THE HEALTHCARE SYSTEM IS SICK

The Dutch healthcare system is sick. The Netherlands is no exception as a similar situation exists in all Western countries. And it comes with a price. Healthcare is rapidly on track toward becoming unaffordable. Structurally, something is wrong because very few people manage to go through life drug-free in old age. Consequently, the creation of affordable healthcare seems to be a tough proposition. The solution, however, is not very complicated. However, it requires a clear shift in medical thinking and practice.

In this article, you will read about eight steps to affordable and truly healthy healthcare.

By C.F. van der Horst
Sept. 4, 2015, updated Sept. 1, 2022

First, let’s look at the development of costs. In a now distant past, there was such a thing as a health insurance fund that was completely free for many. These days, everyone in the Netherlands has to pay for basic insurance. There is a deductable on top of that. Costs are rising every year and drug use is increasing alarmingly. Clearly, the basis of our healthcare system is flawed. The numbers speak volumes.

According to the Central Bureau of Statistics, healthcare spending in 2013 was 93.9 billion euros, up 1.2 percent from 2012. In 2014, health and welfare care costs rose 1.8 percent to reach 95 billion euros. That amounts to 5,630 euros per capita, 79 euros more than in 2013. To put the figures in perspective, in 2003 there was 57.5 billion euros spent on health care, which (without adjusting for inflation) represents a 163% increase in 12 years. But as you can see in the bar chart below, the costs have continued to rise dramatically after that to nearly 125 billion euros by 2021, or an increase of nearly 34% over 2013!

Vektis, an information center for declared care, calculated that in 2013 the cost of care from basic insurance (paid by health insurers) averaged 2,153 euros per person. The individual citizen pays his monthly health insurance premium (for a family with small children easily 200-300 euros) and the deductible. Both amounts keep rising. For the latter, one had to add 155 euros out of pocket in 2009, in 2016 it became 385 euros. On top of this are costs that are not covered by insurance or covered only to a limited extent, such as those for dentistry or physiotherapy.

In 2019, the average healthcare cost per person was 2,625 euros per year, and it was expected that the expenses for this will continue to increase in the coming years. That turned out to be correct, with an average of 7,116 euros per person spent on healthcare in 2021. That is 466 euros more than in 2020, CBS calculated. Where will this development stop?

The problem of rising costs seems to lie mainly in the fact that more and more people have long-term conditions. VZinfo.nl, a website of the National Institute for Public Health and the Environment (RIVM), reports, “On January 1, 2020, over 10.3 million people in the Netherlands (59% of the Dutch population) had one or more chronic conditions. A ‘chronic condition’ is defined here as a condition in which there is generally no prospect of full recovery.” Furthermore, 5.6 million people were found to have two or more chronic conditions (multimorbidity), equivalent to 32% of the total Dutch population. June 18, 2024 reported that as of Jan. 1, 2022, 10.4 million people had one or more chronic conditions; the number with two or more chronic conditions had dropped to 5.4 million (30% of the population). How reliable are these data? The RIVM further reports on VZinfo.nl, “The absolute number of people with one or more chronic conditions increased in the period 2011-2022, from 7.5 million people in 2011 to 10.4 million people in 2022.” This is surprising, because in 2013 the RIVM reported on its own website that 5.3 million Dutch people had a chronic disease in 2011. According to that data, the deterioration is much more severe: in 10 years, the number of people with chronic disease has almost doubled.

Decay, by the way, begins above 40, the website signals. The Dutch are getting older, but very few are aging healthily and do not need to take medication. Caring for our elderly and infirm requires an army of people: as much as five percent of the workforce was employed in the elderly or home care. On top of the personnel costs come the huge sums for especially patented drugs. Especially with chronically ill patients and the associated—almost inevitable in allopathic medicine—long-term drug use, this meant a heavy economic burden. Moreover, long-term drug use disrupts the normal functioning of the body’s systems and in turn triggers disease itself. The current medical model fights its symptoms with even more medication, and there is no end in sight to the downward spiral.

In its business model, the pharmaceutical industry throws money around to influence doctors’ prescribing behavior. Examples include ‘independent’ studies on the effects of medication, paid ‘editorial’ articles and advertisements in professional journals, pharmaceutical representatives, and paid speakers at conferences and continuing medical education (CME) days. The editor-in-chief of the British medical journal The Lancet, Richard Horton, complained about these practices in an editorial. He wrote: “Professional journals have become machines for ‘laundering’ information for the pharmaceutical industry.” That manipulation of independently believed professional literature is unchanged to this day—if not exacerbated.

Not only is the volume of drug use steadily increasing, but it is unnecessarily expensive due to patents. When a patent (read: monopoly) expires, a drug may be produced by other manufacturers as well. As a result, its price drops dramatically. To keep shareholders happy, the manufacturer often launches a new, ‘better’ remedy to replace the old one. Of course, the new medication is again subject to patent law, which means that a premium price must be paid. These new drugs are brought to the doctor through a prohibitively expensive and hard-market approach. The latter should primarily prescribe the new, patented drug and not the old and much cheaper one.

Hans van der Linde, family physician, has reservations about the pharmaceutical industry’s marketing.

GP Hans van der Linde from Capelle aan den IJssel identified a problem in 2012: “The drug market is not a market. It does not comply with the ordinary laws of supply and demand. The person who uses the product does not choose it. The one who chooses the product does not pay for it. The one who pays for the product does not use it. Marketing is through the doctor’s “prescription” pen. That is where the marketing of the pharmaceutical industry targets, which earns the most from new, patented drugs, the price of which it can unilaterally set itself.”

New drugs are proving little or no better than the old ones. The medical journal Medisch Contact reported in 2014, “Most new drugs on the Dutch, German and French markets add nothing. New drugs are often no better for health than their predecessor, and sometimes even harmful. So says the Wemos Foundation, which campaigns for the right to health worldwide, based in part on figures from the Medicines Bulletin.” The text has since been removed from the Medisch Contact website, but a similar article can be found here.

Van der Linde previously wrote about the safety aspect: “We, doctors, prescribe these new [gepatenteerde] drugs and we bear responsibility for that, but we are rarely held accountable for it. Those new drugs are always unproven safe and unproven effective. Only after market approval do Phase 4 trials begin: large, long-term studies in which the drug is tested for the very first time on hard criteria, such as longer and better life.”

Drug manufacturers, under pressure from their shareholders, are launching not only expensive but also risky drugs on the market.

It makes one think that paying damages has become a standard part of drug marketing—several millions of dollars are set aside for this purpose. The estimated fines do not outweigh the huge gains that are thought to be made.

The pharmaceutical market approach has boomed since the mid-1980s when the government increasingly withdrew from the university. This made scientiic research financially dependent on exactly what industry wants researched. Study design, endpoints and statistical processing after completion are usually determined by the sponsor. Today, some 80 percent of clinical research at American universities is financed by industry.

In the Netherlands, the situation is not much different. The general practitioner from Capelle aan den IJssel wrote in an article entitled “Who pays, decides?” in the Medicines Bulletin (Ge-Bu): “On the basis of ‘case studies’ it is made clear that skewed growth is imminent if knowledge development is too dependent on industrial research. The development of socially desirable knowledge lags behind if that knowledge is not linked to product sales and profit making. (…) Sponsored research of own products by manufacturers leads to strikingly favorable results. Confidence in scientific research is thus undermined.”

In Deadly Lies: How Doctors and Patients Are Deceived you will find, in addition to numerous health recommendations, extensive documentation of the pharmaceutical industry’s increasing financial involvement in steering scientific research toward the outcomes it desires. Physicians are led astray as a result, and the patient suffers. This information will certainly contribute to the creation of quality and affordable healthcare both in the Netherlands and other countries.

“Deadly Lies: How Doctors and Patients Are Deceived”: vital information for good health.

One aspect of it is the independent university. The independent quality function that the university traditionally performed has come to an end due to Public-Private Partnerships (PPPs). It is a euphemism for financial control of scientific university research by the industry. In fact, it is precisely this collaboration that resulted in university studies being used as a marketing tool.

According to the previously mentioned figures from Vzinfo.nl, a website of the National Institute for Public Health and the Environment, there were 10.4 million Dutch people with at least one chronic condition on January 1, 2022. Again, and as you have read above, the health situation of our population is deteriorating year after year. After all, according to the same source, there were 9.9 million chronically ill people in 2018, 8.8 million in 2016 and 5.3 million in 2011. So in 10 years, we have added 5.1 million people with chronic conditions! It is true that the Dutch population is increasing in numbers, but not as fast as the increase in the number of chronically ill people. According to CBS, the Netherlands had a population of 17,407,585 in 2020, two years later it was 17,590,672 and by September 2024 it was more than 18 million. This increase does not explain the excessive increase in chronically ill people.

Apparently, the cause of illness is not being found and addressed—resulting in lengthy and therefore extremely expensive symptom treatment. Something is structurally wrong in healthcare. It its sick Symptom-oriented treatment contributes greatly to this. How can the ‘patient’ be cured?

According to an old adage, prevention is better than cure. Interesting in this regard is an ancient Chinese text, written at the behest of the legendary Yellow Emperor Huangdi. The manual Huangdi Neijing (Esoteric Classic of the Yellow Emperor) states that the best physician diagnoses and treats before the disease manifests itself in a form in which the patient develops symptoms.t. At the other end of the spectrum, an inferior doctor waits until his patients have developed obvious symptoms. Prevention was emphasized. As a result, in earlier times, doctors were paid to keep their patients healthy, while reimbursements stopped if people got sick. The manual reports that administering medication after diseases have already manifested themselves belongs in the same category as suppressing revolutions that have already occurred, digging a well after one became thirsty or as manufacturing weapons after battle.

Huangdi, the Yellow Emperor (circa 2500 B.C.) had strict rules for rewarding health.

The ancient Chinese system has another advantage. After all, rewarding a clinician for interventions for illness makes him dependent on the existence of ailments. Since he does not obtain income without it, he benefits, whether he likes it or not, from the existence of inferior health. If a physician is paid purely for health, it is there and in preventing disease where his interest and priority lies. By necessity, much of his effort will be shifted to prevention and clinically effective knowledge. To be well paid, he will have to be very effective. Society will benefit in more ways than one. Affordable healthcare will be one of the benefits.

Compared to the time-honored Chinese system, as well as by the economic standards of today, healthcare is flawed on all sides. On top of that, the reimbursement system leaves little time for the patient. In a debate following the Rathenau report Strong stories from the hospital brought up Corine Jansen (Chief Listening Officer RadboudUMC), “Research has shown that patients need an average of two minutes to tell their story. A doctor breaks in after only 18 seconds.” Urologist and former chairman of the quality committee of the Dutch Association for Urology Bart Wijsman complained that because of the pressure on numbers, he doesn’t actually have enough room to hear the patient. With 50 patients a day, his time for each consultation is limited Geert Munnichs (coordinator at the Rathenau Institute) responded that according to the report, listening to stories actually saves money because it improves quality. Better quality should lead to shorter and more effective treatments, thus contributing to affordable healthcare. In response to the report, then-Health Minister Schippers wrote in a letter to the House of Representatives “I will follow the activities in this area in my discussions with parties in the healthcare sector.” That statement turned out to be hot air, as little has been done with the recommendations to date.

Our doctors have little or no training in holistic medicine and tend to proceed symptomatically. Headache? Take some aspirin. High cholesterol? Statins are prescribed. Rarely does a physician investigate the cause of headaches or high cholesterol levels.

The Netherlands is not the only country with these problems. Doctors generally know very little about nutrition and its impact on health. This is disappointing, since the father of medicine, the Greek Hippocrates, is quoted with: “Let food be thy medicine, and let medicine be thy food.” Upon their graduation from medical school, new physicians take the Hippocratic oath. Now this is a code of ethics, but the fact that Hippocrates’ name is attached to it indicates respect for the ancient Greek. Of this, however, in terms of his age-old advice on nutrition as medication, there is bitterly little evidence in medical practice.

That it can be done differently was proven by the British TV series The Food Hospital. Doctors in the program examined the science behind using food to address patients’ health problems. The program’s introductory video concluded with the slogan, “It’s time to eat our way back to health.” Solutions were provided to a range of disease conditions ranging from acne to psoriasis to Crohn’s disease. The focus was on causes and attempts were made to treat them through nutritional counseling. While nutrition is not a solution for everything, the quick results the program showed were remarkable and… for a fraction of the pharmaceutical cost! Affordable healthcare is thus within reach, as the example below illustrates.

Diabetes serves as one example. In the UK, 10 percent of costs (more than £5 billion) are spent annually on treating the symptoms of diabetes with insulin. “90 percent of diabetics suffer from the disease because of their weight and diet. If we change those, there could be huge cost savings,” said Shaw Somers, one of England’s leading gastrointestinal surgeons and one of The Food Hospital‘s physicians. With a diet, Somers was able to get a patient’s blood sugar level from a dangerous 8.5 mmol/l (on a fasted stomach, a value above 6.9 mmol/l is a sign of diabetes) to a normal value of 3.9 mmol/l in six weeks-just by using food as medicine. This averted the symptomatic and therefore chronic use of insulin—a huge cost savings!

Lynda McIntyre, clinical nutritionist at the cancer center at Johns Hopkins Hospital in Baltimore, USA, claimed that “of all cancers, less than 2 percent can be directly related to additives in food, but up to 60 percent of them to what we don’t eat, such as enough fruits and vegetables.” It should be noted that organic crops and produce contain many more essential substances than conventional ones. In the latter, we find significantly less of the so-called secondary plant substances found in organic crops that may play an important role in cancer control. With proper nutrition, cancer and its attendant colossal treatment costs could possibly be prevented—not to mention the suffering saved.

It is clear from the above that the healthcare system is sick. What can be done to cure it and bring about affordable and effective healthcare? The following points will be instrumental in improving the situation:

• Physician training should be restructured after the time-honored Chinese system. The physician should be paid for prevention and health and not for cure. This can easily be done when sick leave and disability costs drop and production losses are prevented.
• All medical (continuing) education should bring together the best of all worlds – pharmacy, nutrition, TCM, Ayurveda, homeopathy, herbal medicine – everything that works in practice to prevent and treat disease.
• A comprehensive nutrition curriculum in the spirit of Hippocrates should be part of it.
• Treatment should consist of finding a cause. For an acute problem, sometimes a pharmaceutical solution may be the right one, but the underlying problem must be addressed with a structural solution (nutrition, exercise, stress, etc.).
• Because of the inevitable side effects, long-term medication should be avoided. Hetzelfde geldt voor polyfarmacie, het gelijktijdig gebruik van meerdere medicijnen door een patiënt. Hardly any drug studies have been conducted that show that the combined use of drugs is safe and effective.
• The university should regain its independent quality function so that conflicts of interest there are a thing of the past and scientific research can once again be trusted.
• Members of advisory and government committees should be chosen only from among scientists from such a university, thus avoiding conflicts of interest.
• New medication should be allowed only if independent studies show that the drug works better clinically (i.e., in practice).

Possibly you know of other and better solutions to improve the quality and economy of our care. Write your ideas for affordable healthcare to your representative in congress and/or to the Secretary of Health and Human Services Your opinion matters—let it be heard!

Ministry of Health, Welfare and Sport
PO Box 20350
2500 EJ The Hague
Telephone number: (070) 340 79 11
Fax number: (070) 340 78 34

How is it that medicine has become so pharmaceutically oriented? How does the pharmaceutical industry go about selling new patented drugs? How are physicians influenced? What else can be done for affordable healthcare?

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