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Dutch government announces large cuts in health spending
MEDICINE AND HEALTH POLICY
MEDICINE AND HEALTH POLICY
WHO targets measles and hepatitis B in Western Pacific he elimination of measles and hepatitis B has been targeted as the next double goal for the 37 states and regions comprising WHO’s Western Pacific region. The twin goals were announced at the 54th regional committee meeting of WHO’s Western Pacific
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region at the organisation’s regional headquarters in Manila (Sept 8–12). The meeting of about 200 delegates, including 16 health ministers, was held to review WHO’s programmes and activities over the past 5 years and to set out the roadmap for the next 5 years.
PA Photos
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
The goals will be achieved through the Expanded Programme on Immunisation, established in 1974. Of 25 million children estimated to have been born in the region in 2002, about 5 million have not received the recommended measles vaccine or the three doses of diphtheriatetanus-pertusis vaccine, delegates at the meeting were told. In addition, routine immunisation for hepatitis B will have to be strengthened since only about 60% of children in the region receive three doses of the vaccine. Shigeru Omi, WHO Regional Director for the Western Pacific, said: “Measles elimination and hepatitis B control are feasible but this will require a high level of political commitment and sufficient funding.” WHO also promised greater efforts to reach groups that are at high risk groups of HIV/AIDS, which has now infected about 1·2 million people in the area. The region also was
warned it could not reduce the under-five child mortality rates by two-thirds by 2015 unless efforts were made to scale up interventions. More than 1 million children in this age group die each year in the region. Omi, who was nominated for a second 5-year term as regional director, set out three priorities for his own governance. These are: “to pick up the people who have been left behind” by regional efforts to fight diseases such as tuberculosis and malaria; “to gear up our health programmes to face the enormous challenges beginning to threaten our countries”; and “to put the heart back into medical practice”. “It will need commitments from all concerned—from WHO, from the health-care sector and from governments”, he said. “But I believe that if we work together, we can make this happen.” Mary Ann Benitez
Dutch government announces large cuts in health spending he Dutch government last week proclaimed large cuts in health spending. The new centre-right coalition is planning €2·3 billion (US$2·6 billion) of savings, bringing the health budget for 2004 to €41·2 billion. Minister of Health Hans Hoogervorst said cuts were necessary because health costs have increased too quickly the past few years—from €28 billion in 1999 to €38 billion in 2002. “Our health system must also stay tenable in hard times. That’s why we have to take action now”, he said. “We can only solve the problem of rising costs by increasing the own responsibility to patients, clients, and care professionals substantially.” Patients will contribute €1·3 billion to the savings: public health insurance will no longer cover the costs of physiotherapists and dentists for adults;
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of the first in-vitro fertilisation treatment; of the contraceptive pill for women older than 21 years; and of taxi transport of sick people to the doctor. Psychotherapy will be limited to 30 treaments, and the insured will be charged €1·70 for every prescription. Almost 50% of the €1 billion of savings within the health sector itself will be financed by reductions in pharmacists’ wages. Other measures are: wage restraint, reduced sick leave, and spending limits on home care. Dutch health organisations reacted mainly negatively to the cuts. The Royal Dutch Medical Association (KNMG) agrees that the health sector should take more responsibility for the quality and efficiency of health care, but says that the proposed measures do not show “a vision of the future that exceeds the level
of the accountant”. The KNMG expects the policy will have a “disastrous effect” and “weakens the position of the patient”. The KNMG also said “the measures will worsen the working conditions and terms of employment of doctors. Pressure of work on doctors will increase unacceptably, which will decrease the attractiveness of the profession.” The Dutch Association of Gynaecologists (NVOG) said the measures are “antifemale” and “will eventually increase health costs”. The NVOG expects that removing the pill from insurance cover for women older than 21 years will lead to more unwanted pregnancies and more abortions. Frank van Kolfschooten
THE LANCET • Vol 362 • September 27, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet.
MEDICINE AND HEALTH POLICY
WHO targets measles and hepatitis B in Western Pacific he elimination of measles and hepatitis B has been targeted as the next double goal for the 37 states and regions comprising WHO’s Western Pacific region. The twin goals were announced at the 54th regional committee meeting of WHO’s Western Pacific
T
region at the organisation’s regional headquarters in Manila (Sept 8–12). The meeting of about 200 delegates, including 16 health ministers, was held to review WHO’s programmes and activities over the past 5 years and to set out the roadmap for the next 5 years.
PA Photos
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
The goals will be achieved through the Expanded Programme on Immunisation, established in 1974. Of 25 million children estimated to have been born in the region in 2002, about 5 million have not received the recommended measles vaccine or the three doses of diphtheriatetanus-pertusis vaccine, delegates at the meeting were told. In addition, routine immunisation for hepatitis B will have to be strengthened since only about 60% of children in the region receive three doses of the vaccine. Shigeru Omi, WHO Regional Director for the Western Pacific, said: “Measles elimination and hepatitis B control are feasible but this will require a high level of political commitment and sufficient funding.” WHO also promised greater efforts to reach groups that are at high risk groups of HIV/AIDS, which has now infected about 1·2 million people in the area. The region also was
warned it could not reduce the under-five child mortality rates by two-thirds by 2015 unless efforts were made to scale up interventions. More than 1 million children in this age group die each year in the region. Omi, who was nominated for a second 5-year term as regional director, set out three priorities for his own governance. These are: “to pick up the people who have been left behind” by regional efforts to fight diseases such as tuberculosis and malaria; “to gear up our health programmes to face the enormous challenges beginning to threaten our countries”; and “to put the heart back into medical practice”. “It will need commitments from all concerned—from WHO, from the health-care sector and from governments”, he said. “But I believe that if we work together, we can make this happen.” Mary Ann Benitez
Dutch government announces large cuts in health spending he Dutch government last week proclaimed large cuts in health spending. The new centre-right coalition is planning €2·3 billion (US$2·6 billion) of savings, bringing the health budget for 2004 to €41·2 billion. Minister of Health Hans Hoogervorst said cuts were necessary because health costs have increased too quickly the past few years—from €28 billion in 1999 to €38 billion in 2002. “Our health system must also stay tenable in hard times. That’s why we have to take action now”, he said. “We can only solve the problem of rising costs by increasing the own responsibility to patients, clients, and care professionals substantially.” Patients will contribute €1·3 billion to the savings: public health insurance will no longer cover the costs of physiotherapists and dentists for adults;
T
1048
of the first in-vitro fertilisation treatment; of the contraceptive pill for women older than 21 years; and of taxi transport of sick people to the doctor. Psychotherapy will be limited to 30 treaments, and the insured will be charged €1·70 for every prescription. Almost 50% of the €1 billion of savings within the health sector itself will be financed by reductions in pharmacists’ wages. Other measures are: wage restraint, reduced sick leave, and spending limits on home care. Dutch health organisations reacted mainly negatively to the cuts. The Royal Dutch Medical Association (KNMG) agrees that the health sector should take more responsibility for the quality and efficiency of health care, but says that the proposed measures do not show “a vision of the future that exceeds the level
of the accountant”. The KNMG expects the policy will have a “disastrous effect” and “weakens the position of the patient”. The KNMG also said “the measures will worsen the working conditions and terms of employment of doctors. Pressure of work on doctors will increase unacceptably, which will decrease the attractiveness of the profession.” The Dutch Association of Gynaecologists (NVOG) said the measures are “antifemale” and “will eventually increase health costs”. The NVOG expects that removing the pill from insurance cover for women older than 21 years will lead to more unwanted pregnancies and more abortions. Frank van Kolfschooten
THE LANCET • Vol 362 • September 27, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet.