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Netherlands

Oefentherapeut-mensendieck (Netherlands)


  • Proportionality information

    1. Have you examined whether the requirements under your national legal system are
    directly or indirectly discriminatory on the basis of nationality or residence?
       There is no direct or indirect discrimination on the basis of nationality. All requirements apply equally to those having Dutch or foreign nationality of diploma's or certificates. Dutch language knowledge is not tested as part of the procedure of recognition of professional qualifications. There are no requirements regarding establishment or ownership attached to this profession.

    2. Which of the following overriding reasons relating to the general interest justifies the measure(s)?
         
    • Public health
    •    
    • Protection of consumers and recipients of services

    3. What specific risks or benefits have you identified that your measure(s) is designed to, respectively, minimise or maximise?

       Please try to be specific in describing the nature of the risks/benefits you have identified
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. Wherever possible please include evidence.

       Patient safety is at stake; individual health damage or insufficient recovery of a patient is possible from incorrect therapy insufficient follow up of effectiveness of treatment or not or untimely returning or forwarding patients that require other treatment. Public health is at stake; insufficient knowledge or training may cause misunderstanding in the contacts between professionals and patients or with forwarding and prescribing doctors and other professionals in the health care sector and the functioning and reliability of the health care system.

    4. How specifically do your measures operate to minimise the risk(s) or maximise the benefit(s) identified in question 3?

       When addressing this question please try to explain how the measures prevent the risks or guarantee the benefits.
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. Wherever possible please include evidence.

       The measure assures patients (it is a free accessible profession) and prescribing doctors, pharmacists and other health professionals alike on the minimum level of training of the mensendieck-therapist and its field of compentence. The Wet BIG (Healthcare Professionals Act) promotes quality in individual health care and the protection of patients against unskillful treatment or negligence by health professionals. Regulation under the light regime of the law on individual health care (art 34) creates a publicly protected and recognizable title. That is especially relevant in professions with patient contact. It helps patients, health workers, insurance companies and others to choose and distinguish the qualified professional from those who are not.

    5. In so far as you are able, please provide information that you have gathered regarding the concrete effects of the measure(s).

       For example, through impact assessments or information gathered during implementation or review of a measure. Member States who have recently undergone reforms may in particular be able to contribute helpfully to this field. Where you are able to provide cost-benefit analyses this would be particularly valuable.
       Information on whether the measures indeed successfully prevented risks from being realised (e.g. the number of sanctions imposed, a drop in transgressions since the measure was introduced or consequences from previous modifications of the regulation) would equally be helpful.
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. You may also wish to include evidence on consumer satisfaction or other measurements of the impact.

        The recognition of this title supports the professional organization in the development of private voluntary register as part of the register for paramedic professions and quality initiatives. The voluntary private register demands periodic renewal of registration to assure that professionals still have sufficient know how and experience. The profession is regulated in this way for too many years to be able to compare the rise or drop in the number of transgressions since regulating this profession under art 34 of the Wet BIG (Healthcare Professionals Act) .

    6. Is the general interest objective you indicated in question 2 pursued in a consistent and systematic manner?.

       In approaching your response to this question please consider examples where you have addressed similar risks for comparable professions, not necessarily within the same sector. Is the approach you have adopted in this particular profession comparable or distinct from such similar cases and why?

       Recognition of the title is on the basis of art 34 of the Wet Big (Healthcare Professionals Act). That is the "light regime", the lowest level of regulation offering title protection only to those who have successfully completed the training for mensendieck therapist. The regulation also determines the content and scope of this profession. There are no reserved activities and there is no publicly protected professional disciplinary law for this profession. This level of regulation is similar to the level of other paramedic professions where patient safety and public health are at stake. The risks do not require specifically reserved activities or professional disciplinary law.

    7. Please explain in how far the degree of complexity or the nature of the activities
    which are reserved justify that these activities can be exclusively performed by professionals possessing a specific professional qualification?

       For example: when the tasks are essentially of a straightforward nature (such as preparing and printing pay slips etc.), or involve essentially the execution of instructions, specific professional aptitudes should not be required.

       There are no reserved activities.

    8. Where you have indicated several measures in place in the screening tab,
    have you reviewed the cumulative effect of all these measures on professional activities?

       If not, why not?
       If yes, please outline for us how you approached assessing this issue as well as the results and conclusions or any learning you drew from this. Where possible please include evidence.

       There is no accumulation of measures; title recognition is the only measure.

    9. Have you considered the use of alternative mechanisms to achieve your objective(s)?
         
    • Use of voluntary certification schemes

       Please briefly explain. Where you have selected more than one option, please be sure to address each of these in your response.

       Regulation under the light regime of the lndividual Healthcare Professionals Act (art 34) creates a publicly protected and recognizable title. That is especially relevant in professions with patient contact. It helps patients, health workers, insurance companies and others to choose and distinguish the qualified professional from those who are not. It helps the profession to set up a voluntary certification system and quality initiatives regarding the profession. Title protection is the only element of public regulation. The existing certification scheme is a voluntary one. Universal coverage through public title protection was necessary and proved helpful for setting up a private and voluntary register and further initiatives to enhance professionalism and quality.

    10. Conclusion

       Following your internal examination of this regulated profession, which of the following have you concluded?

    •    Maintain current system

       Explain where relevant:

       

    The legislation on professions in individual health care Wet BIG was evaluated; Kamerstukken II, 2013-2014, 29 282, nr. 182. The evaluation concluded that article 34 (the light regime) is sufficient for this profession. Patient protection requires title protection to inform the public and other health workers on the competences and the field of work of this profession. The level of risks does not require to regulate specific reserved activities or disciplinary law for this profession.

    The Minister of Health, Welfare and Sport and relevant professional associations are constantly working on modernising the professional requirements. To start with, reconfiguration of responsibilities[1] are made possible so that the group of professionals who carry out reserved activities either independently or on behalf of a third party is expanded. General Practitioners will be able to carry out more procedures themselves and will refer less to specialists. Doctors’ assistants will also be able to take over some of the doctors’ responsibilities. A similar movement is under way in oral care, where dentists will be able to do more complex treatments themselves and dental hygienists will take over responsibilities from dentists. Secondly, changes have been initiated to make more competency-oriented education possible with the aim of shortening the  course lengths for fast-paced students and to increase mobility between specialisations. Thirdly, whether reserved activities can be adjusted more flexibly and rapidly to keep pace with developments in professions and technology shall be analysed. The aim is to review in a directed and controlled way the criteria professionals carrying out reserved activities have to meet. Studies are under way into whether reserved activities can be regulated through general administrative measures (AMvB) rather than through legislative acts. Fourthly, the Care Professions and Education Innovation Commission of the National Health Care Institute will draw up recommendations concerning the professional and educational structure required in the context of the 2030 care demand. The principles mentioned above will be applied in those recommendations.

    [1] Parliamentary Documents II 2007/2008, 31 200 XVI, no. 98 and Parliamentary Documents II 2014/2015, 29 689, no. 542.


    11. Any other comments?
       None.
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