The care cartel: how the modern care industry profits from human suffering

The myth of compassion-driven care

Across the Western world, the term “care industry” evokes warm imagery. It suggests compassion, public service, and social solidarity. In political discourse, funding this sector is often portrayed as a moral duty. Yet behind the veil of benevolence lies a vast and bloated industry where inefficiency, profiteering, and fraud are not the exception but the rule.

From youth care and elderly institutions to mental health services and disability support, the modern care sector has become a complex system of incentives that rewards dependency, punishes efficiency, and monetizes misery. This article exposes how the so-called care industry has been hijacked by interests that thrive not on helping people, but on keeping them in perpetual need.

An economy built on vulnerability

The care industry today functions as a pillar of the modern welfare economy. In countries like the Netherlands, social and health care consume nearly 30 percent of public spending. According to figures from the Dutch Ministry of Health, Welfare and Sport, over 100 billion euros are allocated annually to long-term and short-term care. In the United Kingdom, health and social care funding reached 180 billion pounds in 2022. These numbers continue to grow, not because people are healthier or better cared for, but because the system incentivizes volume rather than outcome.

Much of this money is absorbed not by frontline caregivers, but by layers of bureaucracy, consultants, auditors, and so-called care entrepreneurs. In De zorg is ziek (Ton Heerts), the author demonstrates how private care agencies exploit billing codes, subcontract work to shell companies, and inflate the duration or necessity of treatments. Patients are reduced to billing units. Care is not provided when needed, but when profitable.

Youth care: a well-funded disaster

The youth care sector is one of the most heavily criticized yet under-reformed domains in European welfare systems. In the Netherlands, Jeugdzorg receives billions annually, yet performance indicators have steadily declined. Reports from the Raad voor de Volksgezondheid have shown that children in the system are often worse off than those who remain in their original families, even when conditions are difficult.

In De macht van jeugdzorg (Argos VPRO), whistleblowers revealed how financial incentives drive child placements. Each child placed in institutional care unlocks a stream of funding for therapists, supervisors, institutions, and external consultants. Some foster families receive over 5,000 euros per month per child. The longer the child remains in care, the more profitable the case becomes.

False diagnoses are common. Children are declared autistic, traumatized, or unfit for family life based on subjective criteria, often without second opinions or court oversight. Parents who challenge these assessments are branded as obstructive. In practice, families are often torn apart to feed a bureaucratic machine that needs victims to justify its existence.

Elder care: a warehouse for the dying

Institutional elder care, hailed as a necessary support system for aging populations, is another domain where human dignity is regularly sacrificed on the altar of efficiency. In many care homes, elderly residents are subjected to minimal care routines, processed like commodities in systems that prioritize cost-saving over well-being.

A Dutch parliamentary inquiry in 2017 concluded that care institutions were structurally underfunded in practice but overfunded on paper, with administrators using budget loopholes to divert money toward non-care-related operations (Naar een toekomstbestendig zorgstelsel, Tweede Kamer). Meanwhile, staff shortages, burnout, and negligence led to scandalous living conditions for residents. Similar problems are found across Europe. In Germany, an audit revealed that over 60 percent of nursing homes failed to meet hygiene and staffing standards, even though most received full state subsidies (Pflege in Not, Der Spiegel).

The model is based on maximum occupancy and minimum attention. Residents are kept alive and stable, but rarely cared for holistically. Meals are standardized, routines inflexible, and personal agency erased. In this context, longevity is not a blessing, but a source of ongoing profit.

Mental health: a self-sustaining pathology

The mental health sector has transformed in recent decades from a niche branch of care into a sprawling, powerful industry. Rising diagnoses of depression, anxiety, bipolar disorder, ADHD, and autism have fueled an explosion in pharmaceutical prescriptions, therapeutic programs, and institutional care.

In the United States, the expansion of the Diagnostic and Statistical Manual of Mental Disorders (DSM) has turned everyday struggles into medical conditions. The DSM-5, published by the American Psychiatric Association, now lists over 300 conditions, compared to 106 in the original edition. Each condition justifies treatments, billing codes, and often lifelong pharmaceutical dependency.

This trend is mirrored in Europe. In Dwangbuis van de GGZ (Janneke Monshouwer), the author exposes how Dutch mental health institutions systematically overdiagnose patients to align them with the most profitable treatment trajectories. Children are particularly vulnerable. Behavioral differences that would once have been considered part of normal development are now labeled as syndromes requiring lifelong intervention. The goal is rarely recovery. The goal is repeat engagement.

Long-term therapy, recurring check-ins, and chronic pharmaceutical treatments are simply more profitable than cured patients. The longer a person remains within the system, the more valuable they become to it.

The silent profiteers: consultants and brokers

While caregivers and medical staff often work under pressure and poor conditions, a hidden class of intermediaries thrives behind the scenes. These include care consultants, auditors, data analysts, care brokers, and compliance advisors. They do not offer care but design, monitor, and restructure systems that manage it.

A 2020 audit by the Algemene Rekenkamer found that in some Dutch municipalities, more than 25 percent of allocated care budgets were spent not on services, but on administration, consultancy, and IT systems (Zorggeld zonder zorg, NRC Handelsblad). Care is thus commodified into a bureaucratic puzzle, where success is measured not by health outcomes, but by the completion of forms, the generation of reports, and the ticking of boxes.

These intermediaries rarely face public scrutiny. Yet they are the primary architects of inefficiency. Their reports shape legislation. Their software systems determine access to care. Their invoices drain resources. And because they are not accountable to patients, they operate with impunity.

Institutionalized incentives to prolong suffering

The economic model of the modern care industry is based on recurring engagement, not resolution. This creates a structural perversion: the more enduring a problem is, the more money it generates. This is particularly evident in long-term care and mental health. Treating symptoms repeatedly ensures revenue. Solving root causes removes income streams.

In Het zorgstelsel werkt niet meer (Frits Bosch), the author argues that the current care system is not broken but functioning precisely as designed — to manage rather than solve. This design is protected by lobbying, emotional rhetoric, and political cowardice.

Youth care agencies are not incentivized to reunite children with families. Mental health institutions are not rewarded for reducing pharmaceutical dependency. Elder care providers are not rated based on dignity or happiness. The metrics are quantitative, not qualitative. Patients are trapped in cycles of treatment with no visible exit.

Large-scale fraud behind closed doors

In addition to inefficiency and exploitation, outright fraud is rampant. Across Western Europe, state-funded care budgets have been subject to abuse through fake billing, ghost patients, overreporting of hours, and shell corporations. In the Netherlands, the PGB (personal care budget) program has been repeatedly defrauded.

A notorious case involved Stichting Zorgplan, where millions of euros were siphoned off using forged care declarations, unqualified staff, and nonexistent clients (Zorgfraude bij Stichting Zorgplan, NOS). Investigations found that the oversight mechanisms were so convoluted that it took years to identify the fraud.

In the United Kingdom, the National Audit Office has repeatedly flagged irregularities in care home subsidies, including double billing, contract manipulation, and use of funds for luxury renovations. In Belgium, several non-profit care organizations were found laundering funds to politically connected firms under the guise of training programs (Witwaspraktijken in de zorgsector, De Tijd).

Fraud does not occur in the shadows. It is often embedded in the system, tolerated by regulators, and enabled by the moral immunity the sector enjoys.

The power of moral blackmail

Criticism of the care industry is difficult not because of its logic, but because of its optics. Challenging the system is often framed as an attack on the vulnerable. This moral blackmail neutralizes opposition. Politicians fear appearing heartless. Journalists are accused of lacking empathy. Citizens are discouraged from questioning institutions that use the language of compassion.

Yet it is precisely this taboo that allows dysfunction to flourish. As long as debate is suppressed by moral outrage, reform remains impossible. This is a recurring pattern in public sectors tied to emotive causes, from development aid to refugee housing. The use of moral language creates a protective shield that allows systemic failure to continue unchecked.

Collapse as the only cure?

Meaningful reform would require more than tweaks. It would require a dismantling of the current funding models, the removal of layers of bureaucracy, the banning of internal billing between entities with shared owners, and a strict cap on administrative overhead. It would also demand a redefinition of care — away from codes and diagnoses, toward relationships and outcomes.

However, many observers argue that such reform is politically impossible. The industry has become too large, too complex, and too embedded in national economies. In this context, collapse may be the only way forward. Let the system fail, and allow local, community-based alternatives to replace it. Let care be built anew on human scale, not institutional profit.

Who really cares?

At its core, real care is simple. It is the willingness to help others without condition, without bureaucracy, and without ulterior motive. The modern care industry has turned this basic human instinct into a transactional system governed by paperwork, protocols, and profit margins.

The tragedy is that millions of people enter this sector with good intentions, only to be crushed by its mechanisms. Their work props up a system that betrays its stated values. Until we can separate real care from institutional self-interest, the industry will remain a parasite on human suffering — feeding on pain, rewarding inefficiency, and masking its failures in the language of compassion.