Recently, I attended a very interesting meeting with health care managers. Its theme was ‘Innovation in quality and stabilising costs’. How do you do you go about this? I will focus on costs first. How do you keep them under control? A lively discussion ensued. Nevertheless, there was a general sense of unease and unwillingness about making costs the priority that they should be according to some. And there is no need to do so if you ask me.  Costs actually are a result of good management and control that focuses on prevention and quality of care. Costs are kept under control as a result of sound management. Governments with sound health care policies can easily save on health care expenses by promoting healthy lifestyles. We know that 60% of cancer cases can be prevented, and for heart failure this is more than 90%. Easy gains can for instance be made if five hours of sports were to be made obligatory for primary and secondary school children. Is this cruel? Of course not, you might say that we are now forcing them to live unhealthily. In more than half of households cooking has become a thing of the past. To give another example than smoking for a change. Quality enhancement in health care also leads to cost reduction. The Antoni van Leeuwenhoek hospital operates very efficiently and effectively and has been the best cancer institute in the Netherlands for years. It proves that the best care can be delivered quickly against the lowest possible costs.

A part of the medical-industrial complex benefits by high health care costs, however. This meeting brought together representatives of the health care industry, hospitals, research and the public sector, i.e. the medical-industrial complex. The body of forces around the patient that puts the interests of the patient first, but whose actions do not necessarily benefit the patient. I do not believe that there is any evil intent, but it is a consequence of the interaction between the different stakeholders. Former health minister Ab Klink confirmed this in his talk: ‘a 1 euro investment in health care gives a return of 1.3 euros’. He was quoting from research by Marc Pomp. The figures may be open to discussion, but health care clearly is a very interesting and lucrative sector to enter from a business point of view. Obviously, health care expenses will not drop if you ask the medical-industrial complex to cut costs.  You are in fact asking them to give up a part of their earnings, which they are seldom willing to do. Again, there is definitely no evil intent, but together we are upholding a system that wants to deliver more care and needs more patients. The unhealthy lifestyle promoted by the government is guaranteed to boost turnover and margins.

The solution is fairly obvious: put the patient at the centre of the complex and discuss all interests openly. There is nothing wrong with industry making a profit, and with serious concerns about employment and incomes at hospitals and in research, and there is nothing wrong with public servants being dependent on these parties. But interaction should be on an equal basis together with patients to champion the interests of this group and achieve better policies and management this way. Will the medical-industrial complex have the guts to include patients as equal negotiating partners and policymakers in their midst? The good news is that this is slowly beginning to happen, but not fast enough to my mind. I’m structurally dissatisfied as tomorrow there will again be thousands of patients knocking on the doors of care providers in the Netherlands and we need to make haste. Act first and then think. We’ve been deliberating long enough. Patients know very well what to do. In our Inspire2Live group we have 35 motivated and highly educated patient advocates who are very much aware of what’s going on and what to do about it. Make the complex complete and embrace these advocates is what I say. This will be to everyone’s benefit.