Introduction

Financial, staffing and societal sustainability of healthcare systems is coming under increasing pressure in the Netherlands and beyond. Causes include the ageing population and the widening of treatment options as a result of technological innovation. In this report we analyse how these trends are affecting the sustainability of healthcare. The broad picture is that the need for care is growing faster than both the economy and—even more urgently in the short term—the labour force. This situation is expected to persist for decades, giving cause for concern about the sustainability of healthcare. This presents a challenge not just for the health care sector, but for society as a whole. This report concludes that good healthcare for all requires better choices, precisely because these limits of its financial, staffing and societal sustainability are coming into view. Specifically, this means that the key task now before us is to better delineate the sector’s future growth, in so doing steering it as carefully as possible towards those healthcare and preventive interventions which achieve the greatest health benefits and safeguard public values most effectively. This will be no easy task. It requires clear and sometimes uncompromising decisions, which can be difficult to make from a normative point of view. And these in turn require a long-term vision of the role and function of healthcare in our society that has broad public support. In this report we explain how we have arrived at these conclusions. We also discuss perspectives drawn from various scientific disciplines on making choices within and about healthcare, and explain why the processes involved could be better. Finally, we suggest concrete ways to make better choices.