'Mediprudentie' aan de hand van casuïstiek over arbeidsongeschiktheid

- The assessment of claims on performance restrictions as an expression of illness is a complex business. As well as the illness, personality factors and their interaction with a person’s environment play an important part in the process. The assessment requires normative considerations. In 2005, the Health Council of the Netherlands advised the various medical specialists to adjust their guidelines in order to improve the coherence between the assessment, treatment and the supervision of patients. For this purpose, the so-called 3B guidelines had to be developed. Ahead of this and not without a certain amount of political pressure, the Council already drafted ten protocols related to insurance medicine. These protocols concern disorders that often lead to long-term occupational disability. Due to the limitations involved with diagnosis interpretation, the protocols however can only act as a rough guide. The Council therefore advised additional comments on relevant cases to be published. Mediprudence concerns general aspects and dilemmas of the assessment of claims. Such mediprudence has a public character and should primarily be developed by the professional group in collaboration with other (non-medical) disciplines and patient organizations. The initiative of the Health Council of the Netherlands may facilitate the integration of treatment of patients and assessment of claims. The centralized structure does not, however, guarantee the development of professional support. As the representative of various interested parties, the Council avoids formulating starting points for the assessment of claims. It is possible that these will be addressed during the development of the mediprudence but this will put a very great strain on the capacities of the professional group.

Ned Tijdschr Geneeskd. 2007;151:2305-7