It is a coming and going of ambulances, another one is already approaching. The blue flashing lights echo on the walls. After the back door is opened, the ambulance personnel lift the stretcher out. Gasping and gasping for air, the next Covid patient lies on the stretcher. There is no time to waste; quickly he is wheeled in. He is the forty-seventh today. The influx is huge this close to Christmas. Crowded corridors with deathly ill people. I look at the chaotic scene with disgust, so many sick people in need of help. The hospital is almost collapsing under these numbers. It is urgent to free up beds to cope with the new flow of patients. There is no choice but to transfer patients to hospitals in Germany.

This has quickly become a regular day in a hospital emergency room. The image of overcrowded hospitals makes us shudder. The pandemic gave the final push to overcrowded hospitals. The country had to go into an immediate ‘lockdown’ to prevent worse. The lack of intensive care beds caused a fierce public debate about our healthcare system. A common opinion is that market forces and severe budget cuts are the cause of this problem. And solutions to this are widely available. Such as more money for care, fewer managers and back to the health insurance system also called the National Health Care Fund, it echoes in every debate. But are the claims about market forces and cuts überhaupt true? Is less market forces and more money the cure? Should we look for the solution in this direction? Or are there other possibilities?

Cuts in healthcare

Let's look at the facts whether there über any cuts at all? Ministry figures show that the healthcare budget is expanding by some three billion euros every year to a staggering figure of nearly one hundred billion euros annually. And yet, with all that money, hospitals could not be prevented from going under. The cuts have created a shortage of hospital beds, at least that is the tenor. But is this assumption true for hospitals? Well no, because between 2011 and 2019, hospitals received a 42% increase in their budgets. There have been no cuts. Whether all the money has been well spent? Of course, you can discuss that but that is an entirely different discussion.

Market forces in healthcare

Is market forces then to blame for the lockdown? Market forces thrive especially when there is competition. Does competition then cause a shortage of intensive care beds? To compete, a hospital must think about its costs. In short, profit optimization takes hold. Costs have to come down. And unused intensive care beds are incredibly expensive and are the first to be reduced to a minimum.

Market forces within hospital care also bring another effect. New entrants enter the market in which they offer only the profitable care. Thus, entrants are cherry-picking. You see that the number of commercialële treatment centers has increased significantly in recent years. These privéclinics do not offer acute care. Expensive intensive care beds then you will not find at the privéclinics. A regular hospital, with the arrival of the privéclinics, will see profitable care disappear. They will have to finance the expensive intensive care beds with less profit. Logically, as a hospital with less money, you will also have less expensive beds available.

With market forces, health insurance companies are often mentioned in the same breath. By shaking up the basic insurance system, things will get better is preached by certain groups. Thus, with a National Health Insurance Fund, the deductible will disappear, more care will be available to all. Abolish health insurers and set up a National Health Care Fund. Without unnecessary bureaucracy and money-wasting competition. And without a deductible. But we had something like this before; the health insurance fund. That's exactly what we wanted to get rid of in the Netherlands. Besides, this system change will have no significant impact on the capacity of hospitals.

If budget cuts and market forces are limited the cause, what is the cause? What if the diagnosis affecting the capacity problem is to be sought in another corner? You know one thing for sure that you are undergoing wrong treatment when the diagnosis is wrong. Preventing diagnostic errors is therefore essential.

Healthcare, the most labor-intensive sector!

One in seven people work in healthcare. This is an unsustainable model for several reasons. Healthcare is very labor intensive with low labor productivity. This makes healthcare unsuitable for further mass production. Scaling up in times of a pandemic is impossible within healthcare. It is not the shortage of beds that is the problem; it is the lack of personnel that causes the current capacity problems. This shortage will be even more noticeable if, during the pandemic, some of the healthcare personnel are sick at home. In addition, due to an aging population, a large part of the healthcare personnel will retire in the coming years.

It is inevitable that labor productivity must go up, with or without new e-Health applications. The standard Pavlov response of asking for more people is not feasible. Sufficient well-trained people are not available in the short term. More care will have to be delivered by fewer professionals in the future. Only then can future pandemicën be faced.

Increasing demand for care

The environment within healthcare is demand creating and consists of two pillars. On the one hand, suppliers within healthcare have great interests in a continuously growing demand for healthcare. For example, the pharmaceutical industry has a pill for every ailment. But then you have to take this pill permanently for the rest of your life. Oh yes, for the side effects of the prescribed pill, they also happen to have a pill.

But on the other hand, greatly improved imaging techniques are also increasing the demand for care. An ultrasound, an X-ray, a CT scan, PET scan, MRI scan.... Doctors are getting better and better at looking inside the body. Doctors always see something on the photo. A cyst, a spot; it all requires a follow-up examination to rule out something more serious. What also doesn't help is that doctors are paid based on their services rendered, also known as ‘performance funding’. While this helps prevent waiting lists, it creates an incentive to (continue to) treat.

Health disparities in 50 Dutch neighborhoods!

Another possible cause for the increased demand for care. This has a social background. Research shows that up to 50% of health complaints are related to lifestyle and the social environment. Half of the conditions in the consulting room are related to this. Asthma, eczema, high blood pressure, migraines, type 2 diabetes, high cholesterol, cancer, cardiovascular disease are the result. In this way, lifestyle plays an important role in many diseases of affluence and puts enormous pressure on mainstream care.

Major health disparities exist within different population groups. A significant portion of health care use occurs in neighborhoods where people live with low incomes and benefits. These are neighborhoods with a low socioeconomic status. These neighborhoods are mainly located in the 40 largest Dutch municipalities. Neighborhoods where many residents go to the doctor more than 25 times a year.Health disadvantages, while a complex problem, is fortunately ééone that is manageable. It involves fifty neighborhoods in the Netherlands where most health care costs are incurred. Reducing health inequalities in these fifty neighborhoods will reduce healthcare costs by billions of euros. This requires an adequate delta plan for care! A delta plan prevents unnecessary casualties like the flood disaster of 1953.

Wrong diagnosis leads... To wrong treatment!

The aforementioned Delta Plan calls for action and a strong director. Unfortunately, the Ministry of Health has always been a policy ministry and not an implementation ministry. This limits the possibilities for direction at the national level. Direction that is indispensable. Because within the fifty neighborhoods with the highest healthcare costs, various healthcare insurers, healthcare offices, municipalities are active together with a large number of healthcare providers. All with different interests and therefore unable to take the lead. Also, existing laws and regulations often stand in the way of this. Of course, the key to solving the health inequalities lies not only within the healthcare landscape. Exercise, debt issues, housing, smoking and healthy eating are also essential for this. For affordable care, a delta plan is sorely needed… But, of course, based on a proper diagnosis.