Dutch public healthcare on shaky ground, advisory body warns

The foundations of public healthcare in the Netherlands are “weak,” “shaky,” and “too vulnerable,” the Council for Public Health & Society (RVS) said in advice to the government. The GGD municipal health services don’t have enough money or people to perform basic prevention tasks like vaccinations and infectious disease control, NRC reports.

Public healthcare is “arranged too non-committal and fragmented, too focused on the short term, and has too little invested in it,” RVS said. Half of the Dutch population currently has one or more chronic diseases. There are large socio-economic health differences. And the Netherlands has dropped from a leading position in the EU to the middle bracket of average life expectancy.

The 25 GGDs, which fall under the municipalities, largely provide public healthcare. Their task is to protect and promote locals’ health through vaccinations, youth healthcare, infectious disease control, and keeping track of health risks, among other things. The pandemic has made it very clear that, through prevention, the GGDs are vital for reducing the pressure on the overburdened healthcare sector. Now that Covid-19 has reached the endemic phase, the RVS worries that attention to public health will weaken again. “And that must not happen.”

But what the pandemic also showed is that the GGDs have too few people and too little money to perform regular tasks, the RVS said. “Even without a pandemic, the GGDs do not sufficiently cope with the multitude of tasks they have.” They face a “disastrous” shortage of forensic doctors, and various GGDs struggle to cope with tasks like conducting sex investigations on minor victims of sexual violence. The GGDs also don’t have the capacity to carry out infectious disease control, the RVS said.

The municipal health services also face endless arguments with municipalities about how much money they get for which tasks, according to the RVS. “Shockingly little is spent on public healthcare.” In 2019, the Netherlands spent 97 billion on healthcare. Only 2.8 billion of that amount went to public healthcare. Budget increases are often temporary.

The RVS made many recommendations to strengthen the foundations of public healthcare, including structural budget increases and legally laying down the objectives, such as getting the Dutch average life expectancy in the European top five in a given year. Those goals are currently “too non-committal,” the RVS said. Ministries other than Public Health must also become more involved in public healthcare to give it a less “narrow and vulnerable base.”

A new, special government commissioner could help get the above recommendations implemented, the RVS said. It advised the government to appoint a “vigorous figure with a clear assignment and a clear mandate” for a long time. The commissioner could propose goals, draw up a health agenda, encourage municipalities to do their best, and report to parliament and the Senate. They can also help the GGDs become more visible to attract more staff.