'This is a disaster for patients and entrepreneurs in healthcare. This will inevitably lead to a wave of bankruptcies and exponentially growing waiting lists in healthcare that, for example, in cardiology can extend up to two years. If you survive that waiting list while urgently needing heart care', states Ger Jager, chairman of the Foundation for the Enforcement of Free Choice of Physicians. Jager has been fighting since 2012 on behalf of more than 10,000 healthcare providers for the preservation of this fundamental right.
Ger Jager warns of significant consequences of government policy for independent clinics and entrepreneurs.
New hip will soon be unaffordable
Jager: 'Many specialists who establish themselves outside the hospital do not get contracts with health insurers. This means that these healthcare entrepreneurs only receive 60 to 70% of the hospital rate for the same treatment. The remaining amount must be paid out of pocket by the patient. For a hip replacement surgery, the out-of-pocket contribution is about 4,000 euros. Unaffordable for many people, but of great economic importance for an entrepreneur who cannot afford to sit at home on the couch.'
To avoid long waiting lists for targeted procedures such as a new hip, many entrepreneurs turn to independent clinics.
'But no contract also means that the health insurer has no power. In the hospital, they can impose revenue caps on specialists. For example, by limiting the reimbursement for hip surgeries to 300 per year while the health insurer and the specialist know that 600 are needed. The 300 patients who can no longer be helped because the budget is exhausted will end up on next year's waiting list. That accumulates because the 600 patients from that next year also need to be helped. In short, long waiting lists for years. Entrepreneurs who want to bypass these waiting lists choose independent clinics where they can be seen almost the same week.'
Power play of health insurers and waiting list care
'These independent clinics cannot be restricted by health insurers. This is a thorn in the side of the health insurers. They prefer to have 100% control over the number of treatments, and thus the expenses. They do not consider the resulting long waiting lists to be their responsibility. A patient on the waiting list costs no money. Meanwhile, the Dutch pay a high health insurance premium every month for care they do not receive.' Moreover, all Dutch citizens are required to have insurance, but health insurers have no duty of care
'Thanks to a lobby with manipulated figures, health insurers have managed to ensure that the reimbursement for independent clinics is scrapped by the end of 2028. All this for a meager saving of €150 million according to the coalition agreement on a healthcare budget of 60 billion.'
Longer waiting times can lead to a worsening condition, which heavily impacts productivity and the economy.
'Due to this measure from the cabinet, patients must either pay for the entire treatment themselves or be forced to join the waiting line. Paying out of pocket is nearly impossible for anyone. So, due to this coalition agreement, hundreds of independent clinics will go bankrupt. Clinics that are desperately needed to eliminate waiting lists. Clinics that operate significantly cheaper than hospitals and thus keep care affordable. The logic is lost. Moreover, this leads to an exodus of well-trained medical personnel who often have traded the bureaucracy of the hospital for the efficient and patient-oriented approach in the independent clinic. Once care and staff disappear, it cannot be reversed. This is a capital destruction of 1 billion euros. We are heading for a healthcare disaster. And I fear that people in The Hague will only realize this when it is too late.'
Ger Jager is astonished that The Hague has allowed it to come to the point where a whole vital sector is being wiped out for a supposed saving.
Manipulated figures
'Politicians and policy makers are not as sharp in understanding the accounting as entrepreneurs. Otherwise, they would have seen that health insurers have used manipulated figures to make this measure 'credible' in The Hague. The Ministry of Health, Welfare and Sport reports to the House of Representatives that non-contracted care amounts to 1.7 billion euros. What they do not mention is that this amount includes out-of-pocket contributions from patients, which are often also waived by the clinic. With an average of 35% out-of-pocket contribution for a treatment, the costs are therefore more than 500 million lower.' There is thus €500 million of hot air in the macro figures. With proper and correct accounting, the macro costs would be €500 million lower. That is already more than the intended saving of €150 million in the coalition agreement.
'Moreover, the condition of patients on the waiting list can worsen. This leads to higher costs for society. Especially if someone becomes incapacitated for work or is long-term sick at home. The continued payment of wages and loss of productivity weighs heavily on entrepreneurs. The cost savings on the independent clinic without a waiting list do not outweigh the negative effects on our economy. But that is not the responsibility of the health insurers, but is paid from another pot, such as the UWV. So that does not concern them.'
