Presentation of “Health Care Reforms in an Ageing European Society, with a Focus on the Netherlands”

On Thursday, March 17, 2011, the Centre for European Studies (CES), in coordination with the Christian Democratic Appeal’s (CDA) Wetenschappelijk Instituut, held an event in Brussels to present the research publication “Health Care Reforms in an Ageing European Society, with a Focus on the Netherlands” authored by Evert Jan van Asselt, Lans Bovenberg, Raymond Gradus and Ab Klink.

CES Director Tomi Huhtanen began the event by welcoming the panelists and audience members and by introducing the topic. He noted that before the recent economic and financial crisis, there was much debate across Europe about demographic change and its impacts. However, the crisis diverted our attention to more urgent problems and, as a result, we have lost two years of time in addressing changing trends such as ageing and the impacts of these trends on health care policy. It is therefore even more important that we refocus our attention on these problems—especially given that the long-term costs of ageing, if not properly addressed, could easily amount to ten times the cost of the economic crisis. Mr. Huhtanen stressed the importance of looking at successful policy measures in one country, learning what has worked well, and applying those lessons elsewhere, while of course taking national differences into account.

He then introduced the moderator of the panel, Professor Raymond Gradus, who in turn introduced the first speaker, Drs. Evert Jan van Asselt.
Mr. van Asselt summarized the central themes of the paper. He noted first and foremost that individuals in the Netherlands and Sweden enjoy a legal right to long term care and, as a result, long term care expenditures in these two countries, measured as a percentage of Gross Domestic Product (GDP), are the highest in the EU. However, ageing populations across Europe have made current systems unsustainable, including in the Netherlands; therefore policymakers have been forced to re-think how governments can best provide access to health care and long term care.

Mr. van Asselt then highlighted the successes stemming from the Dutch curative health care reforms of 2006, which created a private system with public guarantees. Important aspects of this system include the fact that it is competition-driven (insurance companies compete for clients), it is fair (premiums are the same for all, regardless of age or health) and it focuses on income solidarity by providing tax allowances for lower and middle income people. It is also patient-driven in that government assistance comes in the form of vouchers given directly to the patient, which puts personal choices about how and where to seek treatment in the hands of individuals. Mr. van Asselt then emphasized that successful aspects of these reforms need to be applied to further reforms, especially regarding the issue of long term care, and that they should be started as soon as possible.

The next speaker, Professor Reinhard Busse began by sharing one piece of “good” news, namely that Europeans are getting older because they’re getting healthier; while there are some pessimists who argue that longer life-spans simply mean additional years of bad health, the reality is that more people are living longer and enjoying more healthy years. However, the “bad” news is that public health care expenditure is the highest for older age groups—not necessarily those who are very old and very sick, but for those aged 65-80 who are still relatively healthy. In order to address this issue, the one aspect that policymakers can influence is cost, and there are a number of ways to do so. First, the use of new and better technology can allow more treatments to be conducted by a General Practitioner, as well as allow patients to receive care at home. Another important way to cut costs is to focus on disease prevention (and in doing so, Mr. Busse noted, it is never too late to start). In addition, coordination throughout the health care industry should be improved to allow for a more integrated approach to treatment.

Following Mr. Busse’s presentation, comments were offered by Dr. Ab Klink, who began by noting that health care costs in the Netherlands are expected to increase to 30 percent of GDP by 2040. In addressing this problem, Mr. Klink maintained that competition is the key to creating a situation in which prices go down. He applauded US President Obama’s past remarks that saving lives leads to saving costs. However, Mr. Klink noted that costs can be reduced in other ways, including by reducing overtreatment. For example, a recent report in the United States shows that up to 20 percent of patients with defibrillators do not actually need that treatment. Furthermore, Mr. Klink emphasized that the health care industry in the Netherlands is currently too fragmented. A major part of the solution is therefore to create a system in which health care providers are better integrated, thereby reducing patient costs and increasing the quality of care.

Following Mr. Klink’s presentation, Mr. Gradus opened up the discussion to include questions from the audience. The first question related to the issue of prevention—specifically, how realistic it is to concentrate on causes rather than symptoms. In response, Mr. Klink stated that it is difficult to get people to adjust their habits to lead a healthier life (for example, persuading them to eat better, quit smoking, etc.). When doing so, however, the most effective approach is for health care providers—not the government—to wage this campaign. The next questioner asked about the role of technology and whether it can really make a sizeable difference in cutting costs. Mr. Busse responded that indeed it can, especially when technology platforms are introduced that allow General Practitioners to do treatments that previously could only be performed by specialists. Mr. Klink followed up by noting that electronic patient records can also improve the efficiency of the system and that the U.S. company Kaiser Permanente is a good example of this. The final question asked about improving coordination between the worlds of medicine and technology—specifically how research and development can be spurred. Mr. Busse responded that in Germany, and at his university in particular, the two worlds are already well integrated, though efforts should be made to maintain and improve this cooperation even more.

Mr. Huhtanen then thanked the panelists and audience members once again and closed the discussion.

The following stakeholders were involved:

• Drs. Evert Jan Van Asselt, Deputy Director of the Research Institute for the CDA (author of the study)
• Prof. Dr. Reinhard Busse, professor for Management in Health Care at the Technical University of Berlin and Associate Head of Research of the European Observatory on Health Systems and Policies
• Dr. Ab Klink, former Dutch Minister of Health Care and Sport and former director of the Research Institute for the CDA (author of the study)
• Prof. Dr. Raymond Gradus, Director of the Research Institute for the CDA, professor of Economics at VU University Amsterdam and member of the CES executive board (author of the study and moderator of the panel)
• Mr. Tomi Huhtanen, CES Director

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