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According to the Professor of Health Law, the deductible is in place for several reasons. “Firstly, legislators have found that something of the ‘user pays’ idea should be somewhat maintained in collectively funded care. For the sake of fairness, it has been argued that not all of an individual’s healthcare costs should be borne by the community of insured people. Secondly, the deductible is meant to somewhat counteract the effects of moral hazard,” Buijsen explains. Moral hazard is a phenomenon where insured people start to behave more riskily because they know they are not directly at risk for the consequences of the damage since they are insured against it. Buijsen: “In the case of health insurance, this implies that those with insurance obligations are more likely to seek care (and perhaps unnecessarily so).” Thirdly, Buijsen explains that paying for healthcare oneself brings about cost-consciousness among those obliged to pay insurance. “If citizens with insurance obligations would never have to pay bills themselves, they will never realise that healthcare is simply an expensive business.”

Chronic condition 

It is not always easy to determine when someone is chronically ill, argues Buijsen. “If you have diabetes, it is obvious; you are constantly dependent on insulin. If you have asthma, it will also be obvious. But if you have an allergy, for example, which only affects you in spring, are you chronically ill or not? It is difficult to define what a chronic illness is and when someone is chronically ill. It is hard to predict, and it is definitely not easy to manage.”

According to Buijsen, it is relatively easy to eliminate the deductible for this group of people. “Legally, there are no obstacles. This way, essential care becomes more accessible to those who depend on it: the chronically ill.” According to Buijsen, affordability is also an aspect of accessibility. “The real barriers are practical. When does someone count as chronically ill? ‘Chronic illness’ can be defined both broadly and narrowly.”

Higher premiums 

Buijsen explains why politicians would want to abolish the deductible for a certain group. ‘There are political parties that went into the House of Representatives elections promising to eliminate the deductible entirely, the PVV leading the way.” According to Buijsen, this is because the cost of health insurance is hard to bear for more and more people. ‘In the current system, eliminating the deductible inevitably means that healthcare premiums will increase for everyone. Health insurers will have no choice but to do so.” 

Collectively funded care in the Netherlands is paid for almost entirely from premium income. “Those higher premiums are not bearable for those liable to pay insurance from lower income groups either.” Buijsen suggests that a compromise might be opted for: ‘A compromise would be to eliminate the legally compulsory deductible only for the chronically ill; those with insurance obligations who are almost certain to ‘use’ the deductible in full.”

Solidarity

But where should the money for treatments come from when the deductible has been eliminated for a certain group? “Because healthcare is paid for from premiums, healthcare premiums will have to go up. That is a given. The question is how much will those premiums have to increase?” says Buijsen. According to the Professor of Health Law, the government cannot give certain guarantees regarding the deductible level. “That will not be possible. What one person will not have to pay must be brought up by another. If the deductible is eliminated for one group, a greater appeal will have to be made to the solidarity of the other groups.”