“Richer people can more easily avoid waiting lists,” says this expert, who doubts whether political parties have realistic healthcare plans

When it comes to healthcare, too little is seen through the lens of justice, says Marloes Kleinjan. She conducts research into health, care and equal opportunities at the HAN University of Applied Sciences as a lecturer. She sees a “clear ideological divide” in the election manifestos.

It’s a well-known concept in the social sciences, and a maybe even more famous image on social media. You have equality (equality), equity (equality) and justice (justice), she explains. ‘Equality’ guarantees an equal basis for everyone regardless of individual differences. ‘Equality’ guarantees equal opportunities by offering support and removing barriers for those who need it. ‘Justice’ guarantees this at a structural level by removing the causes of inequality.

What do the plans of political parties mean for the resulting health differences?

Kleinjan: “Left-progressive parties such as GroenLinks-PvdA and D66 propose the most structural reforms that can reduce health disparities. In the middle we see the CDA: that party recognizes inequality, but the measures focus more on encouraging healthy choices than on the system that influences those choices. Right-wing liberal parties such as VVD and JA21 mainly emphasize affordability and even more on individual responsibility.”

Which measures contribute to reducing health differences?

“The most important thing is: including health promotion in all policy areas. This means that you look at the influence that living environment, income and subsistence insecurity and education have on health. And that you focus heavily on prevention.

“D66 and GroenLinks-PvdA most explicitly opt for this approach. D66 does this by directly linking health to living conditions, income, green neighborhoods, neighborhood initiatives and strong primary care. GroenLinks-PvdA strengthens it Prevention agreement and proposes coercive measures, such as a sugar tax and limiting the power of companies that make society unhealthier.”

‘Prevention’ appears in almost all party programmes.

“That’s good, because most of the money now goes to healthcare and a smaller part to health promotion and prevention. These relationships have to change. Prevention works like an oil slick: rub it in and the effects penetrate all kinds of areas – educational results, mental health, substance use.

“I find the emphasis on individual choices a bit short-sighted. Not because I am against freedom of choice, but because I think people often do not realize how much your own choices are influenced by large, powerful companies.”

The PVV and GroenLinks-PvdA want to abolish the deductible and reduce the health insurance premium. What does that do to inequality?

“As many health economists also say: it is a measure that benefits everyone and not just the people who need it most. I wonder how parties can keep such promises.”

GroenLinks-PvdA wants ‘the richest Dutch people’ to pay for it.

“In any case, they indicate where they want to get the money from, which is more concrete than in some other programs, such as that of the PVV. That can contribute to justice, but you still take a generic measure and then try to restore it. Then it is better to immediately look at more specific solutions that strengthen equality.”

Many parties want to look more critically at the basic package. Not unwise, according to health economists. But what does it do to health disparities?

“It makes sense to look at what has been proven effective and what cannot be removed from the basic package, as D66, CDA and VVD propose.

“But: it takes quite a long time before something is ‘proven effective’. Treatments for conditions about which even less is known may no longer be reimbursed. Someone with more resources can then still choose such a treatment themselves.

“In addition, some people have complex complaints that are difficult to prove, but that does not mean that their complaints are any less genuine. I am not saying: stay away from that basic package. I am saying: if you look at it critically, also take this perspective into account. “

Mental health care relies heavily on uncontracted care, partly because of the long waiting lists. This mainly affects patients with more complex problems, he said NRC last year on. They must pay a personal contribution of 15 to 30 percent.

CDA and VVD no longer want to reimburse at all.

“Then even more people cannot pay for their treatment and they become dependent on care that is contracted and for which there are much longer waiting lists. Richer people can more easily avoid those waiting lists. That can increase the health gap. Here too, it is important to see who you affect with your plans, and whether you should not formulate your plans more specifically. Because you can also look critically at uncontracted care, but not at all. Stopping can have negative consequences for people in a more difficult position.”

According to Kleinjan, the same risk looms when increasing personal contributions in long-term care, as many parties propose, and removing the reimbursement for domestic help from the Social Support Act (VVD and CDA). This mainly affects the chronically ill and the elderly. “Once again, wealthy people can buy more themselves.”

Which measures make elderly care more fair?

“Caring communities, which D66, GroenLinks-PvdA and CDA call, are promising in that area [gemeenschappen waarin bewoners bijdragen aan de zorg voor elkaar]. But even within these initiatives, you must pay explicit attention to inclusion and inequality between groups of elderly people, for example in migration background or socio-economic position. Some people may find it much easier to join such a caring community than others. We need to investigate this further.”

According to the Central Bureau of Statistics, people at the top of the prosperity ladder live 25 years longer in good health. Can voters vote against that ‘divide’?

“My analysis of the election manifestos is that most parties recognize the interaction between poverty, living conditions, social security and health – and that interaction lies at the basis of the inequality that creates health differences. But the ambition to structurally change this differs considerably from party to party.”

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