For residents of Bonaire, Saba and St Eustatius, many types of specialist medical care are not available locally. For this care they must travel to another location. This is referred to as a medical referral and is arranged by the Care and Youth Caribbean Netherlands (ZJCN) directorate of the Dutch Ministry of Health, Welfare and Sport. Research conducted by the National Ombudsman shows that residents of the Caribbean Netherlands experience problems with medical referrals in three main areas. They are not sufficiently informed about their transfer, their needs receive too little attention, and the complaints procedure does not function properly.
Complaints are still being received
The National Ombudsman has been focusing on the position of citizens of the Caribbean Netherlands who need medical referrals for some years. Nevertheless, he still receives complaints about the way medical referrals are organised. This prompted the investigation into the difficulties experienced by residents of Bonaire, Saba and St Eustatius when they are transferred for medical care.
A long journey
Based on the experiences shared with the National Ombudsman by residents and healthcare professionals, three main issues have emerged:
Residents do not receive sufficient information
The provision of information to residents about both the practical and procedural aspects of a medical referral (before, during and afterwards) needs to be improved. Residents indicate that, following the referral from their doctor, it takes a long time before the medical referral actually takes place. They have no insight into the status of their application or the further progress of the process, and they are informed only shortly beforehand when they have to depart. Decisions refusing a medical referral are insufficiently substantiated, and residents are not always aware that they can lodge an objection against such a decision.
Too little attention to residents’ needs
When assessing an application and arranging a medical referral, ZJCN pays too little attention to residents’ needs. The efficient and lawful execution of procedures often takes precedence. In addition, it is difficult for residents to contact a ZJCN staff member who is in a position to provide tailored solutions. As a result, residents often feel that their needs and concerns are not taken seriously when they express them.
The complaints procedure does not function properly
Discussions show that many residents do not dare to submit a complaint. They feel too dependent on ZJCN and too insecure about their relationship with the organisation. In addition, residents do not know how or where they can submit a complaint. Even when they succeed in submitting a complaint, residents are dissatisfied with the course of the complaints procedure and with the eventual outcome. Finally, residents do not always receive a response to their complaint. There is an external complaints advisory committee, but the role of this committee in the complaints procedure is limited.
On all these points the National Ombudsman has made recommendations to ZJCN in order to improve the process surrounding medical referrals for residents.