No cure, no pay

Reward hospitals for every healthy patient they deliver and fine them for fraudulent bills. That’ll make them sit up and take notice, says Annemarie van Gaal.

Six months ago I was having coffee with André Rouvoet, the chairman of the insurers’ association. ‘Do you know how many babies are born each year in the Netherlands?’, he asked. Without waiting for my answer, he said: ‘175,000. And do you know how many deliveries insurers are being billed for each year?’ ‘I have no idea, 175,000?’, I said. ‘No. Every year insurers are billed for 225,000 deliveries.’

30% more bills than births. Part will probably be down to deliveries that were supposed to take place at home but ended up taking place at the hospital because of complications, or children being still-born. But that still doesn’t explain 50,000 extra deliveries.

The extent of healthcare fraud involving unjustified billing is now being investigated but does that mean we are also going to look into the problem of unnecessary care? The cost of superfluous treatments and over-medication? Over-treatment is not making society any healthier and is hugely expensive.

Perverse incentives

We’re going about it in completely the wrong way: the medical specialist is the person who decides which treatment is appropriate, who performs it and who knows the ensuing bill will be paid no questions asked. The way we have organised healthcare doesn’t lead to a healthy society but one that is vastly over-medicated and over-treated and full of perverse incentives paving the way for fraud and waste.

If we really want a healthy society we need to overhaul the way we finance our healthcare system. What we should be paying for is health, not illness. Imagine what would happen if hospitals were paid per healthy citizen and not per treatment? Specialists would take extreme care to rid their patient of whatever ails them for once and for all, keep their – and their colleagues’ – eye on the ball and refer hypochondriacs to a therapist.


The politicians are now looking into a plan to present each patient with a clear, itemised bill of their healthcare costs so they can check it themself. That’s all fine and good but how many people are going to study their bills if flagging up fraudulent entries isn’t going to do any good?

Transparency only works if bad behaviour is punished. If a client discovers his bill is fraudulent he should be able to register a complaint. If this complaint is found to be justified he should be rewarded by not having to pay his own-risk charge for that year. That amount will then be paid by the hospital as a fine. That will keep everybody wide awake and should help keep healthcare affordable.

Annemarie van Gaal is an entrepreneur and head of AM Media. She is also a writer and television personality.

Thank you for donating to

We could not provide the Dutch News service, and keep it free of charge, without the generous support of our readers. Your donations allow us to report on issues you tell us matter, and provide you with a summary of the most important Dutch news each day.

Make a donation