Health Council of the Netherlands Reports 2003 - Gezondheidsraad

First, health care must be readily accessible to all. A ‘solidary’ insurance
package is funded on the basis of solidarity of rich with poor, young with old,
and healthy with sick. It includes all of the care services for which mutual
solidarity can reasonably be invoked. This first objective requires criteria for a
‘solidary’ package.
Second, government should protect its citizens against their own ill-advised
decisions and those of others. This objective requires criteria for a ‘compulsory’
package.
Criteria for a solidary package
For which services are people willing to exercise solidarity with one another?
Based on an analysis of earlier attempts (at home and abroad) to develop
effective criteria in this regard, the Committee considers that, in theory,
individual ‘burden of disease’ combined with ‘cost-effectiveness’ forms a good
basis upon which to define a basic package that, in accordance with the principle
of solidarity, is accessible to all. Burden of disease is defined as ‘reduced quality
of life or life span as a result of a disease or some other somatic or mental health
problem in cases where no health care service would be utilized’. The term costeffectiveness
denotes the relationship between the effectiveness of a health care
service (i.e., the degree of reduction in burden of disease) and the costs (in terms
of financial resources, manpower, equipment and time). Thanks in part to the
major advances made in scientific research in recent years, ‘burden of disease’
and ‘cost-effectiveness’ are, in theory, workable criteria that have in the
meantime also been applied in a number of situations. However, we currently
still lack the data needed in order to apply these criteria to many care services.
Criteria for a compulsory package
For which services is compulsory insurance justifiable?
Burden of disease and cost-effectiveness are not sufficient conditions for this.
Additional reasons are required. One can decide on paternalistic grounds to
protect individuals against self-made decisions that may prove to have adverse
consequences in the longer term. An example of this would be failure to take out
insurance for an expensive service that one would not expect to need. Another
motivation for compulsory insurance is to protect individuals against
unfavourable decisions made by others – for example, if these other parties fail to
insure against prevention and care of infectious diseases. A third reason is to
22 Health Council of the Netherlands; Reports 2003