Can the discount be canceled for all people with chronic diseases? “This is really a political issue.”

One of the main issues during formation: the opponent. The Freedom Party wants to get rid of him as quickly as possible, but other options have also been mentioned. Such as canceling it only for chronic patients. We asked experts about the possible consequences.

Radio 1's Spindoctors podcast discussed this briefly. Political scientist Julia Waters has come up with an interesting proposal: eliminate the deduction only for chronically ill people. “This is possible and manageable,” she added.

Allowed by law

And she has a point there. Eliminating the deductible for a certain group is certainly an option, health care expert Xander Coleman tells us. “This is already permitted by law, including for chronically ill patients.”

But “chronic illness” is a broad concept. According to figures issued by the research agency Neville, 60% of the Dutch suffer from a chronic disease. But not all of these people automatically bear their own risks regarding health care costs. So, you shouldn't cancel the discount for all of these people, Coleman says. “Some of them do not incur a lot of healthcare costs each year and are therefore not tied to the €385 deductible.”

It's hard to define

Saying it's “easy to manage” – as Waters said on the podcast – is too easy, according to Martin Boysen, professor of health law at Erasmus University. For example, it does not seem easy for him to determine when someone has a chronic disease and what exactly a chronic disease is.

“Does this have to be a statement from a doctor? If you are diabetic, it is clear. You are constantly dependent on insulin, for example. If you have asthma, it is also clear. But if you have allergies, for example.” If you only suffer from it in the spring, do you have a chronic disease or not? “This seems to be a point that will not be easy to determine.”

Financed by health insurance premiums

Boysen realizes that eliminating the discount for people with chronic diseases would cost money. “Because health care is paid for through health insurance premiums, it has to increase. That's a given,” he says. “The question is: How much will these premiums go up?”

And Coleman has an answer for that. He says that eliminating the discount for people with chronic diseases alone would cost about 2 billion euros. “Health insurance premiums should then increase by approximately €150 per year for all over 14 million Dutch adults.”

Sharing collective burdens

Coleman says the goal of the opponent is to find balance. “Between the burdens we collectively share and the costs borne by the health care user, who consumes health care themselves.” If the discount for chronic patients is eliminated, it will incur further costs for the entire population. “Because that money has to come from somewhere.”

So the shift in costs. “Whether that's desirable or not is really a political question,” Coleman says. The health care economist says the arrangement won't change anything about the group's use of health care. “Healthcare consumerism exists anyway.”