192 Chapter 7 2095 patients in 2023 – we are still far from 1800 patients enlisted per GP (fte).64 Recently, the LHV has signed the Integral Care Agreement (IZA; Integraal zorgakkoord),65 in which there are certain positive notes that might benefit both GPs and patients concerning the CSPs. The most concrete example here is that GPs get more time per patient (Meer Tijd Voor de Patient). Extended consultations seem essential in order to inform and guide patients adequately also with respect to the CSPs. Regarding the last point, it is a bit difficult to be optimistic. Healthcare costs have been rising for decades, and so far no unequivocal solution seems to have been found to solve this problem.66 It might be useful to think about paying for health and keeping the population healthy, and thus focusing more and more on prevention. Which leads us to the next question. What about prevention? In addition to the public debate on the role of the GP, the role of (primary) prevention is an issue for GPs. When it comes to cancer, there is a lot more that could and should be done to prevent cancer (see also the introduction of this thesis). Most logical steps would be to create more public awareness about cancer risk factors and promoting healthy lifestyle choices. When looking at the numbers, currently only about 1.8% of the total of healthcare costs are spend on population-wide preventive and public healthcare.67 We are willing to spend a significant amount of money on extremely expensive medications and treatments, but there is scarce funding available for the prevention of common diseases. Fortunately, the public opinion regarding this seems to be changing.68-70 Where the Netherlands rated in the top three healthiest countries of the world, only a few decades ago. ‘We’ have now dropped to the 30th place.71 This is the next challenge for politics. Since 2018 there has been a prevention agreement, hopefully this will contribute to a healthier Dutch population in the long run.72 Cancer screening based upon Population Health Management principles Anno 2023, one might wonder if the current population-based cancer screening programmes (CSPs) are still best suited to reduce the burden of the screening-specific tumours for the population as a whole. As stated in the introduction, the WHO declared (based on the Wilson and Jungner criteria) that the benefits of participating in a screening programme should outweigh the potential disadvantages of the screening programme.73 In the current situation there however appears to be a prevailing inclination wherein the advantages at the population level appear to surpass the potential drawbacks at the individual level. Given the findings of our studies presented in this thesis we believe it is
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