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Downsizing in a growing market…. not just a possibility, but a necessity

The arrangements we currently have in the Netherlands for caring for senior citizens are great and I would be reluctant to give them up. The same applies to the provision we make for people with disabilities and all others in our country who rely on specialist medical care.

But what will happen when I get older and become a customer of that same healthcare? And what kind of care can generations X, Y, Z and Alpha expect? One thing is certain: there are going to be major changes in the healthcare landscape. Even if we did have the money to fund all healthcare, our society simply wouldn’t have the people to deliver that care. The report De juiste zorg op de juiste plek (The right care in the right place) predicts a shortage of between 100,000 and 125,000 employees in the healthcare sector if current policies remain unchanged. We can and we must op-erate in a different, smarter way to ensure that we can continue to meet the increasing demand for healthcare in the future. This means thinking carefully about whether all possible forms of care should in fact be provided, about more technology and about doing less in hospitals (where healthcare costs more).

The question that we need to ask ourselves as a society is which specialist healthcare should and should not be available. These will be difficult ethical discussions that will cause tempers to rise. Do we need to draw certain lines? If so, where? And who should do it?

Downsizing as the guiding principle

While this debate is ongoing, hospitals in the Netherlands will need to think about their role and responsibility in the new healthcare landscape. Downsizing isn’t just one of the possible future scenarios that you are free to choose or disregard; downsizing is going to be the guiding principle. This is one of the main messages to have emerged from the agreement negotiated between the various parties in the healthcare system (onderhandelaarsakkoord medisch specialistische zorg). In the years ahead the scope for volume growth will be limited. In fact, the macro-framework set for 2022 is smaller than that for 2021 (when adjusted for price and wage increases). This break in the trend is one that could have been predicted, because everyone senses that the capacity to support rising healthcare costs is coming to an end.

Maintain dialogue and be aware of each others’ interests

Hospitals will therefore have to think about downsizing and prepare themselves for it. What healthcare will we continue to provide? What healthcare do we want to provide in conjunction with others? And: what healthcare are we willing to pull out of entirely? These are not matters that hos-pitals can consider alone, since any attempt to shrink units that provide specialist care or get rid of them entirely without involving other healthcare providers will be doomed to fail. Only if the par-ties maintain dialogue and remain aware of each others’ interests will we be able to future-proof the healthcare landscape. Health insurers and government have a key role to play: by setting the direction of travel and facilitating the process.

Final words

I spent a few years living and working in South Sudan. It’s a country without a healthcare system and without many other systems too. So I’m grateful that I live in the Netherlands: we’ve built up an impressive healthcare system here that we can rightly be proud of. Given that we have managed to achieve this, I am convinced that we will be able to take the next step together, moving towards a future-proof healthcare landscape with smaller hospitals that cooperate effectively with each other and with all other parties in the healthcare system.

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