Dutch healthcare system needs urgent reforms: Better insurance pricing & dental care

The Dutch healthcare system needs urgent reforms. More and more citizens are not getting the care they are entitled to, which will only cause more problems in the future, according to advice from the Council for Public Health and Society (RVS). Among other things, it suggested linking health insurance premiums and the deductible to people’s income and putting dental care back in the basic health insurance package, NRC and AD report.

Healthcare in the Netherlands is getting less and less accessible. Several GP practices can’t take on any new patients, hospitals’ emergency rooms often have to close temporarily, and the waiting lists in mental healthcare have increased alarmingly, the RVS said. “On paper, we have good and accessible care. In practice, we don’t. We need to avoid getting completely bogged down in the future,” RVS chairman Jet Bussemaker said.

In addition to the obvious problems - staff shortages and an aging population that needs more care - the healthcare sector faces a whole array of issues, the RVS said. The current system of health insurance premiums, healthcare deductibles, and a healthcare allowance if you have a lower income almost encourages people to avoid care. “For people who use a relatively large amount of care, the deductibles pile up,” RVS member Martijn van der Steen said. “At least 25 percent of Netherlands residents are chronically ill. We see that people from lower and middle incomes are getting into financial problems because of the care they need.”

And care avoidance isn’t only bad for one’s health but will also cause extra burdens on the healthcare system in the future. Cautious figures show that 9 percent of Netherlands residents have avoided healthcare because they couldn’t afford it. “That number is probably higher. The fear is that it will continue to grow with increasing healthcare costs,” Bussemaker said. Linking premiums and deductibles to people’s income will ensure that healthcare is affordable to everyone and eliminate the need for the healthcare allowance, the RVS said.

The sector is also so “fragmented and complexly organized” that many people “lose their way” and don’t find the help they need. Especially people with complex medical needs - about 10 percent of Netherlands residents - have to deal with many healthcare professionals, organizations, laws, funding, streams, and regulations.

And this fragmentation is exacerbated by compulsory competition between health insurers, the RVS said. It creates an incentive not to invest in cooperation and focus only on limiting their own expenditure. The RVS wants to curb competition in large parts of healthcare - district nursing, emergency care, and mental healthcare, among others - and arrange better cooperation between insurers and providers.

The council also urged the government to reduce the number of laws, financiers, implementing bodies, and healthcare providers to make the system less complex. There are several neighborhoods in The Hauge where 150 district nursing organizations are active, Bussemaker pointed out. That is way too many organizations working at odds with one another to provide the same care.

And put dental care back in the basic health insurance package, the RVS said. It may cost a bit to do so now, but it will save a lot of money in the long run. It will also remove ambiguity. “Oral care for children is still included in the basic package, but people just don’t believe it and are afraid of getting a bill,” Bussemaker said. “The result is that many generations of children now grow up with bad teeth, and you can never rectify that later in life.”