Annemarie van Gaal: A healthy lifestyle pays

Make the own-risk element income-dependent and we might end up with affordable healthcare after all, says Annemarie van Gaal

The income-dependent health premium is history but so are the promised tax cuts. Let’s go back to why it happened in the first place.

The government, worried about the spiralling costs of healthcare, opted for an ineffectual measure: the income-dependent healthcare premium. It’s a measure that doesn’t guarantee better or cheaper healthcare. All it does is give healthcare insurers an excuse to spend even more of their budgets on marketing to lure new clients from the higher income brackets. With high premiums for people who hardly use the healthcare services, it makes sense.

Then, after all hell breaks loose, the government decides to set aside reform and go for a tax rise instead. Is this a logical decision? Not really.

Hip replacements

During one of the final election debates, Geert Wilders commented that the combined salaries and bonuses paid out to the five members of the board of directors of one of our major insurers – some €7m a year – would pay for an awful lot of hip replacements.

Our healthcare costs are spiralling because of the many useless hierarchical management layers in hospitals and care institutions, unnecessary treatments and over-consumption of medication. If you can get ninety pills at the pharmacist’s when you only need thirty who’s going to say no to the extra 60 if you can get them for free? Certainly not the Dutch.

The best way to contain the cost of care is not too far removed from the last one: not an income-dependent healthcare premium but an income-dependent own-risk element. The premium should be the same for everyone but the own-risk element should be based on what people have to spend.

Big risks

What was it insurers were for again? To shoulder the big risks people can’t possibly afford to take on themselves. But some can take on more than others. And what are we all doing? We’re insuring ourselves against things we can easily pay for ourselves. That is not how it should be.

Supposing we were to put the cost of the premium at €50 a month and the own-risk element at 7% of the yearly income. People with €200,000 a year would be paying €14,000, not very nice if they get ill but affordable nevertheless. Most years this money would not be needed. People on lower incomes would pay less, even Stevens across the board, and no capping for the top earners. That is fair.

In business you get the best results when responsibility begins with the workers, at the bottom of the ladder not the top. It never fails. In a country the responsibility should lie with the citizens. It is our own responsibility to live healthy lives, not to smoke, not to drink too much and think before we decide to go bungy jumping, paragliding or car racing. The unused amount of the own-risk element is ours. It stays where it is, in our pockets.

Save money

This would be a fair system and a pleasant side-effect would be that care will become cheaper because, naturally, those who can afford it will shop around for the best specialist or physio who offers the best price-quality ratio. Or they go to the hospital with the best treatment for what ails them for the best price. And you don’t pay for medication you don’t need and never use.

The argument that people won’t seek treatment because they want to save money doesn’t hold water. Everybody cares about their health. Health is the most important asset anyone has. But we are Dutch after all and if it saves money, we will live more healthily. 

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