Barend van Lieshout thinks insurers and the SP are using the hype surrounding the healthcare fraud for their own ends.

‘Three billion’, the Telegraaf said, ‘organised crime’, the SP cried, ‘criminality’, the minister commented. Insurers’ association Zorgverzekeraars Nederland totted up €1.2b of unjustified bills. Is it really true? Have our country’s public health funds been ransacked by greedy gangs under our very noses? No matter: the hype has been created and everyone is using the story for his own benefit.

Meanwhile there’s nothing new under the sun. We’re talking peanuts in terms of money and it is by no means certain the remedy – even more rules – will cure the patient.

Public debate is being dominated by shocking anecdotes and staggering numbers. Doctored bills, shady agencies and networks of embezzlers are being spotted right, left and centre. Billions are lost through the hospitals, hundreds of millions through mental health organisations.  Mind you, these number have yet to be substantiated.

Complex

The reality is much more simple: the DOT billing system is so complex neither insurers nor hospitals, nor their accountants are able to come up with the correct bills. This is common knowledge. The MPs know it, the insurers know it and journalists who do a little digging should know it too. But the story is too juicy, the suspected conspiracy too big and the indignation too satisfying to allow mere facts to spoil it.

So what is happening is that all parties involved are turning the fraud to their own advantage. The insurers are linking it to the obligation to contract. They have been wanting to ditch this for some time and the fraud hype offers a good opportunity to do away with patient choice.

The SP is trotting out the old standard about snouts in the trough and big earners and demanded no less than a parliamentary inquiry to deal a death blow to the evil market forces which are, of course, at the bottom of all this.

The minister – who admits not to have a clue as to the extent of the fraud – sees it as a confirmation of the present policy and blithely announces more rules and more inspectors to monitor them.

Double dealing

Is the medical world free of financial double dealing? Of course not. It happened before and it is happening now. The signs are, however, that the amount of money involved is relatively small. The personal budget fraud was below 1%. Insurers came to the same figure where the hospitals were concerned, but only when asked by persistent NOS journalists.

In a health system that deals with huge amounts of money this still represents millions of euros, but we should ask ourselves whether the game – more rules, more regulatory staff – is worth the candle, especially when, come next year, we will be wondering why the overheads in healthcare are as big as they are.

The only ones who stand to lose as a result of the healthcare hype are the care providers and the patients: hospitals will have to spend more to adhere to the new rules and the patients will get even less care for their premium.

Barend van Lieshout is a healthcare advisor at Rebel