''Verkeerd Beleid Bedreigt Onze Zorg'' Jona Walk & prof. dr. Patrick Jeurissen | #2358

Overview

Professor Patrick Jeurissen argues that Dutch healthcare is not simply “the best in the world,” but that it has strong strengths—especially in highly specialized/tertiary care—alongside structural weaknesses that are increasingly harming patients, particularly those with complex, chronic, or severe conditions. He warns that current government policy and cabinet plans risk shifting costs and burdens onto patients, worsening access and care equity.

How the system is working (and where it falls short)

• The current hospital/GP/medication and significant parts of mental healthcare emerged around the early “Third Way” model, combining political steering with regulated competition/market dynamics—coherent in terms of policy design.
• About 20 years later, that framework is “wearing thin” because it was not designed for today’s patient reality. Many people now have multimorbidity (multiple chronic conditions), yet the system still organizes care and funding largely around single diseases.
• This mismatch contributes to rising indirect costs and fragmentation across multiple laws and sectors, such as:
  • Health Insurance Act
  • Long-term Care Act
  • Social Support
  • Youth Act
  • Public Health

The “three problems” for sustainability

Jeurissen summarizes sustainability challenges as:

1. Multimorbidity Patients often have 2–3 chronic conditions, but care pathways are structured around one disease.

2. Too-high indirect/non-patient costs Fragmentation and administrative burdens drive costs upward.

3. High-end specialization dominates The Netherlands performs very well in tertiary/specialized care for smaller groups (e.g., rare diseases, top clinical institutes), but this emphasis leaves basic/primary and generalist care under pressure.

What policymakers should do: a “high-value care” agenda

He advocates shifting away from continual efforts to stop “inappropriate care” through bureaucracy, and toward:

• Scaling up care we know works Focus on high-value, evidence-based interventions with strong health benefits and favorable cost effects.

• An example is thrombectomy for stroke, where faster treatment improves outcomes and can reduce expensive downstream care (e.g., fewer prolonged rehab/nursing-center stays).

• He also argues that low-value procedures long known to be unnecessary (e.g., ear tubes, tonsillectomy) are not seriously de-funded in practice—suggesting that real change is too slow.

Reinforce policies instead of piling on reforms

Jeurissen criticizes the cabinet approach (and Dutch tradition) for:

• repeatedly changing funding/coverage rules in a fragmented way,
• creating defensive responses and increasing implementation complexity,
• potentially adding new bureaucratic layers rather than redesigning care delivery.

He emphasizes coherence: communication, funding, care packages, and incentives should align.

Budget cuts and shifting burdens to patients

Regarding the new cabinet, he states:

• Cabinet plans include ~€10 billion in healthcare cuts.
• A large share effectively shifts costs to users, such as:
  • higher deductibles,
  • cuts/removal of support (e.g., housekeeping assistance),
  • reduced compensation (e.g., less compensation through tax reimbursements).
• He doubts promised compensation fully offsets these changes, noting that municipal compensation is relatively small compared to the healthcare cut magnitude.
• Overall, the expected effect is that affordability problems are increasingly experienced directly by patients—especially those with lower income.

Inequality and “practice variation” in who gets better treatment

A major theme is health and treatment inequality:

• He argues that disparities in outcomes (e.g., with cancer immunotherapy) appear early, and that lifestyle differences alone likely do not explain it.
• He links this to unequal access to newer specialist treatments and to variation in care across socioeconomic groups and regions (a form of “practice variation,” sometimes addressed historically with other drug examples).
• He describes a pattern where higher socioeconomic groups more often reach specialists and receive advanced interventions, while others remain longer in less specialized pathways.

Additional example:

• People with severe psychiatric conditions have markedly shorter life expectancy largely due to somatic (physical) causes, yet guidelines requiring annual somatic screening are often not consistently implemented.

Mental healthcare and youth care: waiting lists rising

On mental health:

• Waiting lists for youth care and mental healthcare are said to have doubled or tripled over 15–20 years.
• Despite more spending and staffing, demand is rising faster—especially since COVID, when youth mental health reportedly worsened sharply.
• He argues the system “steers toward the lightest form of care” and fails to prioritize those with the most severe needs.
• A structural issue is that mental healthcare has been split across different legal regimes over time (insurance, long-term care, municipal domains, justice/forensic care, public health services), which he says does not work well for people with severe needs.
• He also notes a mismatch: outpatientization reduced inpatient beds, but patient needs increased, worsening overall system strain.

What individuals and professionals can do

In closing, Jeurissen’s practical advice includes:

• Protect intrinsic motivation among clinicians and caregivers—if it disappears, he says the system “is dead.”
• Prioritize what works and reduce attention to bureaucracy and low-value incidents.
• Break taboos about inequality and variation in care.
• Focus future healthcare on sustainable innovation and improved care delivery—aiming for “older in good health.”

Presenters / contributors

• Jonna Walk (host/interviewer)
• Prof. dr. Patrick Jeurissen (guest; Professor of Accessibility and Affordability of Healthcare, Radboud UMC Nijmegen)