Oct10

Update 10 October 2023

For those of you interested in the weather in the Netherlands I can report that even though it is October we are still enjoying an Indian Summer with mostly dry and warm days. In this update we cover the following news from the Dutch healthcare sector:

Upcoming election in the Netherlands. What are the likely consequences for the healthcare sector?
Digital healthcare. How to interpret mixed signals?
Bergman Clinics and relationship with healthcare insurance companies. An update
In a new snapshot we give an overview of Microsure, a start-up developing robots for microsurgery.

Upcoming elections in the Netherlands

As mentioned in earlier updates the Government consisting of a coalition between four centrist / conservative parties has fallen. Mark Rutte from the conservative VVD party has been the premier for the last thirteen years has announced that he will not lead the VVD in the future. Therefore he is not available to continue in his current role even if VVD is the largest party again after the elections in November. This means that the election is more open than most recent elections. What are the possible consequences for the healthcare sector?

The short answer is – probably not much and nothing revolutionary. In most of the published party programs (where the individual parties explain what their main plans are if they get elected) healthcare plays a secondary role to issues such as immigration, housing shortages, climate, etc. Healthcare is seen as an important issue by a large share of the electorate, but the political parties are hesitant about making it a key issue for a number of reasons including:

Many of the real decisions that need to be made will not be popular, so the parties are hesitant to make statements about these issues before an election
There are few opportunities in the healthcare sector for politicians to promise “quick fixes”
Many factors driving change in the healthcare sector are outside of political control (demographics, etc.)

There are some issues that are mentioned by most of the parties and that are therefore likely to be part of the overall program of a new coalition. This includes improving the position and financial situation of independent General Practitioners (who play a very important role in the system as gatekeepers for almost all other types of healthcare activities). As we have written about earlier, there have been discussions in Parliament about the growing role of commercial chains in primary care. There seems to be broad agreement between political parties that this process should be controlled. Finally, almost all parties seem to agree that the semi-independent role of specialists in hospitals should be transferred into a work-relationship.

Some parties on the left of the political spectrum want to move away from the current structure with independent healthcare insurance companies to a national insurance package and a mix of the leftist and populist parties suggest abolishing the current own risk related to the healthcare insurance system.

The outcome of the elections is uncertain and there is a possibility for large gains by two new parties. The BBB (The Farmer Citizen Movement) did very well in the elections for the Senate and might do well in the coming elections as well. There is also a totally new party set up Pieter Omtzigt, a very popular independent politician. Based on current polls this party (New Social Contract) would win the most seats and would then provide the Prime Minister. However, New Social Contract is still working on their election program. A new coalition on the left (Worker’s Party and Green Left) is also poised to do well after many years in the political desert.

It is difficult to predict what the results of the elections will be. However, given the Dutch political landscape a new government will always be a coalition of several parties. This means that the end result of any changes to the overall healthcare landscape will be based on compromises so little substantial change and a continuation of the ongoing programs is the most likely outcome.

Mixed signals concerning digital healthcare

As in most other countries, Covid-19 gave digital healthcare a large boost. Many activities that before Covid-19 took place face-to-face could suddenly take place remotely. Digital healthcare is also seen as a key component in the large-scale programs initiated by the government such as WOZO and IZA. However, some recent news seems to give mixed signals as to how patients view digital healthcare:

The Dutch Patient Federation, supported by one of the political parties, wants to give patients the right to choose a digital consult instead of being “forced” to have a physical meeting with the doctor, psychologist, medical specialist etc. The Federation feels that too many healthcare professionals choose for a physical consult out of habit, and that a digital consult offers a patient many advantages (less time spent travelling, easier to plan a consult, lower costs, etc.)
In Eindhoven a primary care practice has decided to switch to primarily providing digital healthcare. The decision has mainly been driven by challenges in staffing the practice due to country-wide shortages in General Practitioner Doctors and other healthcare professionals. They have chosen to do this in cooperation with Arene Online Huisartsen. This is a company providing primary care to patients via a digital portal but with a possibility for a physical consultation if this is required.

This move, however, has met considerable resistance from the local population. Many patients are angry and are considering a switch to a different primary care practice (if possible). The local resistance has been written up in local and national media, and it would not be surprising if questions were asked about this in Parliament.

There seems to be a serious mismatch between what patient organizations want and what the patients themselves want. Changing on a personal level is always difficult. Due to staffing shortages a move towards more efficient and/or lower quality levels is a given, and it will be interesting to see how patients can be convinced to accept new types of service provision.

Bergman Clinics and relationship to insurance companies

In the previous update we wrote about issues related to the contracting between Bergman Clinics and Menzis (one of the largest healthcare insurance companies). I was contacted by a Director from Bergman Clinics who was unhappy with the write-up as it seemed to imply that refusing new patients insured by Menzis was their choice. My apologies for this. Technically speaking Bergman Clinics could choose to take on patients that they would then not be paid for, but it is quite understandable that this is not a rational choice short term choice and a choice that would weaken Bergman’s negotiation position for future contracts with Menzis. According to Bergman Clinics, the other healthcare insurance companies have seen market growth and increased market share of specialized clinics and have heightened the revenue ceilings, while Menzis has chosen not to do this. This means that Menzis-insured patients having to wait until January to start treatments with Bergman Clinics is a choice made by the insurance company.

Snapshot of a Dutch commercial healthcare company: Microsure

Microsure was established thirteen years ago based on research carried out at Maastricht University Medical Center and the Technical University Eindhoven. Microsure specializes in the development, production and sales of micro-surgery robots and currently has approximately thirty-five employees. The company was recently in the news as it has received new financing totaling €38 million. The investments are mainly from existing owners (local semi-governmental investment vehicles and family-offices), but also from Kineo. Kineo will finance the leasing of Microsure robots to hospitals. The new investments will be used to further develop and market the next generation robot (Musa-3).