Savings of 5 billion on healthcare? That’s too short sighted

Education, climate, housing: billions extra will go into the coalition agreement. And healthcare, in the midst of the pandemic? He will get “a knife in the back and not a cent extra”, SP leader Lilian Marijnissen grumbled in the House of Representatives on Thursday. In fact, the opposition consistently spoke of a cut of five billion euros. “Tough” and “shameful”, said PVV leader Geert Wilders. Jesse Klaver (GroenLinks) could not explain it in corona time. “Healthcare workers are closer to crying than laughing.”

VVD leader Mark Rutte contested that the new cabinet will cut back on healthcare. In the coming years, a lot of money will be added, Rutte said. In the long term, something has to be done, but instead of making cutbacks, he calls this ‘slowing down’ the cost increase. Inevitable, according to Rutte, because otherwise more and more budget money will flow to healthcare at the expense of other policy areas.

Is Rutte IV going to cut back or invest now? The word ‘austerity’ can be interpreted as a decrease in expenditure, in other words: less money for healthcare. That is certainly not the case. Healthcare costs – already the highest budget item – continue to increase, from 88 billion next year to more than 94 million in 2026. Rutte is right that this also includes new investments. An important one is 300 million euros for ‘pandemic preparedness’, such as extra money for hospitals to be able to flexibly expand IC capacity.

Rutte speaks of ‘slowing down’ the cost increase, instead of cutting back

Health economist Xander Koolman (VU University) sees that the new cabinet is investing extra billions on top of the ‘basic path’, the automatic growth in expenditure that is already evident in health care if policy remains unchanged. “You really can’t speak of cutbacks in the coming years,” says Koolman.

The opposition’s ‘5 billion’ cutbacks are in reality 4.5 billion euros, which is the amount Rutte VI hopes to structurally save in the long term. Many measures to achieve this are not yet concrete and will only yield money in years to come. An example is the ambition to separate housing and care costs more, for example by making nursing home residents pay more rent. That reform will cost money at first, but should save a billion a year by 2052.

Are all savings in the distant future and will there be no pain anywhere in the coming years? That is again not the case. Some healthcare sectors, such as nursing homes, will already receive less money during this term of office (350 million). Exactly what these cuts will look like is still unknown. In recent years, the nursing home sector has received a structural additional 2 billion in order to improve quality and to hire more staff.

Handing out gifts

New ‘outline agreements’ between politics and healthcare should limit expenditure growth by almost 1.5 billion in the coming years. The agreements were first concluded in 2012, but Koolman doubts whether this approach can be successful again. “In 2012, the economy was bad and the need was also felt in healthcare. Presents are now being distributed to all kinds of sectors and care should be saved. I think there is less enthusiasm for that now.”

There was a discussion about youth care in the House of Representatives about whether investments or cutbacks are being made. In the short term, money will be added, next year 1.5 billion. Earlier this year, an arbitration committee ruled that the government should pay municipalities more for youth care. In the years after next year, the extra money will decrease rapidly every year, faster than the committee advised. From 2024, Rutte VI even hopes to save on youth care again. “Given the problems in youth care, new cutbacks are not obvious,” says Koolman. “The cabinet presents this as investments, but I think that municipalities view it very differently.”

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