Saturday 15 August 2020

Concern for care avoiders unjustified

Patients are less inclined to see a specialist at the hospital because of the cost. Family doctors are raising the alarm but Barend van Lieshout thinks spiralling costs justify a choice between a new mobile phone and a consultation with the cardiologist.

The own-risk hike, from €220 to €350, was put in place simply to make sure people don’t listen to their family doctors when they refer them to a hospital, or at least not as often. The organisation for family doctors LHV conducted a poll among its members and, lo and behold, it works. 94% of family doctors claim they have patients who say they haven’t enough money to act on the doctor’s advice.

Care avoidance

We know that fewer people go to hospital. Turn-over has been going down slightly after years of steady growth. Nevertheless LHV is raising the alert. ‘Care avoidance is on the increase,’ its press release cries. The term ‘care avoider’ used to refer to a homeless person who would do anything to avoid the loving ministrations of the care system.

Now the ‘calculating citizen’ who chooses not to incur the cost of a visit to a hospital is given the same label. In the world of LHV’s frontman Steven van Eijck there can be no such choice. ‘Patients must continue to put their health first,’ he states.


In the real world, outside the gates of the LHV lobbying office, things are very different. We are making decidedly unhealthy choices every day of the week.

We have a frikandel when we should be having broccoli. We don’t go for a robust Volvo but choose a fast red little number instead. We smile when we see an American tourist don a cycling helmet and mount our own rickety old bike with its flapping mudguards and iffy breaks and proceed to jump a red light.

We are definitely not in the same league as Steven van Eijck. Does that make us into people who don’t take their responsibility to society seriously?

Orange suit

The LVH seems to forget that behind every patient there’s a human being who doesn’t always make the same choices as the family doctor, who is prepared to wait a bit longer, and who wants an orange suit in which to cheer on the Dutch team in the World Cup more than he wants an X-ray to confirm his doctor’s diagnosis.

We are, after all, talking about cases in which the doctor cannot convince the patient that things are grave enough to warrant a visit to the hospital.


Hidden behind this group of calculating citizens are the people who really can’t afford to go to hospital, who wait too long and find themselves beyond help. That is extremely sad.

These are the same people who also have to make the really hard choices when it comes to housing, bringing up their children and the daily shop. The LHV point to this group to make a case for accessible, i.e. free, health care.

Poverty fighting policies

Abolishing the own-risk element in the knowledge that health care costs are spiralling is not the most obvious solution. There’s nothing wrong with asking people to choose between a new mobile phone and a consultation with the cardiologist.

Access to health care for the poor would be much better served by putting poverty-fighting policies in place, not by abolishing the own-risk element for all.

Calculating family doctor

Perhaps we should look at the LHV’s call to action in a different light. Among the caring noises it makes on behalf of vulnerable patients, it slips in the information that it is making extra efforts to treat care avoiders. Cue more money for the family doctors in the next round of tariff negotiations. After all family doctors are calculating citizens too.

Barend van Lieshout is a health care advisor at Rebel.


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