Health economist Sander Boxebeld on the new government’s healthcare plans: “Watch who ends up carrying the heaviest burden”

More funding, but less per patient

Although healthcare expenditure is rising in absolute terms — the Ministry of Health is the second-largest increase in the national budget after Defence — this does not automatically mean there is more room within the system. Due to population ageing, demand for care is rising sharply. “In practice, there is less funding available per person in need of care,” Boxebeld explains. “That forces choices. But those choices will inevitably cause pain somewhere.”

Increase in compulsory excess: risk of care avoidance

The compulsory excess will rise from €385 to €460. According to Boxebeld, this is a striking political decision, particularly as the previous government had planned to reduce it. He understands the economic reasoning behind the excess — it is intended to discourage unnecessary use of care — but also sees risks.

“The danger is that people may avoid seeking care because they cannot afford the excess. Those on lower incomes are disproportionately affected, even if this is partly offset through healthcare allowances.” International research suggests that a higher excess is associated with lower healthcare expenditure, but the impact on health outcomes and accessibility remains a concern.

Sugar tax: effective but politically sensitive

Another measure is the introduction of a sugar tax. In light of rising obesity rates — projected by the National Institute for Public Health and the Environment (RIVM) to reach 62% by 2040 — additional action is necessary, according to Boxebeld. “Whether a sugar tax is effective depends heavily on how it is designed. If only sugar-sweetened beverages are taxed, the impact is more limited than if other products are included.”

At the same time, he points out that lower-income households may be disproportionately affected, as they spend a larger share of their income on food. Public support may increase if revenues are visibly reinvested in prevention or healthcare, for example through free fruit in schools or improved access to sports facilities.

Prevention does not automatically reduce healthcare costs

In public debate, prevention is often presented as a cost-saving strategy. Boxebeld nuances that view. “Prevention is socially valuable, but it does not automatically lead to lower healthcare costs. People live longer and will also use care in those additional years.” According to him, the government should be clear about the objectives of prevention: improving health, increasing labour productivity and strengthening social participation.

Ageing and workforce shortages: the real bottleneck

According to Boxebeld, the main challenge lies not only in financing, but in workforce shortages. “Recruiting and retaining sufficient healthcare staff is currently the biggest bottleneck. I see relatively few concrete plans addressing that.” 

The government aims to encourage older people to live at home for longer and to give communities a greater role in providing supportive care. While this aligns with social preferences, it also increases pressure on informal carers and hospitals.

In addition, there are proposals for a personal contribution for district nursing and a further separation of housing and care. According to Boxebeld, the key question is to what extent these measures will be income-related. “That is where an important question of solidarity arises.”

Careful implementation is crucial

Boxebeld stresses that many of the plans are still broadly formulated. Their ultimate impact will depend heavily on how they are implemented in practice. “The intention will not be to harm vulnerable groups, but the risk is real. That is why careful implementation is essential.”