In the past few weeks, healthcare dominated the agenda of the Dutch House of Representatives. Cabinet announced various (new) measures with far-reaching consequences for the industry and patients. Furthermore, Parliament debated medical prevention, medicine and medical devices policy and management of the health insurance package.
However, these developments received little attention: (trade) media hardly reported on them, the committee debates were barely visited, and the drug debate ended 90 minutes earlier than planned. With the announced changes to the Drug Reimbursement System (Geneesmiddelenvergoedingssysteem – GVS) and the negotiation scheme for expensive medicines, or ‘waiting room mechanism’ (Sluis), one would expect the House and field parties to be at full speed. In practice, MPs debated certain specific issues, while other measures with major consequences were left undiscussed. Since the stakes for the industry are substantial, it is crucial for them to have their voices heard in the debate. Yet, it is the patient’s voice that seems to determine the political agenda.
Who is being heard…
Members of Parliament are especially responsive to concrete appeals from those who are directly affected by proposed policy measures. In the run-up to the debate, several patient associations spoke out against Minister Kuipers’ recent decision (Healthcare) to exclude vitamin D from the basic health insurance package. They did so successfully. During the debate, several parties echoed this narrative.
A similar sentiment by the patient was heard in relation to a pilot study which made the HIV inhibitor PrEP available to groups at high risk of HIV infection. Again, the appeal for this issue came from a vulnerable group in society. Two days prior to the debate on drug policy, a petition from SOA-AIDS Nederland (an advocacy group) called on the House of Representatives to make PrEP more widely available. Under the current pilot there is a large group of people on a waiting list do not have access to PrEP. Under pressure from the House of Representatives, Cabinet promised to include as many people as possible from the vulnerable group within the current budget.
… and who is not?
Other, more technically complicated topics, such as the proposed modernization of the Drug Reimbursement System (GVS), were mainly addressed in a round of written questions prior to the debate. This modernization should bring down government expenditure by €140 million. Though some organizations indicated that patients will be affected as a result of this proposal, MPs discussed this topic less than vitamin D or PrEP.
The fact that not all the concrete consequences of the (GVS) modernization have been mapped out yet does not help the case of the parties opposing the modernization. It remains unclear which drugs are involved exactly and who “the patient” is. As a result, the debate now focuses more on the point of view of medical professionals and the industry, which may make it less attractive for the House and the Cabinet to engage in debate on these issues. Even more so when there is barely any attention from the media and the public.
Find the patient’s voice
The debate about drug policy and the various policy intentions are still to be continued and will be fleshed out in the coming period. The House of Representatives will remain interested in the patients’ perspective. During the upcoming summer recess, it is essential for industry parties to take stock of the concrete consequences of proposed policies and where their effects will be felt the most. Refining the narrative and involving patients could help regain ‘The Hague’s’ attention. In any case, the field has to be more creative in how to get their issues back on the agenda in The Hague.