Discussie over ‘marktwerking’ in de zorg is weer losgebarsten. De aanleiding is een rapport van de Nederlandse Zorgautoriteit. Daarin concludeert de NZa dat zorg goedkoper is geworden. Tenminste, voor het gedeelte waarover ziekenhuizen zelf de behandelprijs mogen bepalen. Concurrentie is blijkbaar een effectief middel om de stijgende kosten van de zorg in de hand te houden. Dit stuit op veel weerstand en onbegrip. Maar waarom is er zoveel angst voor privatisering?
De media schetst privatisering en commercie als kwalitatieve achteruitgang. Toch zijn er in de private sector genoeg voorbeelden van mooie producten, maatschappelijke initiatieven en gezonde concurrentie. Denk hierbij aan de telecommarkt. Hoe prijzig zou het gebruik van de mobiele telefoon zijn als KPN het alleenrecht nog had? Of, hoe zou onze mobiele telefoon eruitzien, als alleen Nokia mocht produceren? Uiteindelijk zorgden open markt en concurrentie in de telecommarkt ervoor dat prijzen kelderden, netwerken verbeterden en telefoons werden doorontwikkeld.
Het argument dat de private sector alleen uit is op winst en dit niet rijmt met de ethische en morele plicht van de zorgsector is vreemd. Deze bijten elkaar namelijk niet. Apple maakt winst, maar heeft ook de intentie om een goed product te maken. De zorg is daarin niet anders. Sterker nog, artsen hebben nu ook een winstoogmerk. Hoe meer ze ‘produceren’, hoe meer ze verdienen. Terwijl de noodzaak om kwaliteit te leveren minder van belang is. Een kwalitatief uitstekende operatie wordt niet meer vergoed dan een redelijk uitgevoerde operatie. Juist nu mist de incentive om te innoveren.
Bron: biopsyreport.com
Wat gebeurt in de zorgsector is half werk. De markt wordt ‘vrij gegeven’ maar blijft gereguleerd en gecontroleerd door de overheid. Bij het vrijgeven van de Nederlandse Spoorwegen leidde dit tot een dramatisch kosten- en kwaliteitsplaatje. De NS mag winst maken, maar in de praktijk is de organisatie de enige aanbieder op het spoor. Gevolg is dat de incentive verdwijnt om de huidige manier van handelen te verbeteren.
Voor de zorg geldt hetzelfde. Ziekenhuizen mogen zelf prijzen bepalen voor een aantal behandelingen, maar uiteindelijk beslist de overheid voor het overgrote deel wat de vergoeding is. Ziekenhuizen hebben daardoor niet de speelruimte om te concurreren op kwaliteit en prijs.
Gelukkig is er ook goed nieuws. Er ontstaat variatie in zorgverzekeraars en keuzebesef bij cliënten. Zo zijn er verzekeraars met bodemprijzen, specialistische verzekeraars voor gelovigen en hoogsegment verzekeraars met complete dekking. Gevolg is dat consumenten steeds vaker overstappen en kritischer kijken naar het zorgaanbod. Met als gevolg: een gevoel van open markt, concurrentie en focus op de cliënt.
Nu de overheid nog. Zij moet het aandurven om de markt zijn werk te laten doen. Uiteindelijk zorgt dat voor verhoging van kwaliteit en verlaging van de groeiende kosten. Slechte ziekenhuizen hebben in een open markt geen bestaansrecht meer, kwalitatief goede ziekenhuizen worden beloond en door de drang om het beter te doen dan de concurrentie draagt het bij aan de innovatiekracht van de sector.
Om te zorgen dat de kwaliteit van zorg gewaarborgd blijft, hoeft de overheid zich slechts bezig te houden met drie simpele spelregels:
- Iedereen moet toegang hebben tot basiszorg en een zorgverzekering
- Concurrentie moet worden gewaarborgd en gestimuleerd
- Kwaliteitscontrole moet plaatsvinden op output
Met deze drie simpele spelregels is het mogelijk om de huidige gereguleerde privatisering vaarwel te zeggen, een gezonde sector op te bouwen en te garanderen dat in de toekomst zorg betaalbaar blijft.
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Investeerders hebben echter gezorgd voor een omwenteling in de vastgoedprijzen de laatste jaren. Zorg dat de woning goed gelegen is en dicht bij het openbaar vervoer snelwegen en faciliteiten zoals winkels restaurants cafes parken en sportfaciliteiten.
Vrijwel dagelijks lezen we in de media over ons nieuwe zorgstelsel meestal helaas in negatieve zin. Alles onderdeel van een waarschijnlijk zorgvuldig geregisseerd plan vanuit Den Haag om de macht van de artsen in te dammen ten gunste van anderen.
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