We must make clear decisions about what we want to spend our healthcare budget on. It is important to cut back on unnecessary care and improve the coordination of the care being demanded. A long-term strategy is essential. These are the main conclusions contained in the book Betaalbare zorg (‘Affordable healthcare’) published by Celsus, academy for sustainable healthcare. The first copy will be presented to the Minister for Medical Care and Sport in The Hague on 19 April.The Dutch healthcare system is working well, but this comes at a price. At present, the average family spends twenty percent of its income on healthcare and this percentage is set to rise in the years to come. Rising healthcare costs can undermine solidarity and put pressure on other public expenditures. Celsus, academy for sustainable healthcare, has studied the affordability of the Dutch healthcare system.
Responding to ongoing changes
One of the biggest challenges facing the healthcare sector is the speed of the changes taking place, such as the use of artificial intelligence, e-health, medicalization, people staying in their homes for longer and the growing role of self-care. There is a risk that many of these alternatives will become available alongside rather than instead of the current range. Expenditure in hospitals and nursing homes is rapidly approaching breaking point, based on the criterion of a care institute needing approximately €80,000 to provide a year of good health.
Avoiding unnecessary and inefficient care
If we are to continue providing good care at affordable prices, we must tackle over-treatment and stop providing care that has not been proved to be effective. Money can be saved through greater prevention, better quality (fewer complications and less variation in practices) and a smarter approach to people and resources.
Another important point is finding ways to bring the supply of care into alignment with the demand for care. This is particularly important for the growing and expensive group of patients with combinations of (complex) conditions, who use several care systems at once. If we do not improve coordination, these people will fall between two stools, while we are charged double.
Long-term strategy and choices
If healthcare is to remain affordable, it is time to make decisions. Regional management is needed. In the long term, labor productivity in the care sector will have to increase, for example. We can achieve this by redistributing tasks, encouraging digitalization and increasing e-health facilities. The funding structure could help in this respect. Research carried out by Celsus shows that an agreed budget in combination with a bonus/malus based on quality, can have a positive effect on both costs and quality. In addition, we need organization models that are better suited to both the demand for specialization and ‘personalized medicine’, and life with multiple chronic conditions.
Patrick Jeurissen, project leader at the Celsus academie: “The main question is this: how can we combine separate initiatives that have been proved to save costs into a single healthcare system? This is an unstructured issue. It requires a pragmatic strategy, in which all players are given a role.”
Betaalbare zorg book
The Celsus researchers have compiled their recommendations into a book entitled Betaalbare zorg (‘Affordable healthcare’). The book contains recommendations and analyses about managing care packages, designing long-term care, the effects of market forces, partnerships between healthcare providers, medicalization and prevention. Much of the information is based on new research. Viewed as a whole, the chapters form recommendations for policy-makers. Gert Westert, head of IQ healthcare at Radboud university medical center: “Successful steps to curb the cost of healthcare, such as efficient purchasing strategies and outline agreements, have already been taken at national level. But the problem is far from solved. If we don’t continue to invest in better, more affordable healthcare, our healthcare system is ultimately at risk of decline. Simply passing on the costs to citizens is not a long-term solution.”
Five years of the Celsus academie
The first copy of the book Betaalbare zorg will be presented to the Minister for Medical Care and Sport Bruno Bruins on 19 April during the Five years of ‘Celsus, academy for sustainable care’ conference.