American policy makers are interested in the Dutch healthcare system. The combination of competition, universal healthcare coverage and relatively high quality impressed a delegation from the United States, visiting the Netherlands last week.
Kerry Weens, a senior official in the Department of Health led the US delegation. The Americans paid a visit to the kidney disease wing of the Leiden University Medical Centre (LUMC). Mr Weens said he was impressed with what he had seen. “We’re intrigued by many of the ideas that we see, such as moving toward more market based solutions. In general I think there’s a lot of consistency between the Dutch system and the US system.”Competition introduced
Mr Weens was referring to a recent overhaul in the way Dutch people purchase health insurance which have made the Dutch system more competitive. Two years ago, a new law went into effect requiring every resident of the Netherlands to purchase their own health insurance, while the insurance companies were forced to embrace open market laws and offer competitive prices for their insurances. But unlike in the United States, for those who can’t afford insurance, the Dutch state still chips in to cover part of the cost.
Insurance companies are required to provide coverage for anyone who applies for it, so no one can be refused due to pre-existing health problems. To help insurance companies cover some of the costs involved with selling coverage to all comers, the government has a formula in which it contributes to the cost incurred in certain cases.
So while competition has been introduced into the system, the Dutch system is not a completely market-based approach. The taxpayer still subsidizes a not insignificant percentage of care in the Netherlands. But competition helps keep overall costs down.
Confronting bills
Nolene Berkhout is a nurse practitioner, and served as one of the hosts of the American delegation at the LUMC. Referring to the new insurance arrangements here in the Netherlands, she pointed to the fact that
“We’re now being confronted with the bills, which is a good thing – this way, we know exactly what we’re paying for.”
Although, she quickly added, individuals don’t actually have to pay the bills themselves.
Ms Berkhout lamented the fact that in the US, more than 40 million people in are uninsured because they simply can’t afford it.
“We would never have that kind of situation here.” Prevention is important
A number of recent changes are meant to improve the quality of care here in the Netherlands. Doctors and hospitals are now required to publish information every year about their performance. That information is available to the public on a website, but it is still too soon to see how much effect it has on patients’ choices.
Costs up, care down
Not everyone is happy with the changes. When the insurance market was liberalised, many complained that the cost of their insurance went up, while the care that was covered went down.
Kerry Weens, the US official, said several states in the US have already implemented a similar system, where individuals buy their own insurance. He sees it as an attractive option.
“I’m going back to the US with the message that the Dutch are solving some of the same problems that we’re solving in the United States, and we should closely cooperate with them, especially in the arena of quality.”
US election issue
Healthcare has become one of the issues in the US presidential campaign. As Democratic presidential candidate, Hillary Clinton promises to succeed in the White House where she failed as First Lady. Fifteen years ago she lead President Bill Clinton’s healthcare reform efforts. It was a fiasco. She says she’s learned a lot since then and will try again.
Some 47 million Americans do not have health insurance, 8 million of them children. Every four years presidential candidates offer ambitious plans to remedy this. It never happens. Hillary Clinton’s new plan will cost $110 billion, her experts estimate. It mandates health insurance coverage for everyone.
Republican policy
Republican presidential candidate Rudy Giuliani takes up this point in his own campaign, by evoking the supposed horrors of socialized medicine in other countries and linking them to Hillary Clinton’s plans. Giuliani and other Republican presidential candidates use other countries’ health systems as bad examples.
Giuliani uses statistics, such as the prostate cancer survival rates in the US and the UK, to back up his case. But various doctors and independent experts have debunked the statistics he quotes in his campaign commercial. They insist that in comparable situations there is no significant difference in prostate cancer survival rates between the US and the UK.
The Republicans want market-based solutions with large tax credits for individuals to go out and buy their own health insurance. Hillary Clinton and the other Democratic candidates also stay away from a government-run health system and also want the private sector involved. But unlike the Republicans, they don’t believe that incorporating foreign examples in their health plans is un-American.
Tags: Health, health care system