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Solidarity in the Dutch healthcare system: monitoring trends in willingness to pay.

Kooijman, M.P., Brabers, A.E.M., Jong, J.D. de. Solidarity in the Dutch healthcare system: monitoring trends in willingness to pay. European Journal of Public Health: 2018, 28(supl. 4) 349. Abstracts: 11 th European Public Health conference: Winds of change: towards new ways of improving public health in Europe, Ljubljana, Slovenia 28 November –1 December 2018.
Background
Increasing costs of healthcare are putting stress on solidarity principles in social health insurance in European countries. This could pose a threat to equal access to healthcare which can have negative consequences for national health. There have been policy changes to tackle rising costs which alter solidarity in the healthcare system and spark a debate on how resources should be distributed. Institutionalized solidarity principles rely on a broad societal support for equal access to healthcare. A decrease in public support might affect solidarity in healthcare systems.

Aim
The aim of this research is to monitor solidarity in Dutch society. The focus is on willingness to pay for healthcare costs for others through the years.

Methods
Questionnaires have been sent out to a random selection of the 12.000 members of Nivel’s Dutch Health Care Consumer Panel, and included, among others, questions about solidarity in healthcare. Data are available from 2013, 2015 and 2017. The response was N = 764 (51%), N = 633 (42%) and N = 668 (45%) respectively.

Results
In 2017 74% of the respondents stated that they were willing to pay for others, compared to 73% in 2013 and 63% in 2015. If we look at willingness to pay for certain groups the results are similar over time: people show more solidarity towards others when others experience health issues beyond their ‘control’ like a genetic disposition. People show les solidarity when others face health problems due to lifestyle choices like excessive smoking and drinking. Results show time trends, especially for certain groups that have low education or poor health.

Conclusions
Results show that the willingness to pay for others is high; thus reflecting a high degree of solidarity. However, there is less solidarity for certain groups and attitude is changing over time. Since social health insurance is based on a broad societal support for equal access to healthcare it is paramount to keep monitoring solidarity and see if trends continue.

Key messages
Willingness to pay for healthcare costs for others is high; showing high degree of solidarity over time.
There are trends in willingness to pay which could affect solidarity in healthcare systems.