The chairman of the board of the largest hospital in the Netherlands and chairman of the interest group for centers for acute care, Ernst Kuipers, will become Minister of Public Health for D66. The chairman of the board of an institution for long-term care and chairman of the interest group for administrators in long-term care, Conny Helder, will become minister of long-term care for the VVD. Two directors who make the transition from one side of the negotiating table to the other: from advocate to minister.
It once again makes clear how closely intertwined interest groups are with Dutch politics. If it is new politics to make representatives of interest groups ministers, you have to ask yourself whether we should not go back to the old politics.
For former ministers, the rule applies that after their term of office they are not allowed to act as a representative at the ministry for which they were responsible for two years. Conversely, this does not apply: advocates can become ministers without any problem in the department where they previously lobbied.
The evaluation of the corona policy will come soon
Both Ernst Kuipers and Conny Helder have played an important role as advocates in tackling the corona pandemic. Kuipers stood up for the interests of hospitals, Helder for those of long-term care. This also makes both appointments politically risky.
In the spring, the Dutch Safety Board will evaluate the policy during the first months of the corona pandemic. It is very well possible that the Dutch Safety Board is critical of the influence of interest groups on corona policy. This could put both ministers in trouble.
Consider, for example, the fact that in the early days of the pandemic all protective equipment – such as mouth masks and protective clothing – were claimed by hospitals and were not available for nursing homes and home care. The Dutch Safety Board could clarify what role the association of hospitals had in this decision and why the interest group for long-term care, Actiz, of which Conny Helder was chairman, agreed to this.
Kuipers served the large academic hospitals
It is good that after more than four years, ministers are coming back with knowledge of healthcare, but the vision that both ministers have on healthcare is strongly colored by the positions they have held and the interests they have represented.
The trade magazine Healthcare vision gave an overview this week of Ernst Kuipers’ vision on the future of hospital care. Kuipers is in favor of concentrating complex care in a limited number of large hospitals, he believes that the number of emergency rooms should be reduced, all medical specialists should eventually start working as an employee of the hospital, just like in academic hospitals, and the number of IC beds in hospitals should be expanded.
These are views that are mainly in the interest of the large teaching hospitals and not of the smaller general hospitals where most medical specialists work as independent entrepreneurs. It is a vision that suits a chairman of the board of the Erasmus Medical Center. A Minister of Health, Welfare and Sport may be expected not only to serve the interests of the large academic hospitals, but also to conduct policy in the interest of the patient and the entire healthcare system.
Healthcare expenditure may rise less than necessary
In the media, Kuipers’ appointment has been compared with that of Els Borst in the 1990s. Both members of D66, both doctors. The comparison is justified, but for a different reason than expected. In the first Kok cabinet, where Els Borst was Minister of Health, health care expenditure was only allowed to increase by one and a half percent per year. That was not enough to absorb the growth in healthcare demand. The result was that waiting lists increased enormously during the Kok cabinet. The waiting lists also increased dissatisfaction among the population with regard to care. In The ruins of eight years of Purple Pim Fortuyn has described this dissatisfaction in detail.
Something similar will happen in the coming cabinet term. An additional 15 billion euros will be needed over the next four years to meet the increasing demand for care due to the aging population and the rising costs associated with the use of new medical technologies. However, the Coalition Agreement stipulates that health care expenditure may only increase by 9 billion in the coming years. That is less than is needed to absorb the aging population and also a lot less than the growth in health care expenditure during the last government term.
Even less growth
This tight budget policy for healthcare means that Minister Kuipers will spend a lot of time making agreements with hospitals, general practitioners and mental healthcare to keep the growth in healthcare expenditure within the limits of the coalition agreement. Whether this will succeed is the question.
The hospital administrators, of whom Ernst Kuipers was one until recently, are already complaining that the growth in health care expenditure in the past cabinet term was too little to remain financially healthy as a hospital. Kuipers will have to convince them that they will have to settle for even less growth in the coming years.
Opposition didn’t get it
During the debate on the coalition agreement, the opposition parties did not realize that the growth in health care expenditure was less than necessary to meet the increasing demand for care. The opposition parties talked about ‘austerity’ in 2052, but overlooked the lagging growth in spending during this cabinet term.
When ChristenUnie party leader Gert-Jan Segers interrupted and said that expenditure would increase by 9 billion euros in the coming years, the three left-wing party leaders Ploumen, Klaver and Marijnissen had no defense against it. Nowhere in the coalition agreement is it mentioned that the organic growth in health care expenditure is much lower than previously estimated by the Central Planning Bureau.
No extra salary increase for healthcare staff
This cabinet is not a marriage made out of love, it is a must. In a marriage of convenience, the parties will strictly adhere to the agreements made. For ministers, this means that they will mainly have to complete the bullet points from the coalition agreement. Deviating from the agreements made will be difficult.
And the bullet points of the coalition agreement contain a number of things that will be difficult for the new ministers of VWS. For example, the coalition agreement does not state that there will be money for an extra salary increase for healthcare staff. For the unions, the extra salary increase promised by the cabinet during the General Reflections was only the beginning of closing the pay gap with the business community.
During the General Considerations, the cabinet promised 675 million for an extra salary increase. The trade union for healthcare personnel NU’91 demands 2.5 billion for salary increases and reduction of work pressure, the FNV believes that 2.25 billion is needed. As director of Actiz, Conny Helder also argued for higher salaries for healthcare staff. Now she will have to convey the message that no money has been included in the coalition agreement for an extra salary increase.
Longer waiting lists
Minister Helder will also have to convince her former fellow board members that vulnerable elderly people should be admitted to a nursing home less quickly and should receive more nursing home care at home. This change will undoubtedly meet with resistance from nursing home administrators and from relatives of elderly people with dementia who have to live at home longer. The waiting lists for admission to a nursing home are often long, but they will only increase due to the policy that Minister Helder must implement.
Ernst Kuipers and Conny Helder will have to jump over their shadow of advocates and, as ministers, make decisions that they would probably have been vehemently opposed as advocates in healthcare.
Wim Groot is professor of health economics in Maastricht. For Wynia’s Week, he regularly reviews government policy. Do you find this clear reporting essential, also in 2022? You can donate to Wynia’s Week HERE Thank you!
–
