Combining Money and Health in Dutch Future Affordable and Sustainable Therapy Policy
‘Fast’ is not usually an adjective readily associated with developing drugs. This may change, at least in the Netherlands, as the Ministry of Health, Welfare and Sport and the Ministry of Economic Affairs and Climate Policy seek to effect change through the Future Affordable and Sustainable Therapies (FAST) programme. This programme aims to accelerate the relatively slow, incremental, and high-priced innovation in the pharmaceutical field; it offers an “integrated and focused approach to develop affordable therapies”. A few days ago, State Secretary for Economic Affairs and Climate Policy Mona Keijzer and Minister for Medical Care and Sport Tamara van Ark sent a letter to the Dutch Parliament. This letter contains the Cabinet’s reaction to both the FAST programme proposal and a related ‘Action Programme’.
The FAST programme starts with a clear problem definition: “getting new necessary treatments to the patient as quickly as possible, at acceptable costs, that’s where there is still much to be gained”. The authors propose an annual investment of at least 150 million euros for specific target areas. These target areas, which different stakeholders would need to agree upon together, could include rare diseases, regenerative and personalised medicine and, of course, vaccine development. Regardless of the exact targets, the thrust of the document is clear: “by using public resources in a more targeted and coherent way (…) affordability and innovation go hand in hand.”
This ‘going hand in hand’ is a clear theme throughout the proposal. The one-page management summary alone contains thirteen more near-synonyms denoting this element, such as integration, cohesion, and cooperation. It also refers to the financing landscape as “fragmented” and promises to develop a “well-connected infrastructure”, suggesting the current infrastructure leaves something to be desired. What it is exactly that needs to go hand in hand is epitomised by the two ministries involved, namely Economic Affairs and Health, respectively. The document continually seeks to dovetail financial and health-related aspects, private and public interests. As the summary reads, moving swiftly from one to the other:
“After all, the deployment of public resources offers opportunities to reduce the cost of capital in therapy development or to take on the cost of failure in some cases. In addition, conditions can be built in to keep medicines and treatments of the future optimally available and affordable for patients.”
Organisation scholars have previously characterised such various aspects as deriving from different logics . Such logics denote a mode of meaning-giving, communication, and practice shared with others over time. In scholarly literature, the economic version is well-known and usually referred to as the ‘market logic’, and the second might be described as a ‘patient-centered logic’. Moving from one aspect to the other repeatedly within one document, as in the FAST proposal, would be analysed as combining different logics.
Combining different logics can be a promising strategic route for sure. It allows for ‘using the right words with the right people’, by which a renewed investment, say, or a reorganisation, may be justified and enabled. Combining different logics may also lead to problems. Research suggests that combining logics may turn into conflicting logics, fueling resistance and complicating adoption and implementation processes. Such conflict and complication may also provide reason and space to pause, bring stakeholders together, take a moment to deliberate carefully and proceed differently. In other words, it may provide opportunities for social innovation in the pharmaceutical field.
 Michel Dutrée & Saco de Visser (2020) FAST Impuls voor innovatieve therapieontwikkeling, Rijksoverheid. Available at: https://www.rijksoverheid.nl/documenten/rapporten/2020/12/18/samen-werken-aan-future-affordable-and-sustainable-therapies  Michel Dutrée & Saco de Visser (2020) FAST Impuls voor innovatieve therapieontwikkeling, page 2.  See for a brief introduction: https://en.wikipedia.org/wiki/Institutional_logic  See for instance: Judith van den Broek, Paul Boselie & Jaap Paauwe (2014) Multiple Institutional Logics in Health Care: ‘Productive Ward: Releasing Time to Care’, Public Management Review, 16:1, 1-20, DOI: 10.1080/14719037.2013.770059 Currie WL, Guah MW. Conflicting Institutional Logics: A National Programme for IT in the Organisational Field of Healthcare. Journal of Information Technology. 2007;22(3):235-247. doi:10.1057/palgrave.jit.2000102
Written by: Tineke Kleinhout-Vliek, PhD
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