Which treatment expenses should and shouldn’t be covered by the basic health insurance package? And which role do the patient’s burden of disease and age play in this decision-making process? Dr Vivian Reckers-Droog delved into these and other questions in her dissertation Giving Weight to Equity: Improving priority setting in healthcare.
What’s your dissertation about?
“I’ve researched how healthcare actors decide which new treatments are funded within their public healthcare system. Which treatments are covered by the basic health insurance package? And which criteria are adopted in this context? What’s important is that the choices made actually contribute to an efficient and equitable disbursement of the healthcare budget. In the Netherlands, this efficiency is determined on the basis of cost-effectiveness and to which extent the decision does justice to patients’ burden of disease.
“For example, we recently gained a new treatment for a rare disease that costs 1.9 million euros per treatment. The question at that point is whether this treatment should be paid from taxpayers’ money. As a country, our touchstone for determining whether costs should be considered prohibitive is the burden of disease. The worse shape a patient is in, the higher we’re prepared to set this limit. An infected toenail shouldn’t cost too much, in other words. I’ve also examined whether this policy reflects equity considerations found in society, and which relation there is between these considerations and the patients’ burden of disease and age.”
What were your main conclusions?
“There’s considerable support for linking a treatment’s cost-effectiveness to a patient’s burden of disease. But what people may well find even more important is that cost-effectiveness is viewed in relation to the patient’s age. In other words, people find it important to take on board both how ill someone is, and how old. Even though in the Netherlands, age is explicitly ruled out as a criterion for patient selection – we have ethical objections. But there’s still a relationship between the method used for calculating the burden of disease and age: in reimbursement decisions for elderly patients, this burden is given a higher relative weighting.
“So one of my conclusions is that you will have to do something with these preferences – by incorporating them in your decision-making framework, for example. And even when you don’t feel the need to accommodate public opinion – giving every patient the same level of access to care – you would have to correct the current calculation model for burden of disease, since right now it discriminates in favour of older patients.”
Read the entire interview on Erasmus Magazine's website.
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This interview was published on May 26th on the website of Erasmus Magazine.