Advisor of Minister Schippers
These were exciting times, in which a massive amount of work had to be undertaken. Edith wanted me to radiate internally she wanted to speed up dossiers and notes were more decisive. One of the major dossiers, was the transition in hospital finance. Four different changes came together. Hospitals transferred to performance-based funding with integral tariffs. The budgets and separate money pots for depreciation of housing and remuneration of medical specialists would disappear. In addition, tens of thousands of Diagnosis Treatment Combinations (DTC’s) would be replaced by thousands of DTC’s towards the future (DOT’s)( Pardon me for the dreadful jargon, who has ever come up with those names ☺ … ) The third development was the enlargement of the freely negotiable part of tariffs in curative care to 70%. Fourthly, insurers were at higher risk. These parallel developments caused growing uncertainty, for the whole field. The insurers were fearing a rise in claims and an increase in the remuneration of medical specialists, the civil servants wanted to maintain tight control on the budget, the NZa advised to allow only a small deviation of the former budgets until 2015. We thought that was much too long, it would block all initiative.
In those first months we had talks with various people in- and outside healthcare to discuss how an alternative approach would look like, in the evenings and on Saturday mornings at Edith’s home. It was a clarifying process: we decided to prioritise what we believed would work: more free pricing and abolition of the budgets. The reform had to be faster and the insurer had to play his part, so we would finally loose the wretched ex-post-budget cuts.
Until that time, the cuts would remain a credible threat. The result was that the transition took place in 2012 and 2013. I organised a roadshow with civil servants for spokespersons of all political parties. The aim was to prevent slips on this tough dossier. The whole system change has passed the two houses of parliament intact.
In 2010 the global crisis was at a high and at the same time the healthcare costs were increasing dramatically. It was the first year that the Ministry of Health had to cover the exceeding of the budget by itself as all the other departments were already cut massively due to the crisis.
The overspending was 2,1 billion euro, covered by new measures of 1 billion euros in the budget of 2012.
The minister, secretary of state and the two political advisors cooperated intensively. My financial background was of use as I only needed one word and a table of the director of finance to be able to continue negotiations. But it was a difficult situation with the PVV and CDA, it was a lengthy process as the ball was in the Court of the parliamentary parties. Finally, the approach of the spokespersons was pragmatic, they did not choose morally, but only on what they could agree on. The package encountered a great deal of resistance all over the country, with the Malieveld in The Hague full of mental health patients. The car had to be protected by horses to safely drive us there to address the audience....
The overspending and the introduction of performance-based spending have given rise to the first global agreement with the entire sector. It was ‘poldering’ (Dutch for reaching consensus), but everyone committed to reform and providing sensible and economical care.
There were many other issues those years, too many to mention. In short: the National Switchpoint that cost 300 million euros to develop ran aground in the Senate; new professions, as the physician assistant and the nurse specialist were admitted. But a lot of crises as well: the PIP implants that leaked, the IGZ that did not respond appropriately, the fire on the chemical plant in Moerdijk, the different assessments of the costs of the Olympic Games 2018. In short: an intense period, where I had to be sharp-edged most of the time, but a highly educational and enjoyable experience.