“What constitutes good care? We need to talk to each other about that a lot more”

The Dutch population is aging. And that has an impact on all sorts of things, such as the housing market, the healthcare system, the economy, the labor market and the pension system. In a series of articles, we cover these topics using interviews with an expert and with people who are part of the gray wave. This time, Patrick Jeurissen, professor of Affordability of Care at Radboudumc, and pensioner and former care worker Marianne van Keulen on the impact of the grey wave on our healthcare system.

“Our healthcare system is not really that bad,” Jeurissen opines. For instance, he says, access to care is well-organized in our country. “There is always a hospital nearby. And it is affordable and the quality of care is also of a high standard.” But he also says some maintenance is needed. “The current healthcare system has been in place for 18 years now, and the Netherlands really does look quite a bit different now than when it was introduced. We are aging, which brings with it an increasing need for care.”

Jeurissen distinguishes between long-term care and curative care (care aimed at healing and treating acute and chronic physical conditions). “There are few problems with the latter, although waiting lists are increasing. That could become problematic. But overall, it is a well-functioning and affordable component.” Jeurissen is aware that it’s different for long-term care. “The crazy thing is that compared to other countries, such as Germany and Sweden, we are aging less but we still have the most expensive senior care in the world. How can that be? Dutch seniors spend a relatively long time in a care home, partly because we view informal care very differently from Italians, for example. We consider taking our mother who has dementia for a walk around the block to be informal care, while an Italian informal caregiver washes his or her mother’s bottom. Those are really big cultural differences and you pay a price for that.” Some countries also have rules for a big personal contribution, Jeurissen tells us. “In England, anyone who has more than 35,000 euros in savings, including their own home, has to pay a hefty extra for care. We don’t have any rules like that.”

Mandatory insurance
Jeurissen feels that is the way it should go. “In Singapore they have a public healthcare system funded partly by the government and partly through mandatory insurance, such as Medisave. Medisave is a personal savings program. Each month, a percentage of income is deducted and deposited into the personal Medisave account. This is used to save for future health care and retirement expenses,” Jeurissen explained. The plan has never been widely embraced. Why not? Jeurissen: “That system is good for healthy people, but those with a lot of health issues end up paying a lot more. In other words; it creates inequality and the system has no built-in solidarity.”

On top of that, the group of Dutch people, young and old, with chronic conditions is growing to more than ten million. Moreover, that group is changing. “More and more people have multiple chronic conditions at the same time, or multimorbidity,” Jeurissen tells us. That has implications for care. “In the Netherlands, chronic care is organized mostly condition-specific, while people with multiple conditions need caregivers who can look beyond those boundaries. To change this, innovation is needed. Not only to improve the quality of their care, but also to control costs. After all, this is a very expensive group, accounting for 30 percent of total healthcare costs. And the prediction is that by 2040, one in three Dutch people will have two or more chronic conditions, and more than one in five will have three or more conditions. So, to the people who say aging will make care unaffordable, I would say; look at this vulnerable group. These people have vastly different care needs, and they make a huge demand on available manpower and resources as a result. If you want to make a difference, this is precisely where you need to innovate.”  

Overhead and quality control
Innovation in healthcare is important in any case, Jeurissen believes. “The indirect costs for overhead and quality control, for example, are substantial. They amount to billions. Within the system, we need better coordination, with more standardization, cooperation and innovation.” Jeurissen also touches on another important aspect, namely the intrinsic motivation of healthcare workers. “Care workers today spend a lot of their time on peripheral matters: administration, recording what they have done. Whereas the focus should be on care and autonomy - and less on the administrative burden. If they are too preoccupied with other things, they can become dissatisfied, lose motivation and turn their backs on care. If that happens, we will really have a big problem. After all, the number of ‘hands at the bedside’ is already limited.”

In that context, Jeurissen also mentions the Bermuda Triangle. “Three major dangers play a role: the growing administrative burden, limited multidisciplinary thinking and overpriced drugs. Among other things, an awful lot of money is disappearing into that triangle, and administrators, insurers and policymakers in The Hague should do something about that. That won’t be easy; it’s a whole economic framework. But I think we should reason much more from the point of view of care. What constitutes good care? That is what we need to be talking about.”