Concerns about removing vitamin D from basic package: ‘The right form of prevention’ | Inland

“This is a short-term cutback that will lead to an increase in healthcare costs in the long term,” said the spokesperson for the pharmacists’ organization KNMP. “You can’t just assume that people will buy the vitamin D themselves. Experience shows that if you delete something from the basic package, people are less adherent to therapy. Less vitamin D leads to more bone fractures, with an extra appeal to rehabilitation, (district) nursing and informal care.”

“Especially the elderly, people who don’t get out much and people with dark skin benefit from vitamin D. Many babies of non-Western mothers also have a deficiency,” says health scientist Dr Charifa Zemouri.

‘Chronic fatigue’

Last year, 1.5 million Dutch people were prescribed vitamin D; in total that cost 115 million euros. Zemouri: “Those who are deficient in vitamin D can become chronically fatigued, develop weaker bones that break easily, develop muscle and joint pain, and have a higher risk of cardiovascular disease.”

Minister Ernst Kuipers has taken over the advice of Zorg Instituut Nederland (ZIN) to remove vitamin D from the basic insurance because it can be obtained fairly cheaply at drugstores. According to Zemouri, that is not correct. “Many patients need tablets with such a high dose of vitamin D that are really not for sale at the drugstores. There they often sell low-dose tablets, which are not effective for people with extreme deficiency. And there are those who simply cannot afford it themselves; if they don’t take it, their medical condition will worsen.”

The House still has to approve Kuipers’ proposal. Large organizations such as KWF, Reuma Nederland, the Kidney Patients Association, the elderly associations and the Osteoporosis Association send an urgent letter with the KNMP to the parliamentary committee of VWS, asking to retain vitamin D in the package. This will be debated on 9 June. The Osteoporosis Association asks to at least make an exception for syndromes where vitamin D – and often C – according to the medical guideline must go together with certain medication. “There is osteoporosis medication that has only been tested and approved in combination with vitamins D and C,” says chairman Harry van den Broek.

Parallel

However, health economist Xander Koolman of the VU University Amsterdam points out that it is still uncertain whether people will actually buy less vitamin D. “You always have to wait for that. There is a real chance that this will happen, but to what extent is still unclear.” He draws a parallel with stomach acid inhibitors, which were removed from the basic package ten years ago. “Then you could see that there was a significant decrease in use.”

According to him, this issue is primarily a question of solidarity. „As a society, are you prepared to pay for medicines that you do not use or do you think that only the ‘users’ should pay for them? If only vitamin D is removed from the basic package, this will not directly affect the health care premium, but decisions will be made about more medicines. It is not desirable to include everything in the basic package. If other resources are also scrapped, the collective health insurance premium will eventually fall. In that respect, that could be beneficial for society.”

At the same time, Koolman immediately makes a comment. “Health insurers now purchase these resources for a very favorable price, so that users also have to pay less. If these drugs go out of the basic package and individuals have to purchase them themselves, you can expect the cost per unit to rise. Ultimately, the total expenditure in this country may still increase as a result, but you just ‘pass it on’ to the users instead of everyone.” He emphasizes that burden sharing is a political issue.

‘Vulnerable group’

According to Ruud Coolen van Brakel of the Institute for Responsible Medicine Use, ZIN’s advice is rationally well motivated. “But the question is whether this is socially desirable. So you’re talking about a vulnerable group of people who you want to keep using it.”

The spokesman for the KNMP: “The whole idea of ​​eliminating vitamin D is at odds with government policy, which advocates prevention. Taking vitamin D is just such a form of prevention.”

ZIN states that a dose of 20 micrograms of vitamin D per day costs an average of 7.30 euros per year. The highest strength of ampoules – intended to make up for a vitamin deficiency – would cost around 25 euros per year.

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