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On May 14, 2018, KtM commented on Substitution of care :

Hi Viv,
from you description I get the idea that we at ErasmusMC are in a similar situation. What is not clear to me is what it is you are substituting; it reads as if you are just trying to push some kinds of care out. In some of our departments we have been successful substituting secondary care to tertiary care and deal this out with insurance companies, but this has not been easy as some departments have more possibilities for this than others.