The end of the opponent is in sight. The majority of political parties in the House of Representatives, including the Freedom Party, want to cancel the €385 deduction. This costs about 6 billion euros, but is possible if healthy people and employers pay more.
In het kort
- Een politieke meerderheid is voor afschaffing van het eigen risico. Dat kost 5 à 6 miljard euro.
- Als alle volwassenen meer zorgpremie betalen, is dit plan financieel haalbaar, zeggen experts.
- Een risico is wel dat we dan meer zorg gaan gebruiken, waardoor de totale zorguitgaven nog verder stijgen.
PVV, GroenLinks/PvdA, BBB, SP and PvdD agree that the deductible should be reduced or even eliminated at once. Together, these parties enjoy a majority in the House of Representatives and the Senate. Thus, the SP and PvdD’s proposal to abolish the deduction received support from the majority of the House of Representatives on Wednesday.
About half of Dutch adults use the full deductible annually, thus spending €385. People with a higher deductible voluntarily incur lower health care costs, according to figures from the Vektis Healthcare Information Center.
The PVV’s argument is that people are now avoiding care because they partly have to pay for it themselves. In addition, health care “is becoming inaccessible to an increasing number of people,” the election manifesto said.
The National Association of General Practitioners (LVH) has heard that GPs are already concerned about care avoiders. High energy and grocery costs make many people feel insecure. “This impacts demand for care,” says a company spokesperson.
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Healthy people pay too
With the discount eliminated, some of these concerns may disappear among people on a limited budget. But two important features are also missing, says health economist Marko Farkeviser.
The deductible keeps mandatory premiums lower per adult. People pay a small portion of their care out of their own pocket through the deductible.
“This makes a difference in the wallets of people who don’t benefit from care,” Farkeviser says. “Because no matter how you look at it, these billions need to be passed on in mandatory health care premiums.”
Fellow health economist Xander Coleman sees eliminating the deductible as a cost shift. “From sick citizens to all citizens,” he says. “It is solidarity.”
400 euros per person
A rough calculation shows what that would look like. Eliminating the discount would cost around €6 billion, according to the Central Planning Bureau (CPB). Coleman and Farkeviser believe insurance premiums should increase to cover this amount as a society. This amount was divided among approximately 14.5 million premium payers, which equates to more than 400 additional euros per person per year.
In the mathematical example, half of the €400 is added to the premium that people have to pay to their health insurance company, which is called the nominal premium. Most of them pay this monthly. The employer will pay the additional €200 through the income-related premium. Businesses and citizens now also share healthcare costs.
Thus the bill to repeal the deduction could be distributed to more people and more money. “This means that it is not only citizens, but also companies, who will pay much more,” Farkeviser says. So he doesn’t expect employers to cheer.
The alternative is for the six billion to come from taxpayers’ money, but then the tax would increase. Otherwise, the government will have to make significant cuts in other expenditures, such as defence, climate or education. So €6 billion a year is a lot of money. “You can’t fund that with a smaller number of asylum seekers,” Coleman says.
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“Discounting makes people cost conscious.”
According to Farkeviser, there is an advantage to the opponent as it stands now. “It ensures that people realize that there is a cost to health care.”
If the deductible price incentive disappears completely, there’s a risk that people will buy more care, the health economist believes. “This leads to more health care spending and greater health care staffing shortages.”
Coleman wonders whether more treatment will be available once the deductible disappears. Hospitals determine the number of treatments based on the budget they receive from the health insurance company. “Total spending simply won’t go up,” he says. “Most hospitals do not have enough staff for further treatment.”
Waar komt het geld voor de zorg vandaan?
De zorgverzekeraars verdienen onder meer geld door de verplichte premies die mensen betalen. Ook betalen werkgevers en zzp’ers verplicht een inkomensafhankelijke bijdrage aan de zorgverzekering.
Volwassenen betalen jaarlijks tot 385 euro aan eigen risico als ze gebruikmaken van bepaalde zorg. Daaronder vallen medicijnen, ziekenhuisvervoer, ziekenhuisbehandelingen en operaties.
De huisarts, verloskundige en wijkverpleger zijn uitgezonderd: een afspraak met hen is gratis. Minderjarigen hoeven helemaal geen eigen risico te betalen.