It is up to the doctor to say 'no' more often to preventive actions and pointless checks

The decision by the Dutch Healthcare Institute last week to remove so-called Parp inhibitors for cancer patients from the basic package is correct and could herald the start of more considered choices to curb the costs of the basic package.

In most patients, it turned out that Parp inhibitors did not work, while they did cause side effects and cost 30 million euros in one year for 944 patients. Only patients with a certain gene mutation benefited from the inhibitors; for them, they will continue to be reimbursed. And rightly so.

Healthcare has been known for more than twenty years to be increasingly expensive. Demand is increasing because people are living longer than before and are surviving more serious illnesses, but are remaining patients for a long time. This will continue for a while: in 2040, a quarter of the population will be between 65 and 99 years old.

In addition, doctors apply a lot of preventive medicine, with check-ups (consultations, blood tests, scans, ultrasounds), in which the patient is happy to participate and sometimes even insists on it. As the chair of Medisch Specialist 2035, Esther Cornegé, said in NRC last week : "We were always very cautious, safe. Because what if that one patient says: 'You should have checked this according to the guideline, but you missed it' and then sues you? Then you're in trouble."

And then there is the ethics: doctors sometimes prescribe drugs that may be life-saving but will certainly be burdensome for the patient. Few patients say no, and they cannot be expected to. They hope that the side effects of the drug will be worth it, even if it is only a few months of life.

Overtreatment of the elderly has been a topic of discussion for years , but it keeps happening. No one expects an 89-year-old patient who has fallen to need a brain scan. Yet it happens. Every doctor will say that one elderly person is much fitter than another, and that is true, but minimal medical intervention should be the motto.

The only party that has an interest in reimbursement for drugs that do not work, or in excessive use of scans, is the manufacturer. Patients, premium payers and insurers do not.

The hospital often does too. The more treatments, the more money comes in. That sounds flat and hospitals are not profit-oriented companies. They usually use the proceeds wisely. But they do need income.

Some in healthcare advocate a completely different financing: only reimburse afterwards what has worked, so if the patient is better or a certain goal has been achieved. Therein lies the possible danger that complex patients do not qualify because they are seen as a financial risk.

If healthcare is to remain as accessible to everyone, regardless of their budget, as it is now, doctors will have to say 'no' more often. They find this difficult because their guidelines prescribe that they err on the side of caution. And patients hope that scans and tests prevent illness and that prescribed medication works.

Let it be the most learned physicians who write those guidelines per specialty. They can write 'no' in it. Less preventive actions and pointless checks, only prescribing medicines if there is a big chance that they will work.

It is up to them to change this. They can expect little from politics. For decades, politics has not dared to intervene in the ever-expanding basic package.