Risky business: Dutch deductible dilemma

Abstract

Situation
In the Netherlands, the deductible is an essential part of the healthcare system, designed to regulate healthcare usage and keep healthcare costs manageable. The current deductible is €385 per year, but there are growing concerns about the accessibility of care for vulnerable groups such as chronic healthcare users and care avoiders. These concerns have led to political debates and policy proposals to revise the deductible. The Dutch government is set to adjust the deductible in 2027, spreading the cost over multiple treatments, €50 per treatment with an annual maximum of €165. While these adjustments are intended to increase access to care, little is yet known about the broader social impact of such changes to the deductible.

Complication (Question)
The central question of this thesis is: “What are the social costs and benefits of the policy change in the Dutch deductible to €50 per treatment with an annual maximum of €165, compared to the current system, for the entire Dutch society over the period 2027-2070?”

Approach
To answer this question, a Social Cost-Benefit Analysis (SCBA) was conducted to evaluate the social impact of four policy options: elimination of the deductible, reduction to €50, reduction to €165, and the Spread scenario. The SCBA looked at both quantified and monetized impacts, including the benefits of accessibility through perceived cheaper care, increased costs of nominal premiums and income-dependent contributions through changes in healthcare usage, costs, and health benefits. The analysis period was from 2027 to 2070 and took into account uncertainty factors such as population growth and price elasticity of health care demand. Sensitivity and uncertainty analyses were conducted to evaluate the robustness of the results, and critical assessments were made of the assumptions underlying the model.

Results
The analysis showed that all four scenarios result in a negative Net Present Value (NPV), indicating that costs exceed benefits over the entire period of analysis. The Spread scenario resulted in a total NPV of -€194 billion, with an average annual NPV of -€4.41 billion with extremes values
-€4.92 billion and -€2.56 billion. These results suggest that the social costs, mainly caused by higher nominal premiums and income-related contributions, significantly exceed the expected benefits, such as reduced spending on deductibles and health benefits from improved access to care.

In addition, the results show that the intended financial threshold of the Spread scenario may not be effective in reducing healthcare usage. The analysis indicates that total costs for healthcare users under this scenario are often lower than under the current situation, even after multiple treatments. This implies that the lower cost per treatment may actually encourage rather than inhibit healthcare usage, leading to higher healthcare usage, longer waiting times for care, quality reduction in care, and higher costs to society.

At the individual level, we are talking about an average annual NPV of €275 per person. But this includes an increase in nominal premium and income dependent contribution of €452.90 plus the cost of the deductible. This will increase nominal premium more than the deductible will decrease. Society's solidarity will be greatly called upon, because the difference between payments for healthcare users and non-healthcare users will be significantly reduced, while the cost of the nominal premium will increase by 26%.

Next Steps
The study contained several assumptions that require further research to reduce uncertainties. It is recommended that follow-up research be conducted on detailed demographic analyses to better understand societal responses to policy. Furthermore, it is important to identify the long-term effects of early disease interventions to better estimate future care needs. In addition, it is crucial to reconsider the current policy proposal and conduct extensive research on its potential effects to ensure that policy goals are achieved without undermining solidarity.

The findings of this thesis contribute to the broader debate on the future of the Dutch healthcare system by emphasizing that policy choices around the deductible should not only be financially feasible, but also fairly and sustainably aligned with the fundamental values of solidarity and accessibility in healthcare.