The future of health care

Read the Dutch publication 'Toekomst voor de zorg'.

The Netherlands knows two standard packages of uniform health care insurance for all its citizens: the Health Insurance Act (Zvw) for curative care and the Exceptional Medical Expenses Act (AWBZ) for long-term care. The quality and accessibility of Dutch health care are high, according to international standards, among other things because of the application of advanced but also more expensive medical technology, as well as the increasing numbers of well informed citizens who know where to go for which type of care. The likely continuation of this trend will also see a continuation of the current debate on the sustainability of the care system.

This study offers a framework for thinking on the future health care system. This framework consists of four different worlds along two fundamental dimensions: those of care solidarity and risk solidarity. Care solidarity concerns the health care itself and the consideration between systems with uniformly and publicly organised health care on the one side and those that offer more differentiated and personalised care on the other. The considerations for risk solidarity relate to the desire to insure the risks and the necessity of personal financial contributions to reduce any excessive use of health care. The core issue, here, is that of the large societal value of health insurance combined with the increasing demand for freedom of choice and personal management.

Specifically for the Netherlands we conclude that limiting the standard health care packages may call for better options for supplementary insurance. Some regulation may be needed in the markets for supplementary insurance, in order to prevent adverse selection. Currently, for old age care supplementary insurance in the Netherlands is totally absent. Research into this possibility would be warranted.

In the cure, there is scope for efficiency gains by expanding co-payments targeted to specific expenditures (‘value based insurance’). For the long term care, a further increase in copayments is hardly possible within the current system, especially for the low incomes.

The study shows that prevention in the form of a healthy life style would deliver large benefits for people; they would enjoy a longer life, larger personal employability and pension. The government also benefits when people use their improved health to increase their labour input and retire later, as this would yield more tax revenue and pension premiums.