The Dutch healthcare system squeaks and creaks and is in need of major maintenance. More and more citizens are not getting the care they are entitled to according to the law. That is a major risk to their long-term health.
This is what the Council for Public Health and Society (RVS) writes in its advice Go with the flow, which will be released this Tuesday. The accessibility of healthcare continues to deteriorate. For example, the number of GP practices that are no longer accepting patients is increasing and emergency departments are more often temporarily closed. Waiting times in mental health care have increased sharply, especially for specialized mental health care. Both citizens and the healthcare sector state that “the limit has been reached and it can no longer go on like this,” writes the RV, an important advisory body for government and parliament. Council chairman Jet Bussemaker says in an oral explanation: “On paper we have good and accessible care, in practice we no longer have it. We need to avoid getting completely bogged down in the future.”
Some causes have been known for some time: the staff shortage (in 2060, one in three of the working population should work in the care sector to prevent a shortage), the low salary (“groups of care workers have a salary that makes them hardly economically independent can be”, the report states) and the so-called double aging: there are more and more elderly people, and the proportion of people over eighty is also increasing.
Healthcare is so complex that many people do not receive the help they need
But there is much more going on, the council notes. The healthcare sector is so “fragmented and complexly organised” that many people “lose their way” and do not receive the help they need. They have to deal with many different healthcare professionals, healthcare organisations, laws, funding streams and regulations. This is especially true for elderly people living at home who suffer from multiple chronic conditions and for people with a serious psychiatric disorder. About 10 percent of the Dutch have to deal with ‘complex care questions’. In its investigation, the Council refers to the story of NRCeditor Jeroen Wester, who tried to help his elderly uncle Cees find the right care, but got lost in the healthcare system himself.
Also read this article: How editor Jeroen Wester got lost in the healthcare system when he helped his old, single uncle with a healthcare application
The fragmentation and inaccessibility of the health care system are exacerbated by compulsory competition, according to the RV. The competition between health insurers creates an incentive not to invest in cooperation: they mainly focus on limiting their own expenditure. The number of healthcare providers is also growing rapidly, which makes collaboration difficult or time-consuming. Bussemaker: “There is a lot of air in the system. That has to come out.”
In addition to the inaccessibility, high costs also play a role. Too little account is taken of the capacity of people. In 2021, 8 percent of the population decided not to receive care because, for example, they were unable to pay their own contribution. “That seems cheaper, but later those people will need much more expensive care,” said Bussemaker, himself State Secretary for Public Health from 2007 to 2010. Although there is the health care allowance (4.6 million households received it in 2022), but it is insufficient or too complicated for many people. Some people are also afraid of refunds from the tax authorities. The way in which we finance care “threatens the idea of solidarity of the health care system,” the council concludes.
Another problem is new care initiatives, which often fail, the report says: “The system often works against instead of cooperating. Good initiatives now often have to swim against the current.”
Less competition
How is it then? The ideal system does not exist, writes the council, which comes with a laundry list of recommendations. Such as: curb competition in large parts of healthcare – for example district nursing, acute care, mental health care – and arrange better cooperation. Reduce the number of laws, financiers, implementing bodies and providers. Let municipalities and insurers work together at regional level. Set a maximum for the number of own payments. Reduce the health care premium significantly and ensure an increase in the income-related contribution, so that the health care allowance can be largely abolished.
Also read this article: The doctor will soon be in your back pocket: digitization in general practitioner care is increasing rapidly
The Rutte IV cabinet has concluded two major agreements with, among others, healthcare parties, the Integral Care Agreement (IZA, aimed at the sustainability of the health care system) and the Healthy and Active Life Agreement (GALA, mainly aimed at prevention). But that is too noncommittal, says Bussemaker. “That’s not going to get us there.” The recommendations of the RVS are comprehensive and will take time. Bussemaker speaks of “major and small” steps. The advice is aimed at a new cabinet, she says. “It takes political will and political courage. And there is still a lot to be worked out.”
The RVS recently showed itself to be critical of the state of public health care, largely carried out by the 25 GGDs. These GGDs have too few people and money for regular prevention tasks – from vaccinations to infectious disease control.
A version of this article also appeared in the June 20, 2023 issue of the newspaper.