2. Abandoning collective base insurance

Keywords:
- home care
- home operations
- telemonitoring
- teleprevention
- personal health information (PHI)
- decentralisation
- genetic screening

Story:
Health care in 2020 in Amsterdam dramatically changed since the beginning of this millennium. A number of developments led to this change. In this story some major developments and their impact on health care are reviewed.

Since the late seventies of the last century electronic devices became smaller, cheaper, simpler and have more functions. This trend, in combination with the developments of the internet and especially the invention of an inflatable sterile operation room balloon in 2015, dramatically changed health care.

In 2000 Amsterdam counted eight major hospitals. The hospital buildings were between 40 and 100 years old. The existence of extremely resistant bacteria in these buildings was known at that time, but this did not cause problems and therefor was not paid any attenttion to. Somehow, since 2013, the existence of these bacteria started to cause major problems. They seemed to be everywhere and became more aggressive than ever experienced before. Two major hospitals in Amsterdam had to be demolished in 2015 because the situation could not be controlled anymore.

Since the invention of the inflatable sterile operation room balloon, ordinary living rooms can be turned into operation rooms in less than one hour. Therefore, almost 50% of the basic operations can be done at the private home of the patient. The patient is given home care and recovery of is monitored through telemonitoring via the internet.

Nowadays also the prevention of illnesses is also done through telemonitoring. The condition a patient is constantly monitored by his hospital via an online service company and in case of any health threats preventive actions are suggested to the patient. The preventive actions can vary from online tips (via e-mail, telescreens), service call or visits from doctors.

Also since 2015, the DNA profile and family history of every patient is known from before the birth. Due to this and the on-line condition monitor, which provides continuous real-time information on the health of a patient, it is now possible that continuous care can be given to a patient. Hence, in 2020 patients are not patients anymore in the definition of in 2009. They are healthy human beings operated upon before they get ill, preventing a life-threatening situation. Health is made personal.

Not only the way that health care is provided to patients dramatically changed over the last 20 years, but also the way that health care is financed. Due to the aging of the population in Amsterdam and the enormous costs that were made in the attempt to control the bacteria problems in hospital buildings, health care was almost not payable anymore in 2015. In a reaction to this situation health insurance companies initiated the development of the DNA data bank and eagerly followed the availability of the on-line personal health information (PHI). In 2015 collectivity system for health insurance was abandoned. This process was speeded up by the marketing techniques of health insurance companies. Patients who were willing to share their personal health information and DNA data with health insurance companies could get significant discounts on their health insurance. Therefore more and more people agreed to share this information with their health insurance companies, which in turn supplied them with personal, custom made insurance products. This reduced the cost substantially but killed the loved Dutch solidarity system.