Wednesday , February 1 2023

Health insurance clients more often make verbal complaints

Clients of the Caribbean Netherlands Health Insurance Office ZVK in St. Eustatius and Saba are less inclined to file a formal, written complaint about ZVK services and decisions. Instead, they often opt to complain verbally at the counter, which adds to the pressure on the staff.

This is one of the findings in the report on the ZVK complaints procedure, published by the Dutch National Ombudsman on Friday. The Ombudsman assessed whether the handling of complaints at the ZVK complies with the requirements of proper dissemination of information and professionalism.
The Ombudsman concluded that the ZVK provides sufficient information to the public regarding the filing of a complaint at the ZVK and at the Ombudsman. However, clients should receive better, timely and more detailed information when they have to leave their island for medical treatment elsewhere.
Verbal complaints are currently not being registered. This should change, according to the Ombudsman. Verbal complaints should be recognised as an actual complaint and dealt with accordingly. Also, the consultations with clients who have filed a formal, written complaint should be recorded.
St. Eustatius and Saba have a particular position within the ZVK. “Clients are hesitant to file a formal complaint. They opt to complain at the counter. As a result, ZVK employees experience higher work pressure, which often prevents them from carrying out their work in a proper manner.”
The Ombudsman observed that having to deal with the many verbal complaints at the counter takes a lot of the workers’ time, resulting in additional backlogs. This in turn leads to more complaints about the providing of service. The staff in St. Eustatius are often complained to, are continuously harassed in their spare time, and even sometimes threatened.
The ZVK is planning to hire more personnel for the Windward Islands and to employ a person to whom clients can easily turn with their complaints. The ZVK recently hired additional personnel for its St. Eustatius branch to address the high work pressure. The Ombudsman welcomed this positive development.
Regarding the assigning of a specific person in the Windward Islands who can handle complaints in a quick, low-threshold manner, it was noted that it was important that this person was not influenced by politics. The idea is for citizens to feel more at ease and to filter out the emotions before a formal complaint is filed at the ZVK.
The Ombudsman further pointed out that ZVK staff in St. Eustatius did not receive feedback from the main office in Bonaire about complaints that were filed regarding their work. “This is something that needs to be improved. After all, the feedback provides the employees with an indication on how to adapt in their work,” stated the Ombudsman in its report.
Windward Islands’ residents complain that they are informed too late about the time of their medical referral as a result of which they do not have sufficient time to arrange things at home – for example, to find someone to look after their children, the Ombudsman stated in its report.
The ZVK responded that it was not always possible to inform the clients ahead of time, as their medical referral abroad depended on the (availability of the) airline, hotel, hospital and specialist, as well as the information from the client’s general practitioner on the island.
Having received information that the ZVK did not always communicate clearly, the Ombudsman concluded that a large part of the complaints in the Windward Islands had to do with providing too little information to clients about the trajectory of medical referrals.
“The reason for these complaints originates from different expectations that citizens have about the ZVK in this process. The ZVK depends on the airline, hotel, hospital and information from the general practitioner, but this is not always clear to citizens,” the Ombudsman stated.
“Therefore, it is important that the ZVK tells its clients from the start about the possibility that he or she will hear shortly before the medical referral that he or she has to depart. It is comprehensible that medical referrals cause stress and that leaving the island involves proper preparation. By providing this information beforehand, the client can anticipate a sudden departure.”
The Ombudsman pointed out that a listening ear to the complaint of a citizen could take away a lot of the anguish and tension, and that a personal consultation often resulted in an early solution. “This approach also fits in the local culture where people know each other and where formal procedures are less common.” Some citizens will make use of a personal talk with a complaints officer to vent their frustrations without the intention of filing a formal complaint.
The Ombudsman analysed 20 randomly selected complaints dossiers: 10 from 2015 and 10 from 2016. In two out of 10 cases of both 2015 and 2016 the legal term to handle the complaint in question was not met. One of the 10 cases of 2016 concerned a complaint that was also filed at the Ombudsman regarding the period of treatment of the medical referral and the duration of the daily allowance.
The ZVK registered and handled in total 72 complaints in 2015, of which 32 were in St. Eustatius, 30 in Bonaire and seven in Saba. Seventy complaints were registered and handled in 2016, of which 42 were in Bonaire, 21 in St. Eustatius and six in Saba.
Most complaints regarded the time it took to get a doctor’s approval for a medical referral, the logistical execution of medical referrals and the late receiving of the daily allowance during the stay abroad.

The Daily Herald.

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