2004-04-24 Thomas Colignatus aan professor Van de Ven

Subject:              With respect to your MGZ Seminar 26.04.04
 Date:                  Sat, 24 Apr 2004 16:18:50 +0200
 From:                 "t. cool" <t.cool / a t / erasmusmc.nl>
 Organization:      ErasmusMC Rotterdam
 To:                     vandeven / a t / bmg.eur.nl

Dear professor Van de Ven,

As your seminar is intended for a meeting of minds and falls in my area
of competence, it seems useful that I formulate some questions that
everyone can consider and that hopefully can be discussed.

PM. I am an econometrician, now at MGZ, but formerly 1982-1991 at the
Dutch Central Planning Bureau (CPB), where I collaborated on the study
"Nederland in drievoud 1990-2015" and "Scanning the future". 
PM. I enjoyed your contribution to "Perestrojka in de zorg,
Basisverzekering in aantocht", Erasmus MC Monitor Jaargang 33 • nr. 2 •
april/mei 2004 (pag 22); and e.g. your contribution to CPB REPORT at

(1) Would you agree with me that the CPB is a highly qualified institute
(though there could be errors) ?

(2) Are you aware that the CPB directorate censors science since 1989/90
? (= censuur van de wetenschap)

(3) Would you agree that censorship is unacceptable from the viewpoint
of the integrity of science ? 

(4) Would you support a plea at KNAW that any possible censorship is to
be investigated by KNAW ?

(5) Would you agree that censorship at CPB could have an impact on
policy making, since government and employers and labour unions also
rely on "information" from the CPB ? (So that the censorship would not
only be unacceptable from the viewpoint of the integrity of science but
also from the viewpoint of the ethics of medicine because of the

(6) The summary of your seminar says "last 15 years good progress has
been made": but this is a value judgement. Would you not agree that it
would be better to say "more progress could have been made had there not
been censorship" ? (Progress measured in QALYs or in terms of a social
welfare function.)
(The "progress" in outpatient care might be qualified with respect to
recent cut-backs.)

(7) Would you agree with the following interpretations of the words
"central planning": (a) "central planning" in the "Central Planning
Bureau" has been interpreted as "indicative planning". (b) its
interpretation for the system of care is not like central planning as in
the USSR. (c) The declaration of policy of the Dutch government that
took office in May 2003, “The central planning by government has failed
and will be replaced by regulated competition as soon as justifiable”
uses the words "central planning" only in a rhetorical fashion, less
useful for scientific discussion.

(8) Would you agree that the "failure" that the Administration observes
- that differs from your "good progress" - must be qualified: (a) the
failure derives from policy making based upon censorship of science, (b)
where it has failed, there it does not follow from some mysterious
force, but can be identified rather clearly, and often has been
foreseen, (c) it's actually not a total failure and some elements of
"central planning" will remain required.

(9) Would you agree that a social scientist who is involved in research
in an area that is also subject to policy making, should also be aware
of the structure of policy making and should comment on clear errors
there ? (Since major problems in the area can be caused by that
structure.) (Your summary specifies areas for policy making but not the
process of co-ordination itself.)

(10) Would you agree that social scientists (also in your area of
research) have been negligent up to now in protesting against the
censorship of science by the CPB directorate ?

(11) Would you agree that conclusions on these questions have also
consequences with respect to what we tell our colleages in the European
Union and the world at large ? (So that e.g. conclusions for the poor in
the US or Central Europe should not be based upon erroneous policy based
upon censorship by the CPB directorate.)

Respectfully yours,

Thomas Colignatus / Thomas Cool

cc. colleagues at MGZ

Some lay person introductions:

Advised reading: Thomas Cool & Hans Hulst, "De ontketende kiezer",
Rozenberg publishers 2003

> Dear colleagues,

> On Monday April 26th, Wynand van de Ven, professor of Health Insurance
> at the institute of Health Policy and Management (iBMG, ), will give a
> seminar on "Health Care Reforms in the Netherlands".  A summary of the
> seminar is given below.

> You are all kindly invited to participate in this meeting which will
> be held in Colloquiumzaal K, 12.00 - 13.00 h.

> Kind regards,
> on behalf of the seminar committee
> ----------------------------------------------------------------------------------

> Health Care Reforms in the Netherlands

> In this Seminar major aspects of the Dutch health care reform will be
> discussed. The key challenge of these reforms, initiated by the reform proposals of the
> Dekker-Committee in 1987, is to improve the incentives for efficiency while maintaining
> solidarity. The last 15 years good progress has been made with the reforms, in particular with
> respect to outpatient care. The next 15 years the reform efforts will focus on
> inpatient care. In this Seminar major reform issues will be discussed, such as the
> risk equalization system for insurers, cost-based prices for hospitals/physicians,
> competition policy, abolishing all differences between sickness fund and private health
> insurance, yes/no for- profit hospitals and insurers, consumer information, and, last but not
> least, European regulation. According to the declaration of policy of the Dutch government that
> took office in May 2003, “The central planning by government has failed and will be
> replaced by regulated competition as soon as justifiable”. With these last 4 words,
> government on the one hand stresses the urgent need for reform and on the other hand indicates
> that not all preconditions for regulated competition are yet fulfilled. Only time
> will tell whether, after 15 years of health care reform toward regulated competition, the
> halfway point has already been passed.