Appraisal Process of the Health Care Basic Benefits Package in The Netherlands

Summary Relevance/Context Although countries differ in their political, social and health care systems, they also have many problems in common. Many countries have stagnating national incomes and spent more of their scarce resources (in absolute and in relative numbers) on social and health care policies. This results in growing difficulties for governments to finance and deliver health care. This pattern is not sustainable in the long term (Blank & Burau 2007). There are several reasons for the extensive growth of health care spending. The first reason is the changing demography of the population. The first wave of the baby boom generation will reach the retirement age soon and at the same time fewer children are born, resulting in an ageing population. Furthermore, life expectancy of the elderly has increased, because of improved social factors, healthier habits and new capacities of medicine (Blank & Burau 2007). The second reason is the rise of new medical technologies, both in diagnostics and treatment. Most of these new technologies are also expensive, resulting in increased health care expenditures. Probably the proliferation of new medical technologies and pharmaceuticals are the most important cost drivers in health care (Bodenheimer 2005). Finally, public expectations and demands for the health care system have increased. One of the forces behind the introduction of new technologies in health care are the providers of health services. This resulted in some countries in a “do-everything approach” (Fuller 1994). Any attempt to limit access to health care services will result in protests by providers, patients, industry, public and media. When this pattern continues, it will become increasingly difficult to reform, although reform may be inevitable (Altman et al 2003). The only stakeholder with power to limit access to health services or new technologies is the government (Blank & Burau 2007). However, in government the politicians are in power. Politicians can only deny access or introduce co-payments within the context of the rising expectations and demands of the general public, because they want to be re-elected and remain in power. On a societal level everyone agrees with the principle of cost containment, also for health care. But when their own or somebody’s health close to them is at stake, constraints are perceived as unfair (Blank & Burau 2007). For these reasons, it is difficult to reach an agreement on the difficult choices which has to be taken. In The Netherlands these choices are discussed in the appraisal process by the Appraisal Committee (ACP). Motivation Choices in health care are almost always a public matter and subject to a lot of discussion in the media, such as the recent discussion about the draft advice of CVZ regarding the expensive drugs for rare diseases (NOS 2012). Many people in society are not familiar with the decision making process and/or the criteria that are used. Yet, it is interesting to understand how these decisions are taken. The subject of this master thesis is the appraisal process of the health care basic benefits package in The Netherlands, because the deliberation of the different arguments is executed during the appraisal. Thesis goal It is the main goal of this master thesis to evaluate the task of the Appraisal Committee (ACP) after it joined the decision making process in 2008. What is the role of the ACP in the decision making process, and what is its influence on the outcome (advice & final decision) of the process? Problem statement What is the role and contribution of the ACP to the outcome of the whole decision making process for the health care basic benefits package?