Could Dutch healthcare reform be derailed?
Short-term, the reforms planned for this year will now not happen. This means that long-term care plans will not be starting in 2013. It also means that a law allowing private equity to invest in the 100 large Dutch not-for-profit foundation hospitals will not be implemented in 2012 and may prove too politically contentious even in 2013.
But the proposed privatisation of Dutch labs is likely to go ahead.
Long-term, the political consensus which allowed the Dutch to pursue a consistent programme is also in danger of unravelling. The socialist party has said it is opposed to the idea of competing insurers and proposes some sort of unitary payor.
On the whole, our sources in private equity and insurers are optimistic that there won’t be big reversals. They say that it would be very difficult for the left, even if it won an election, to overturn the strong consensus for the market led approach. At the moment the polls do not suggest a landslide for the left.
Meanwhile the next six months will be stormy. Exclude the PIIGS and the Netherlands is the only solvent West European country to start to throw entitlements out of the publicly funded basket of healthcare services. In January it introduced big co-payments for psychiatry, for instance. Expect more such moves. One insurer reckons that we will see a €1bn cut in the long-term budget to be paid for by limiting access. A further €600m will come out of what is covered by collective insurance either through limiting co-payments or through mandatory co-payments.
We think that the concept of co-payments is becoming more politically acceptable to European citizens but the Dutch have been far more masochistic than their neighbours in introducing them.
It will be interesting to see if they do in fact make it into law without providing a landslide for the left.
