the largest healthcare insurer we find it time to improve outcome for our insured and concentrate prostate care in two hospitals in the Netherlands in 2019. With two centers with each 6 urologists there is sufficient bundling of expertise and the number of 200 – 250 procedures by each urologist can be reached. Holding 31.5% of the Dutch market, it is for us of no use doing this alone. So we filed a request at the Dutch Federal Trade Commission to be allowed to work together with three other healthcare insurers, together holding 88.47% of the market, to concentrate prostate care in two hospitals.
There is no way of knowing what the Federal Trade Commission will decide. Suppose we don’t get a green light on working together or concentrating prostate care in two hospitals. What should our way forward be? Given the current outcomes, doing nothing is no option.