The Dutch council for health and society (RVS) is recommending a radical overhaul of the way healthcare is organised, saying the current system is no longer providing the necessary care for an increasing number of people.

“On paper we have good, accessible healthcare but in practice we don’t,” RVS chairwoman Jet Bussemaker told the NRC. “We have to prevent things from seizing up altogether.”

Some of the issues highlighted by the council are well known – there is a major shortage of staff, pay rates are low and people are getting older. In addition, the healthcare sector is “so fragmented and complicated” that people cannot find their way and are missing out on the care they need, the council said.

In particular, the 10% of the Dutch who have “complex care needs” are facing problems, the council said.

The fragmentation and complexity are worsened by compulsory competition which,  the council said, means companies focus on keeping their costs down rather than on working together.

In 2021, some 8% of people did not go ahead with some form of treatment because they could not pay their own contribution. “That might seem to be cheaper, but in the long term people end up needing much more expensive care,” said Bussemaker, who was junior healthcare minister from 2007 to 2010.

The council recommends removing competition from large parts of the system, including community nursing, mental health services and acute care. There should be fewer laws and providers and health insurers should work together with local authorities at a regional level, the RVS says.

It also recommends making premiums more income-related and lowering the basic premium so that healthcare benefit can be largely scrapped. Healthcare benefit was paid to some 4.6 million households last year.

The current cabinet has already agreed on two major healthcare-related packages with the private sector, one focused on costs and one on prevention.