Trends in public health care in the Netherlands

Life expectancy continues to rise, but at a slower pace than in the past 10 years

The life expectancy of Dutch men is 79 years, making it one of the highest in the European Union. Women live to an average age of 83. They average ten averages of other European women, because they smoked relativily much in the past. Life expectancy in the Netherlands has risen sharply in the last 10 years, by more than three yerars. This development could largely be insured against prevention and health care. Deaths from coronary heart disease and strokes in particular fell sharply. According to the trend scenario, life expectancy will continue to rise, albeit less difficult than the past 10 years: between 2012 and 20030, Dutch men will gain 3 years and women more than 2 years. Compared to other countries, the Netherlands remains at around 6th place.

Socio-economic differences are large and may become larger

Life expectancy is on average 6 years shorter for the lower educated than for the highly educated. For life expectancy in good perceived health, this diference is 19 years. These differences have remained about the same for the last 10 years. We expected the differences to widen in the near future. Many of the effects of the recent economic recession, such as unemployment, are only now being felt and are mainly affecting people with a low level of education and other vulnerable groups. Wheter and how this trend will continue in the long term is uncertain.

Mental disorders, cardiovascular disease and cancer are responsible for most of the burden of disease

Mental disorders, cardiovascular disease and cancer are responsible for the largest burden of disease. Within these main groups, coronary heart disease causes the highest burden of disease, followed by diabetes mellitus, stroke, anxiety disorders, COPD (chronic bronchitis and emphysema), lung cancer, mood disorders, and neck and back problems. The burden of disease is high if the disease occurs frequently, lasts a long time, is relativily severe and/or causes high mortality. According to our projections in the trend scenario, coronary heart disease and diabetes are still the diseases with the highest disease burden in 2030. The disease burden of infectious diseases is curently low. The future is uncertain. New infectious diseases may emerge. In addition, more and more bacteria are resistant to antibiotics in the future.

Smoking is the main cause of disease and death

Smoking is by far the most important cause of death and disease (accounting for 13 % of the burden of disease), followed by overweight, little exercise and an unhealthy diet. The percentage of  adult smokers is falling and, according to the trend scenario, will fall further, from 23% in 2012 to 19% in 2030. For overweight, the long-term increase seems to be coming to an end for the time being. The percentage of overweight people remains high (48%). One in three Dutch people move little and this will also be the case in 2030. In addition to lifestyle, the social and physical environment are also important for the development of disease. For example, unfavorable working conditions and environmental factors each contribute approximately 5% tot 6% of the burden of disease. However, the environment can also lead to better health, for example by making public spaces more attractive for cycling, sports and outdoor games.

The number of elderly people will rise to a quarter of the population in 2030

Demograpic developments are one of the main drivers of public health trends. The age structure of the Dutch population in particular is changing strongly. The proportion of over-65s rose from 14% in 2000 to 16% in 2012 and will increase further to 24% in 2030. There are also changes wihin the group of elderly people over 70, while the 80-year-old of 2030 will probably be healtier than the 80-year-old of today.

The number of people with a chronic illness is increasing, limitations are stable

Partly due to the aging of the population, the prevalence of most diseases has increased in the past decade and this increase is expected to continu. Early detection of diseases plus better treatment means that people live longer with disease. In total, we expect the number of people with a chronic disease to rise from 5.3 million in 2011 (23% of the population) to 7 million in 2030 (40%), with the number of people with two or more conditions (multimorbidity) also will increase. The aging population and the increase in the number of chronic diseases in the population have not led to more people with disabilities in recent years; this number wil also remain approximately the same in the future.

Most chronically ill patiens participate, especially limitations hampering

About 80% of the 20-65 year olds wihout illness have a paid job of 12 hours or more. People with a chronic illness work less. However, this is especially true for those who also have limitations (40% work) or who rate their health as less good (49 work). Two-thirds of the 20-65 year-olds with a chronic illness have no limitations and assess their own health as good. This group has a paid job almost as often as the non-chronically ill (77%). It is therefore not so much the diagnosis that determines labor participation, but rather the percieved limitations and perceived health. This also aplies to volunteering.

New older employee is more educated and less limited

The number of 20-65 year-olds will decrease between now and 2030. However, the potencial working population will remain the same, at approximately 10 million people. This is due to the gradual increase in the retirement age to 68 years in 2030. In 2030, approximately 0,7 million of the potencial working population will be between 65 and 68 years old. This new working population differs from the current 65-68 year olds. They are much more highly educated (28% of this age group has then completed a higher or university education), have fewer limitations, but more often have one or more chronic diseases.

More emphasis on self-management, but not everyone is equally self-sufficient

Trends show that there are more and more chronically ill people, who live longer, feel healty more often, do not always have limitations and often participate in society. This means that there is an enormous variety within the large group of chronically ill people. A medical diagnosis seems to be less and less important for health and participation. The ability to adapt and take control becomes more important. Most people with a chronic illness prefer to keep control over their illness and care. However, some of the chronically ill, especially the elderly, singles and people with complex problems or physical limitations, cannot do without help. They need support that matches their abilities and wishes.

Health care use has costs and benefits

In 2012, we spent 83 billion euros on healthcare according to the definition used by the Central Planning Bureau in its analyzes of healthcare expenditure. This is almost 5,000 euros per capita and 14% of the gross domestic product. The use of health care not only leads to costs, but also to substantial benefits. A large part of the increase in life expectancy can be attributed to curative and preventive care. The quality of care in the Netherlands is also high in terms of patient satisfaction and accessibility.

Most of the money goes to care for cardiovascular disease and mental disorders

Most of the money goes to care for patients with cardiovascular disease, other psychological disorders (such as chizophrenia, depression and alcohol dependence) and intellectual disabilities. Health care expenditures for cancer, diseases of the nervous system and sensory organs and metabolic diseases rose reativily quickly. These are diseases that mainly occur in the elderly, so that the effect of aging is relativily strong. In addition, many new, relativily expensive medicines have become available for diseases in these groups in recent years.

Healthcare expenditures continue to rise, but uncertain how fast

Between 2000 and 2012, healthcare expenditure rose by an average of 4 tot 5% per year (at constant prices), with growth being lower in recent years. As a percentage of gross domestic product (GDP), health care expenditure rose from about 10% to almost 14% during this period. If this trend were to continue, expenditure on health care would increase to approcimately EUR 150 to 170 billion, or 19 to 21% of GDP in 2030.

(Source: National Institute of Public Health and Environment, Dutch Ministry of Health, Well-being and Sport)

 Prevention is better than to Cure