We may buy gadgets with our child benefits but the system itself is not flawless, thinks Barend van Lieshout.

I may as well own up: the first quarter has barely begun and I’m cheating the system already. Not only did the child benefits buy some nice gadgets for mum and dad (and not for the first time), we also spent the health care allowance on the car and the mortgage tax relief on a holiday. The tax inspector is probably not going to lose any sleep over this as long as I haven’t claimed these benefits fraudulently and the children are happy and healthy.
How differently things are in the world of health care. Why is it so important that care money goes on government designated care and government designated care only?
Flat screen fraud
There is both a rational and a psychological reason. The rational reason is that if a person who is ill spends his care allowance on a flat screen television instead of a doctor’s services this person could end up close to death on the steps of the nearest hospital. Society then relents and coughs up the money for the care – by now much more expensive – this person needs. The cost of care is doubled (or tripled). In order to avoid situations like these, the state is rigorously checking that we are spending our care money on care before we trespass on the kindness of our fellow man.
The emotional reason is that we’re used to it. If you eat like a bird you’re not expected to give back part of your state pension. But if you – in spite of physical impairments – prefer to do your own cleaning your allowance is cut. We think this is completely normal. We even think it’s headline news when health care money is spent on something else.
Overhead fraud, health care allocation decision fraud, waiting list fraud
But it’s not as straightforward as we think. Because we are so anxious to know where the money goes we are wasting an awful lot of it. Monitoring is costly. The amount of paperwork for citizens, authorities and health care providers is huge and administration accounts for up to 10% of the overall cost.
People don’t have any reason to cast a critical eye on the quality of care: it’s free and the more the better. And moreover, the emphasis lies on delivering the care, not on the care allocation decisions made by the authorities, an area much more open to fraud. Maximising the care allocation decisions is a popular ploy with health care providers to cope with price depression.
The system is hypocritical to boot. All that expensive monitoring of the consumption of care, meant to avoid higher future costs, is being frustrated by money saving mechanisms built into the health system: consumption of the allocated care doesn’t take place because of long waiting lists, or is discouraged because there is an own contribution to be paid. Sometimes a health care provider simply doesn’t deliver the care. The Dutch health care budget is much lower than the cost of the allocated care.
‘Schwindel’
It doesn’t have to be this way. The German government takes the adult view: after the care allocation decision has been made a citizen is free to choose between money and care in kind. As happens with Dutch child benefits (how many children do you have) or the old age pension (are you over 65) it is enough to determine entitlement to be given the money.
Germany is no stranger to monitoring, far from it. And there is bound to be some financial hanky panky going on somewhere along the line. But they are saving a fortune on administration costs and the over consumption of seemingly free health care.
Barend van Lieshout is a care advisor at Rebel