Future health and healthcare

Why this theme — the scope

Good, affordable, accessible healthcare is one of the most pressing societal challenges worldwide. The Covid-19 outbreak emphasised the issue and its broader societal impacts on prosperity and democratic stability. It stressed the urgency of difficult trade-offs concerning healthcare to ensure its long-term sustainability.

Public health has improved substantially over the past decades. Life expectancy increased by almost ten years in fifty years; the number of persons aged 80+ will almost certainly double in the next twenty-five years. The Netherlands' healthcare system ranks high internationally — but those high rankings have recently shown a downward tendency.

Rising costs

Healthcare-related costs in the Netherlands have increased significantly — mainly due to population ageing and the rising costs of medical technology. Lifetime healthcare costs are primarily incurred at older age, half of which is after retirement. Advanced medical equipment comes at a price.

Staffing shortage

The supply side needs improvement. Fewer than one in six works in healthcare today; in 2040 this is expected to be one in four. That implies an unrealistic recruitment and training effort for a sector characterised by hard work at irregular hours. The sector has the highest sick-leave rate.

Effects on society

The Netherlands spends over €100 billion / 15% of Dutch GDP on healthcare. That amount represents a substantial opportunity cost: three times higher than all education expenditures and six times higher than all academic and applied research spending. Without significant changes, healthcare costs will double between 2015 and 2040 — limiting the ability to invest in other vital areas.

Environmental impact

Due to its strong growth, the healthcare system has become a significant source of harmful emissions and waste — among the most carbon-intensive service sectors in the industrialised world. Aligning healthcare with environmental sustainability while remaining financially affordable is a significant challenge in itself.

How we engage — our work

In September 2022, the Ministry of Health concluded a comprehensive Health Care Agreement (Integraal Zorgakkoord, IZA) with many organisations. It clearly defines what is at stake: "We must and can do better; otherwise, we get stuck". The IZA proposes:

• Strengthening of primary care to reduce hospital visits
• More concentration of care to realise scale benefits
• More dispersion of care to increase accessibility
• Better use of digitalisation and innovative technologies
• Strong emphasis on prevention, to lower demand for cure and care

Economics & Business research can support and enhance decision-making through statistical and methodological expertise; insights into patient preferences; behavioural-economics expertise to raise effectiveness of medical interventions; consumer-behaviour expertise on healthy diets; healthcare delivery and operations management; knowledge platforms with stakeholders; and knowledge of critical trends (social, technological, behavioural, political).

What to expect — our contribution and impact

The Economics and Business sector has identified five topics for contributing to the debate on improvement and change:

Value-based healthcare and effectiveness

An essential requirement for better cure and care is a better understanding of effectiveness. Quite a few medical interventions need more solid proof. Given particular patient demands, intervention A could be effective, but so could intervention B, or doing nothing. Dutch healthcare is known for its fragmentation. Comparing health outcomes is complicated by variation between patients and medical history — yet this understanding is crucial to provide the best expenditure quality. Economics and Business contributes unique expertise in comparative statistics, pricing, and valuation.

E-Health

E-Health needs an overall perspective on opportunities, risks, and considerations around digital transformation in healthcare. The COVID pandemic significantly increased application of digital solutions. Identifying key elements that influence effective change management and charting critical success factors for digital-based programmes is essential. Long-term strategy must be clear from the start. Data-driven research combined with practical expertise can help further develop E-Health applications.

Individual healthcare consumption

People persist in specific insurance choices even when behaviour has become suboptimal. Insurance companies cannot stimulate clients to make more value-based choices. Current measures like the deductible can be counter-effective — causing people to avoid care, often triggering more expensive care afterwards. Economics and Business suggests more effective ways to stimulate personal ownership of healthcare consumption.

Prevention

While effective cure is essential, prevention is better. Almost 75% of total healthcare costs are related to avoidable chronic diseases. More than 50% of factors associated with individual health correlate to lifestyle. Roughly 5% of the population accounts for ~50% of health expenditure. Unhealthy lifestyle choices have instant gratification but long-term health consequences. Only 3% of the Ministry of Health's budget is devoted to preventive programmes — consistent with a system designed for providing healthcare, not stimulating health. Behavioural-economics expertise in nudging can help realise more effective health promotion.

Health equity

While population health has improved spectacularly, observable differences between subgroups (rich vs poor) remain significant. In the egalitarian Dutch society, life-expectancy differences between those with limited education and those with university degrees remain substantial — and are increasing for some age groups. Health disparities are a manifestation of social and economic inequalities. Differences are partly determined by circumstances early in life, even before birth. Economics and Business can enhance understanding of the interconnection between socioeconomic status and individual health.

Global health

Many Dutch healthcare challenges also apply to other countries, including developing nations. The Netherlands is well-placed to act as a healthcare lighthouse — innovative changes can be exported abroad, new ideas researched and developed into expertise that could benefit countries and their people, sometimes instantaneously.