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The demand for healthcare continues to grow; this is due not only to the greying of the population but also, for example, due to the increasing availability of ever more advanced and expensive treatments. A higher standard of living also encourages the expectations regarding health and the available healthcare to rise. But each euro can only be spent once. The resulting pressure on the available healthcare budget means that policymakers are faced with difficult choices. Which treatments should be reimbursed in the basic healthcare insurance package and which ones ����dzܱ����’t? What role do the burden of disease and the age of the patients play in reimbursement decisions? Do these decisions match society’s preferences? These are the kinds of questions that Vivian examined in her research.

To do this, she instigated various choice-based experiments, like a representative … of the Dutch population and the [citizen forum ‘choices in healthcare’]. From her research it became evident that the Dutch population finds it valuable to keep both disease burden and the age of patients into account when deciding on reimbursement within the health insurance. There seems to be a preference and higher willingness to pay for the treatment of younger patients than that of sicker patients. “In the current decision-making process disease burden is already taken into account, whereas the age of patients isn’t explicitly considered. But,” added Vivian, “the way in which disease burden of patients is calculated [in reimbursement decisions] is deeply connected to their age. Based on this calculation, older patients implicitly receive higher priority over younger patients in the Netherlands. In reimbursement decisions policymakers [will] have to keep patients’ ages in mind, regardless of whether its purpose is to consider age-related preferences in society or to prevent ageism between patients.”