Just skip 2014, hopefully more luck in 2015!

By Nardo van der Meer | April 3, 2014 | 2 min read

Profiteer! This is the over-simplified term for everyone who earns more than the universally known norm: the salary of our prime minister. According to many, our country is bursting with profiteers!

By definition, a profiteer is someone who makes a lot of money at the expense of someone else and that makes us, justifiably, feel uncomfortable. Asking for money (and getting it) for useless work makes one a profiteer, and that goes for the health care sector as well. Something isn't expensive until you don't get what you paid for! Every discussion on salary – and this goes for the health care sector too - should not be about the absolute amount. It should be about what one does to earn the salary!As far as I am concerned, this is where the Pay for Performance (P4P), cost effectiveness and creating genuine value for the patient come in.

Opportunities for the health care sector

These times offer a huge opportunity for the health care sector. The opportunity to provide value to the patient. And what happens?

We discuss only one aspect (salaries in the health care sector) and we miss out on huge opportunities. Our health care sector involves around 93 billion euro's. More than a quarter of this is spent in hospitals and another 10 percent of that (2.5 percent on balance) goes to the fees of the directors and medical specialists. The Netherlands has 17,250 medical specialists, of whom around three-quarters are self-employed.That 2.5 percent is a lot of money, I do realize that, and we need to discuss that with an open mind.But it also shows that we can and must take very sensible cost-effective measures regarding 97.5 percent!

Lost year

The emphasis on the absolute salary leads to paralysis in the health care sector and has already made 2014 a lost year for creating value for the patient. Two concrete examples. Due to the Standardization Top Incomes Act, administrators cannot or will not give up their current position as he/she will then face a salary cut in a new position in the health care sector. This fear leads to defensive management. But what's worse: the performance of the administrator is not under discussion, his/her salary is.

Medical specialist

2015 As a result of the discussion ‘medical specialist 2015’ (60,000 Google hits!), there have been many discussion with self-employed medical specialists both inside and outside the care institution on the fiscal future (and therefore the income) of the medical specialist. I know from experience that three-quarters of all of the discussions within hospitals this year concern constructions that guarantee the independence of the medical specialist. And seeing that the ministry of finance only wants to review this development later on, this discussion will continue well into the year 2015. This takes a huge amount of time; time that is not spent on thinking about and implementing the creation of value for the patient.

Meaningful care

Within this framework, I would have preferred to have spent this time in 2014 on improving the (meaningful) care of the patient. Better doctors and nurses with better administrators that improve the cost-effectiveness of the organization. More concrete? That is a possibility: cancel all redundant and unproven care, stop pumping 5 million health care allowances around (5 million Dutch citizens pay an excess on the one hand, while receiving a health care allowance on the other) and drive back the 3.3 percent no-show at the outpatients' clinics of our hospitals! A few examples. This discussion on salary distracts us from the true question: what really benefits the patient? But perhaps we will have that discussion in 2015? This blog was also published on

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