In the Netherlands we have a solidarity and accessible healthcare system. At least it should be. That is a great asset: we expect quality and timely treatment in healthcare, and that costs money. Mandatory health insurance allows sick people to receive the care they need without having to worry about costs.
About the author
Hans Westgeest is an internist-oncologist at the Amphia hospital in Breda. This piece is written in a personal capacity.
Unfortunately, these principles are being tampered with. Under the guise of market forces, health insurers now offer various so-called in-kind policies, including the budget policy. For a lower premium, you can insure yourself for care that is not contracted in all care institutions.
If you do receive non-contracted care, you have to pay 20-25 percent yourself. This is of course clearly communicated by this insurer when taking out the insurance. However, the free physician’s choice is over.
Good guess
The budget policy is recommended for people who expect low healthcare costs or who are satisfied with a limited choice of healthcare providers. Yet I think that it is precisely the financially vulnerable or naive optimists who take this insurance. But how do you, as a healthy person, make a good estimate of the healthcare costs that you can expect? Although emergency care is covered everywhere, the dividing line between emergency and no emergency is often not sharp.
A tumor or heart attack cannot be announced well in advance, but regularly manifests itself with unclear symptoms and not always in the emergency room. An average insured has no idea how great the financial risk can be with a personal contribution of 20-25 percent of the total costs.
Care-avoiding behavior
Finally, I am concerned about care-avoiding behavior if the insured person experiences the risk, with potentially much higher costs for society. For example, if you urinate blood as a healthy 60-year-old patient, you will be referred to the hospital by your GP for examination and the diagnosis can range from a harmless kidney stone or bladder polyp to life-threatening cancer.
If you as a patient do not pay attention to exactly how you are insured (that is of course possible if you are concerned about life-threatening diagnoses), and if the general practitioner does not pay attention to that either (because he does not know), and neither does the hospital (how far does our responsibility in it?), then you walk in to a skilled practitioner and you are quickly helped. Fortunately, the tumor is gone, there is a chance that you are cured.
And then a bill falls in the letterbox: a personal contribution of almost 3,000 euros and the treatment, which has only just started, will take another year.
Budget care is expensive
I work as an oncologist in the only hospital in my area. Unfortunately I know several examples. If you get sick, cheap budget health insurance is expensive. This results in an extra logistical hurdle to gain access to reimbursed care (by bus to the hospital down the road) and a new administrative hurdle for the hospital (‘Are you aware of our contracted care?’).
It is also a threat to solidarity. There are patients who enter debt counseling or make a payment arrangement with the hospital. As a medical specialist, I then ask myself: have I provided good care if the patient ends up in debt counseling as a result?
As a society, we are worse off with this free choice in health insurance. You too may find yourself in an anxious situation tomorrow and need help. If you have a budget policy, the bill can be unexpectedly high. What would you do? Pay sporty or will you look for another hospital without murmuring? Are you still counting on solidarity from your loved ones and society in the second instance?
Solidarity and accessible care are part of the foundation of our civilisation. We mustn’t get there. Health care costs should not be managed through budget policy advertising campaigns. Budget policies should be abolished with immediate effect.