Belangrijkste publicaties (5 jaar onafhankelijk onderzoek en advies over het zorgstelsel)

Top 5 publicaties

Platform Betrouwbare Zorgcijfers (co-auteur John J.L. Jacobs):
Corona scenario analyse 14 maart 2020

Volkskrant: Waarom zorg in Nederland juist níét tot de beste hoort

Medisch Contact:
Nederlandse zorg valt van haar voetstuk

ESB (co-auteur Renske Leijten): Zorgstelsel obv samenwerking stelt
patiënt centraal

Skipr: Een patiëntgeoriënteerd zorgstelsel


Voxmedia: Voxmedia“The Netherlands has universal health insurance — and it’s all private”

Stichting Beroepseer: Beroepseer Gijs van Loef bekritiseert de effecten van marktwerking in de zorg op basis van onderzoek naar kwaliteit van zorg

Corona Dashboard EW16/W36

Last update 5 august 2020

Corona Dashboard EW16/W36 (closed)

John Jacobs & Gijs van Loef

Data 04 08 2020

Mortality per million population allows comparison between countries. Major differences are caused by differences in anti-epidemic strategy, which may be affected by the preparedness of countries to the epidemic.

General remarks by making a comparison between countries
We would like to make two important notes.
1. Countries differ in the way the count their mortality rates. The Dutch regional GGD stated early in the epidemic that the national RIVM did not count all cases, i.e. the Netherlands have relevant under reporting of cases.[1] People dying in nursing homes are rarely counted, since these patients will not be tested, even when suffering from COVID-19 symptoms. The Dutch statistics do not count untested people as COVID-19 victims. The data can be corrected for excess mortality. Because the data on excess mortality is delayed for about three weeks, a fixed correction factor is applied.[2]

2. Populations differ in age distribution, and old people have higher mortality rates due to COVID-19.
Using the double-corrected data, a ranking is made from dark red to dark green. The current ranking is (Table 1):
Dark red:> 1000 deaths per million population (> 1000 deaths / M). Ecuador, Peru, United Kingdom, Chile
Medium red: 500-1000 deaths / M. Belgium, Brazil, Italy, Spain, Netherlands, USA, Sweden
Light red: 200-500 deaths / M. France, Ireland, Switzerland, Portugal, Canada, South Africa
Ocher yellow: 100-200 deaths / M. Austria, Denmark, Germany
Yellow. 50-100 deaths / M. Finland, Norway, Israel
Light green: 20-50 deaths / M. Estonia, Czech Republic, Poland, Lithuania, Iceland, India
Medium green: 10-20 deaths / M. Greece, Australia
Dark green: <10 deaths / M. South Korea, Singapore, New Zealand, Japan, Taiwan, Hong Kong, Vietnam

Table 1. Overview of mortality per million people (mortality/M), the raw data, corrected for underreporting [a] and age. Data to determine under reporting is derived from various sources.[b]

[b] , , ,

It is striking that the best-performing countries are located near Southeast Asia, where the SARS-1 epidemic started in China 18 years ago. Many countries learned from this epidemic and were prepared for a new epidemic[3] Every virologist could have predicted that a new epidemic would come, as I (i.e. John Jacobs) did in 2003.[4]
Controlling a virus epidemic requires a different strategy than a bacterial epidemic. The default anti-virus strategy is testing, proactively detecting and isolation of infected cases.[5] To do this correctly is double efficient: lower disease mortality rates, and less social and economic damage, as only infected cases should be isolated. It is also widely practiced in case of veterinary epidemics.[6]

The policies of European and North American countries had weak to poor antivirus policy results.
Mortality is higher, sometimes up to 100 times higher than in Asian and Australian countries.
The impact on social well-being and the economy is much greater.
The differences within Europe are also huge when Greece and Lithuania are compared to the United Kingdom and Belgium.

We should learn from this epidemic.
It is very doubtful if we will develop a good and safe vaccine soon, since, vaccination is a hard strategy when antivirus immune responses contribute to mortality. It could be that antibody-mediated immune responses are the cause of mortality.[7] In most European countries only about 5% of the people were infected, so this epidemic could continue to spread for a considerable time with the potential to cause high mortality rates.[8] The need to learn and act from the learnt lessons from this epidemic is paramount.
New virus epidemics will come. Just like the prediction of this epidemic decades ago, we know that a new RNA virus epidemic will arise after AIDS, SARS-1, MERS, Ebola and SARS-2.
Our epidemic policy has a major impact on human behaviour and thus on the virus epidemic.[9] If we are prepared [10], the impact could be similar to the South East Asian and Australian countries that prepared themselves after SARS-1.

[1] RIVM is national institute for health and environment.

Raw numbers
The Corona Dashboard 1.0 was launched in Dutch at 18th of April 2020 on our websites. It focused at the EW16, 16 ‘modern’ European countries with a population of at least 4 million people. These countries share political, democratic, social economic and technological development, making them excellent for internal comparison. The list consists of Austria, Belgium, Denmark, Germany, Finland, France, Greece, Ireland, Italy, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the United Kingdom. Japan, Republic of Korea (South) and the USA are added to complete the list, therefore EW16+3.

Table 2. Raw data from worldometer from EW16+3 [1]

Reported mortality rates
The 16 European countries have huge differences in the mortality rates they report. Remarkably, the epidemic in Spain is the first one to have higher numbers of mortality, even before Italy. In Belgium the epidemic raised to the highest (uncorrected level), before being stopped (at about 6%) by the national policy.

Figure 1. Mortality rates for EW16+3. Above: linear, below: logaritmic
Country codes are explained in Table 1.

Case mortality rates
Case mortality rates show the differences of cases per country. Age corrections is shown to compensate for differences in population distribution. France has corrected its data of the number of cases on june 3d.
Table 3. Case-mortality rates.
Number of critically ill and recovered persons. The lack of data on how many people have recovered, shows the limitations of the care registration systems in the Netherlands, the United Kingdom, Sweden and Spain.

Link between testing and mortality EW16+3
Flu-like symptoms are no evidence for COVID-19, and not everyone infected by SARS-2 will develop symptoms. Policy making on symptoms fails because it discriminates poorly and would have people repeatedly in quarantine due to colds or other respiratory complaints. People succumbing to COVID-19 usually don’t go to many places anymore. Infected people are contagious before they get sick, and not everyone will develop symptoms. The high number of sick people in the Netherlands is partly related to many infected people continuing to spread the disease unmonitored, some even working in care facilities.

Proactive testing starts with testing everyone that has symptoms. If someone test positively, all the contacts will be tested. All contacts who are negative will be retested after 1 and 2 weeks. All infected people will remain in isolation – e.g. in their own house or in special hotels. In Wuhan, the government delivered groceries at their homes, to avoid the need of going outside.

An active testing policy will test many people who are not infected, because the infection rate in the population is usually (far) below 2%. Passive testing leads to a much higher number of infections per test. The danger of passive testing is that many infected people are hidden in the population. It is estimated worldwide half of the infections are caused by people without symptoms. These infections mainly occur in countries that do not test enough. People without symptoms and without a test result have no urgent reason to isolate themselves from social activities or go for  quarantine. Figure 2 shows the statistical relationship between the maximum percentage of positive tests in a country and the mortality rate in the population from COVID-19. Corrected data yield similar results.

Figure 2. Relation between mortality rate and lack of proactive policy, uncorrected data.
The shape of countries corresponds to their continent (circle Europe (EW-16), square other Europe, cross North America, triangle: Australia, diamond: Southeast Asia). Clear correlation. For reference R^2> 0.5 is considered a very clear connection in this domain. Country codes are explained in Table 1.

Current status EW16+3

The current status shows how the epidemic develops in various countries. Many European countries have experienced a nonspecific lockdown to defeat the virus’ first wave that has paused the epidemic. This required more time in countries that have had a high peak, such as Belgium (Figure 3). The epidemic seems to be in control in all visualized countries, except for UK, Sweden and USA. Most countries have ended the lockdown. This could reactivate the epidemic. (In specific area’s (regions within countries) the virus is resurrecting and regional lockdowns are the governmental response.) The start of the epidemic is less noticeable in a cumulative graph than in a daily graph. Due to daily fluctuations, the data in Figure 3 is averaged over several days.

Figure 3. Daily mortality rates for 16 European countries + 3.
Moving average over 3 to 5 (and 7 if missing today) filtered for negative values and extreme high values (often data corrections). Country codes are explained in Table 1.

Figure 3A. Zooms in on the most recent dates of Figure 3.

John Jacobs & Gijs van Loef corona dashboard


Dutch version, including remarks from healthcare experts: Corona Dashboard Dutch version EW16/W28

Vox: “The Netherlands has universal health insurance — and it’s all private”


“The consequences of managed competition — there’s no debate, everybody just accepts it,” says Gijs van Loef, a health care consultant and sociologist who has become a prominent critic of his country’s health care. “But the Dutch health care system has fallen off its pedestal.”

Health care spending here has become a much bigger share of GDP since the switch to private insurance, though the growth has eased since the 2012 switch to global budgets. There is a fledgling critique from the left and others in the Netherlands arguing that managed competition will ultimately drive costs up while having a marginal or even deleterious effect on quality.

Gijs van Loef is a proponent of this view. He argues that managed competition is an oxymoron — that market competition and social collaboration are fundamentally at odds. He cites those rising costs and the Netherlands’ middling performance on life expectancy compared to its European peers. Is this what people are paying for?

“The concept of managed competition doesn’t work,” van Loef says. “My fundamental critique is collaboration and competition, at the operational level and system level, don’t really fit together.”

He points to the amount of bureaucracy required to manage all of the private entities that make up Dutch health care. Survey data from the Commonwealth Fund shows that Dutch doctors are more likely than physicians in most other European countries to say that dealing with insurance claims or having to report data to the government is a major problem. Dutch hospitals spend 20 percent of their budgets on administration — less than the United States, but more than the United Kingdom or Canada, which have public health insurance.


Lecture Debate: To reform or not to reform the Dutch Medical Healthcare system (RadboudUMC)

Opnieuw mocht ik dit gastcollege verzorgen. Gastheer is Dr. Niek Stadhouders (IQ Healthcare), coordinator van de mastercourse Health Policy and Economics.

Een tweetal sheets:

Een korte fotoimpressie:

Vorig jaar: Gastdocent Radboudumc 2018


De rijksoverheid heeft de afgelopen jaren bewust een te ­positief beeld geschetst van de medische gezondheidszorg, Gijs van Loef in de Volkskrant

deVolkskrant 2/5/2019 Waarom zorg in Nederland juist níét tot de beste hoort

De rijksoverheid heeft de afgelopen jaren bewust een te ­positief beeld geschetst van de medische gezondheidszorg. ‘Onze zorg behoort tot de beste van Europa’, staat in het Regeerakkoord. Op basis van zelfstandig onderzoek, gevalideerd door deskundigen, stel ik vast dat de kwaliteit van de medische zorg in vergelijking met andere moderne Europese landen sinds 2006 geleidelijk aan ­terrein verliest. Dit is opmerkelijk. Want waarom werd dit onderzoek niet gedaan door een van de kennisinstituten (SCP, CPB, Zorginstituut, Universiteiten)? deVolkskrant Waarom zorg in Nederland juist niet tot de beste hoort Lees het gehele artikel hier> Waarom zorg in Nederland juist niet tot de beste hoort/Het Existentieel vraagstuk Reacties in ZorgWeek19bericht!

Guardian 2/5/2019 Opioids billionaire founder guilty of bribing doctors

The head of a leading drug manufacturer has been found guilty of bribing doctors to prescribe a dangerous painkiller to patients who did not need it, in the first criminal conviction of a pharma chief over the opioid epidemic.(…)Subsys was approved for terminal cancer patients but the company targeted sales at a much bigger and more profitable market of people with non-life threatening chronic pain. Prosecutors said that fuelled the opioid epidemic and cost lives. Guardian Opioids billionaire founder guilty of bribing doctors

RTV Oost 2/5/2019 Meldpunt RTV Oost: ‘Zorgen om zorgbureaus’

De zorgbureaus liggen meer dan ooit onder vuur. Directeuren van zorginstellingen die exorbitante winsten in eigen zakken laten glijden, schimmige vastgoedconstructies, gemeenten en zorgverzekeraars die contracten beëindigen omdat zorggeld niet voor zorg maar voor hele andere zaken wordt besteed. Nadat RTV Oost eerder al kwam met het dossier Zorgfraude lanceren we vandaag het meldpunt ‘Zorgen om zorgbureaus’. RTV Oost Meldpunt malafide zorgburos

NOS 1/5/2019 Protest Gooise apothekers: ‘Schreeuwen en slaan zijn dagelijkse dingen’

Apothekers en hun assistenten in Het Gooi krijgen dagelijks te maken met agressie en discussies aan de balie. Uit protest daartegen hielden zij de hele ochtend hun deuren dicht.(…)Het is ook bedoeld als oproep naar de politiek en de zorgverzekeraars. “Er was al heel veel frustratie bij cliënten, omdat merken niet meer vergoed werden en mensen telkens van merk moesten wisselen. Maar daar komen nu medicijntekorten bij.” NOS Protest Gooise apothekers

Zorgvisie (abonnement) 30/4/2019 ‘De ACM is een dinosaurus’

Ziekenhuizen moeten alles op alles zetten om via intensieve samenwerking medisch-specialistische zorg overal beschikbaar te houden in Nederland. Daarbij mogen ze geen last hebben van de Autoriteit Consument en Markt (ACM), vindt Suzanne Kruizinga, lid raad van bestuur Wilhelmina Ziekenhuis Assen. Zorgvisie ACM is een dinosaurus