Health still lacks a business case

The healthcare industry is under pressure. Too expensive, too many patients, too few healthcare professionals. To avoid a bigger crisis, we can only turn one important knob: prevention. In other words, how do we ensure that people get and stay healthier? A simple question with no easy answer. NOM sought those answers on Nov. 14 during the Prevention in Healthcare Roundtable. Guests with different perspectives discussed solutions to drive the much-needed transition.

''Do you seriously want to do something for people's health? Then you shouldn't study medicine.'' Hatzee. Professor of Economics of Public Health and director of Lifelines Jochen Mierau throws him in nicely. His point is that most of the gains can be made outside the healthcare sector. Get people to live healthier lives and you make much bigger strides. That's exactly what this Roundtable discussion is about. Because: how do we do that? Who is in charge? And is there any money to be made in prevention?

To start with the latter: that's tricky. In fact, for NOM, it's the reason why it's convening this conversation. Director Dina Boonstra: ,,We all know how important the transition from care to health is. Yet we hardly meet any entrepreneurs who are working on prevention. That is strange. We want to know why that is and what we can do to change it.''

It's not that strange, after all. In practice, it is almost impossible to make a balanced business case around prevention. Financiers demand that there be prospects for making profits. And there usually isn't. At least, not in the old-fashioned sense of the word. Because there are plenty of profits to be had, but in the form of social gains according to this order: Entrepreneurs invest in prevention - people stay healthy longer - healthcare costs to society decrease. And also for entrepreneurs, who have to pay out less sick pay.

Working on all problems

So that's where the crux lies somewhere, in the revenue model, in turning those societal benefits into cash. Nick Cramer, the host of this Roundtable discussion, puts it in a woodcutting statement. ,,The benefits of innovations around prevention end up in a different place than the burdens. For that reason, the healthcare system as we know it remains in place.''

So if we are serious about changing the way we deal with care and health, that system will have to be drastically changed. Cramer is busy doing just that. He calls himself Zorgveranderaar and runs the Leefstijlstraat in Emmen, the place where this afternoon - amidst various attributes to work on your fitness - will be discussed. He is convinced that an unhealthy lifestyle is an outcome of other problems. Think poverty, debt, addictions, loneliness and more. If we want to do something about health, we have to work on all those problems.

Then the question is, how are we going to pay for it and who will pay for it? Essentially, we are all paying for it now in the form of taxes and health care premiums. If we now invest in the health of people and all the layers below, we will end up being cheaper. Or at least we will then keep healthcare costs in check. But that's a long payback period. Too long, for economic laws as entrepreneurs know them. Again: there's usually no nice business case to be made.

This is also recognized by Nienke van der Meulen, manager of Strategy and Proposition at health insurer De Friesland. It is simply difficult to free up money for prevention. ,,That is the weakness of our system. It is production-driven. We are only marginally experimenting with outcome funding.'' By this she means that the insurer pays if people do not become ill thanks to certain lifestyle interventions.

Read all about the NOM Prevention Challenge here

From repair to prevention

Yet therein lies the egg of Columbus. Budgets that currently go to 'repair' must shift to 'prevent'. To make that happen, all parties must take up the gauntlet. Government, healthcare, business, all of them. ''That's not so difficult. It's a choice,'' believes Jochen Mierau. ''We have a legal right to care, but not a legal right to health. Once we regulate that, business cases will arise. Then entrepreneurs will have to change and new entrepreneurs can jump into the gap.''

The world is still skewed right now. The entrepreneurs who make us sick (tobacco industry, ultra-processed food producers, soft drink makers and so on) make money from it. So do the companies that make us better again, the pharmaceutical companies. Mierau: ,,If we as a society choose to go for more health, then we are eliminating those two powerful industries. And they won't let that happen overnight. Just look at how the sugar tax slowly but surely disappeared from the health care agreement. That's rock-hard lobbying.''

It takes guts to put that lobby aside and choose what's good for people, and for not increasing health care costs further. It can be done, says Mierau. ,,We have laid down by law how much salt can be in bread and how much fat can be in milk. We can do the same with sugar, with carbohydrates, with ultra-processed foods. You can choose to firmly price producers who use more than a certain amount of those substances. That would also be fair, because then the cost of unhealthiness would be borne by those causing it. As a result, most producers would then fall below that level. And that's where you want to go.''

This is where the role of entrepreneurship comes into play. With new regulations comes a new playing field. ''Entrepreneurs can drive the transition by developing products and services that fit into that new playing field,'' says Els Reeuwijk. She is an expert when it comes to innovation in healthcare and is involved in the Integral Care Agreement in Drenthe. She is not just talking about nutrition, but about all innovations that help people live a healthier lifestyle. ''A new way of funding is needed for that, which doesn't just look at financial gains, but rather at social benefit.''

That funding is typically something NOM deals with. Dina Boonstra recognizes this need to look at things differently. ,,For us this is also difficult, which is why it is so important to hear these opinions here. But I want this to be looked at better, also by us. You have old legislation, and then there will be a transition that leads to a point around which there is no new legislation yet. We need to use that regulatory space, not dismiss it as an impossibility. When it comes to prevention, we see that there is a great need, but not yet a market in the old sense of the word. We are there to help create that market.''

Economic hoop

That this is necessary, Anton Knipper knows. He developed a tool to train memory, he says from his seat in the audience. ,,I set up my startup to help people, to detect dementia early and support keeping memory up to date. But I had to jump through an economic hoop for funding and it didn't work out. The business case wasn't there. So I turned the business around and now I train lawyers using more or less the same tool, which helps them do their jobs better. Somehow, of course, that's not what you want.''

Kai Yiu Ho has a similar experience. Working as an interventional radiologist, he saw long ago that his patients' vessels benefit more from a healthy lifestyle than from medical interventions and decided to work on that. ,,That went great, we had good results. Until the hospital director said that the system we had developed was too expensive and was also saving us income from medical interventions. The plug was pulled. That's how it works.'' Under the name Dr. Healthy, he now helps individuals eat and exercise more healthily via a sophisticated platform.

Here you see how the old world thwarts the new. The helm must be radically changed. Social profit must take precedence over a balanced business case. At least for the time being. Because entrepreneurial opportunities abound. We are on the way to a new world in which health is the starting point, and care is no more than a resort. Can't be helped, because as things are now, we won't make it much longer.

''Those who bet on producing healthy food now, those who bet on innovations that improve health, they may well be the winners of later,'' Jochen Mierau surmises. ''We are at the end of a system and a new balance is taking its place. Then this is the chance to get ahead and cash in on opportunities.'' Dina Boonstra: ,,Whoever has good ideas should definitely come to us. We want to think along.''

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