Well-informed citizens are not just aware of the financial necessity of making choices in healthcare, they are also prepared to make these choices. They do so by providing concrete criteria and examples, which serve as guidelines for politicians to determine which types of care should be reimbursed.Making choices in healthcare is difficult, but citizens will show politics the way
Well-informed citizens are not just aware of the financial necessity of making choices in healthcare, they are also prepared to make these choices. They do so by providing concrete criteria and examples, which serve as guidelines for politicians to determine which types of care should be reimbursed. This can be concluded from reading the manifesto Draagvlak voor lastige keuzes (‘Supporting Difficult Choices’) of the citizens’ forum on choices in healthcare, presented in The Hague on 21 June last. For three weekends 24 citizens from all layers of society took part in this forum and discussed these choices. The citizens’ forum is an initiative of Radboud university medical center, Erasmus University Rotterdam and Radboud University Nijmegen.
Rob Baltussen, Professor of Global Health Economics and initiator of the citizens’ forum: “Not to reimburse treatments is a difficult choice for politicians, as they are under pressure of interest groups or people using the media to express their emotions. But we do have to make choices in order to keep healthcare affordable in the long run. The citizens’ forum shows that the well-informed citizen understands very well both the necessity and the complexity of these choices. And even though they find it a complicated issue, they do voice their opinion on which types of care should be subjected to healthcare cuts. This offers politicians the opportunity to really test and defend their choices, even though they are under pressure to reimburse a certain treatment.”
Which issues are important to citizens?
Participants feel that it is unavoidable that the costs of treatments will play a role in decision making. Costs and benefits should be weighed up; if that step is omitted then some patients say that will ‘open up the floodgates’ and ‘you might just as well reimburse everything’. “Choices will have to be made, unfortunately, otherwise there will not be anything left for other people. I used to think that ‘you’ve got to help everyone’ and even though actually I still feel like that, I know that it is not always possible to do so because there is simply not enough money for it.”
Debbie, participant in the citizens’ forum.
Participants stressed that people should call each other to account regarding their own responsibility and self-reliance; that way care will only need to be provided when really necessary. An example is gastric bypass surgery: the advice is to first change the unhealthy lifestyle that in most cases is the cause of obesity. Participants also stated that for instance inexpensive medication such as vitamin supplements are affordable for most people. They are also critical of treatments that are not medically necessary, such as a dental treatment for cosmetic reasons. To prevent inappropriate use of care participants feel that for certain ailments patients should pay for the first treatments themselves, for instance in the case of physiotherapy. Yet participants express a strong sense of solidarity with patients suffering from a serious illness.
The citizens’ forum presented a total of 16 criteria to make these choices. Participants stress that politicians should explicitly use these criteria when making choices in healthcare. Heleen Post, manager Patient Federation Netherlands, welcomes this appeal. “Every citizen can become a patient, which is why it is so important that citizens are being heard and are actively involved in policy making.”
How to proceed?
The citizens’ forum calls upon Dutch politicians to start involving citizens in making those healthcare choices. “Not with every decision of course, but with important themes such as the role of lifestyle and the patient’s own responsibility. A citizen consultation is an important benchmarking tool, especially with those kinds of decisions to make,” according to Professor Baltussen. Arnold Moerkamp, chair of the National Healthcare Institute in the Netherlands, agrees with Baltussen on this and stresses the challenges facing us. “The citizens’ forum shows that, if citizens are well-informed, there is indeed support for our way of working. All parties involved now need to fully invest in this to widen this support to all Dutch inhabitants.”
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