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The Dutch really have it together on health care, they have a system that has been proposed as a model for the US to emulate. In stark contrast to many other European systems, it’s actually based entirely on private insurers, rather than a single-payer or entirely national system. Yet the Dutch system is universal, has far superior rates of satisfaction with quality of care and access, and still costs a fraction of what we pay for health care per capita in the US. How is this possible?

You can read the Wikipedia entry on the Dutch system or read about it on their Ministry of Health’s English webpage or watch the short film on their reforms below.

So, how does the Dutch system work?


Their system is fairly simple, everyone is required to purchase insurance from highly-regulated private providers. They describe it as “private health insurance with social conditions”. Insurers are tightly regulated for quality, provision of basic services, and to prevent discrimination, as they are required to accept everyone in their coverage area at a flat rate, no matter what their health status. To prevent loss of profitability from chronically-ill patients, they have a risk equalization system so that rather than losing profits from recruiting sicker patients, insurance companies are compensated for providing service to those patients who need it most. And if a citizen wants to change companies, or buy additional insurance they are free to. It’s a system that encourages competition, but is regulated to prevent the companies from selecting only healthy patients, or otherwise abusing the system to prevent health care provision to sick people. The incentives are designed to provide excellent care to as many people as possible, cheaply and efficiently no matter what their health status, rather than the perverse US system in which the incentives are to deny care and only sign on the healthy. The government even runs a website allowing patients to comparison shop among the different insurance companies and hospitals based upon their ratings for quality, outcomes and performance indicators.

A survey of health satisfaction comparing the US and several other countries, including the Netherlands, showed that the Netherlands led the pack in most measures of patient satisfaction and provision of care.

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As we discussed previously, universal healthcare systems beat the US in almost every measure of patient satisfaction, as well as access, quality, and cost. The Dutch lead all other health care systems in almost every measure. Their citizens are the least likely to think their system needs major reforms, they have one of the best access rates with most patients being able to see a physician within the same day, have short wait times for elective surgery, the shortest ER wait times, they are most likely report they are getting the drugs they need, the best treatment technology, and high-quality safe care. They are the least likely to avoid medical care, or to fail to fill a prescription due to concerns over cost. And more objective measures such as mortality due to health care amenable causes shows the Dutch perform better than most other countries in outcomes (the US performs the worst).

And then compare the costs
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The Netherlands spends just 9% of GDP on health care compared to 16% in the US, breaking down to about 3,100USD per capita compared to 6,700 USD per capita in the US.

The system is largely paid for by employers who pay an income-related contribution of 6.5% of their employees’ pay and by individual premiums . Of the total funding, 50% comes from the employer benefit, the government contributes about 5% and the rest paid by the individual in permiums. Most citizens pay the equivalent of about 1-2k USD in premiums, and children up to age 18 are covered for free. Those who can not afford it are subsidized by the government.

You will not hear the corporate shills yelling about patient rights discuss the Netherlands. It is a system that provides universal care, its users rate it higher than that of any other country in quality, satisfaction and access, it has better health outcomes by far compared to the US and most other countries, including single payer systems like UK and Canada. All of this is for half the cost per capita of the US health care system, and without requiring single payer. It shows what a well-regulated private market can do, and that it might represent the kind of system the US could adopt without having to tear the entire current structure down. But well-regulated is the key phrase. The insurers are highly-incentivised to provide inexpensive care and strictly forbidden from discriminating against very sick and chronically-ill patients. By most accounts the system actually does the opposite, and chronically ill patients are actually sought after by the Dutch insurers. We can’t just force everyone into private insurance plans and hope we’ll get this result, the Dutch market is very carefully planned and designed to prevent the frail and desperate from falling through the cracks, while risk-sharing distributes the potential harm caused by more costly individuals.

Comments

  1. #1 Jos
    May 26, 2009

    I prefer any European Health system to the current US one, but: Satisfaction polls in some places need to be read carefully. In certain countries people tend to hide their complaints about national healthcare systems because of chauvinism.

    It´s a national system, so rating it negatively, is admitting your own country has some flaws. I personally experience everyday that people complain in private about many aspects of the healthcare they can access to, but would still give it 5 stars if they were asked in a poll.

  2. #2 LAB
    May 26, 2009

    @Jos

    The same could be said of US health care. People who are afraid of the “socialism” of universal health care in the US frequently point to problems in Canada, Britain, etc., like waiting for a surgery and being turned down for certain types of care. But they never seem to mention all the bad experiences they’ve had with the current US system (waiting four hours in an ER, then paying a $50 copay, then paying $40 for medicine–all despite already paying over $1,000 a month in premiums. I was recently told by a dermatologist–to whom I paid a $40 copay–that my insurance would not cover removal of a large and irritated “skin tag,” because it was not bleeding and/or infected. So even in our current US system, I was turned down for care, despite paying over $1,000 a month in premiums and copays at ever visit).

  3. #3 Paul
    May 26, 2009

    One thing I do not see you address here is remuneration of health care professionals. One of the features of the universal health care system where I live (Ontario, Canada) is a tight regulation of what doctors can bill for their services. OHIP (the Ontario Health Insurance Plan) decrees how much can be billed for each and every procedure and service a doctor can provide. So-called “extra billing,” or billing the patient directly for costs above and beyond the prices set by OHIP is strictly illegal, and doctors can get into a heap of trouble for trying it. I suspect that similar universal health care systems elsewhere must employ a similar system, in order to avoid the problem of differing levels of care based on differing levels of patient wealth.

    Do you think it is possible for a universal health care plan to work without heavy regulation of pricing? How do you think American doctors would respond to the suggestion that the government regulate their earning potential?

  4. #4 Zeroth
    May 26, 2009

    Paul, I think many doctors in the US would be glad to not need two secretaries just to deal with insurance, and that they can actually help people, rather than having any earnings potential limited. Any doctor of yours that refuses a universal system because of a lower earnings potential is a doctor you should avoid.

    I wonder if there’s been a survey done of doctors in the US, and how they felt about the system.

  5. #5 MarkH
    May 26, 2009

    I think many doctors are concerned about loss of income. Especially procedure-oriented physicians. However, their days of charging 10x as much for 1/10th the time will not last not matter what.

    Most of us recognize that a huge portion of our overhead is due to paperwork generated by insurers and fighting for reimbursement. Most physicians, especially in poor or rural areas, donate huge portions of their time to treat the indigent. Getting paid, not having to fight for it, not having patients forgo treatment because of cost – these are things we are willing to sacrifice some total income for.

    Also, not every system is like Canada with such strict controls on what can be charged. Most systems have truly private physicians, and they can charge what they want, but shouldn’t expect government to reimburse them to the full extent. Patients would then pay the remainder over what the physicians charge.

    On the last day of this discussion we’ll talk about physician remuneration in these countries. In the US they do the best if I recall, but in the end, physician income is not the driver of a huge portion of medical costs. Physician income including overhead I believe is about 25% of costs – but I’ll have figures by Friday. It’s a good point.

  6. #6 Lodewijk Bos
    May 26, 2009

    Paul, Dutch medical specialists are amongst the best paid in Europe.

    More general, it’s a quite accurate story Mark tells (I’m Dutch), but it is somewhat more complicated. Especially for the poor(er) and the chronic diseased (very often also living on limited incomes). The insurance covers the basic medical issues (which are very good, e.g. they include full cancer treatment), and they will have to take you on if you want to change insurer, however only for the basic “package”. But additional insurance issues (e.g. accupuncture as pain treatment) will be either much more expensive for chronically ill, or you will simply not be accepted. Physiotherapy is limited in the basic insurance, extension is in the additions, which the poorer can hardly afford and the chronic will not receive unless they need the extension because of a very specific list of illnesses.

  7. #7 dış cephe
    May 26, 2009

    Thanks a lot.great blog.

  8. #8 Uninsured American
    May 26, 2009

    According to the Nursing Zone, the number of people w/out health care access skyrocketed from 56 mil. to 60 mil in just 2 yrs. In addition, a Fidelity survey finds almost half of U.S. employees believe their employers won’t provide health insurance, 2019.

    Like other middle-class uninsured Americans, prescription costs have become increasingly difficult to manage. Therefore, I had to go online to search for money saving options. I found Medtipster.com which is a helpful medical drug search engine that told me where to get generics for most of my brand named prescriptions. Medtipster allows you to type in your drug name, dosage and zip code to search for and locate prescription drugs that are available on discount generic programs across the United States; many of which are available for as little as $4. Prescriptions that are not available on a discounted program often have therapeutic alternatives on a discounted generic program, which are also available on Medtipster search engine. I have told my friends and families about http://www.Medtipster.com

    http://medtipster.com/search.php

  9. #9 Stu
    May 26, 2009

    But additional insurance issues (e.g. accupuncture as pain treatment) will be either much more expensive for chronically ill, or you will simply not be accepted.

    Which is a good thing. If someone wants quackery, they should bloody well pay for it themselves.

  10. #10 Comrade PhysioProf
    May 26, 2009

    Excellent post, holmes! The depth and breadth of the lies that the insurance industry has been spreading since forever about reforming the US system is simply mind-boggling.

  11. #11 Michelle Schatzman
    May 26, 2009

    In France, you have doctors who take only the publicly regulated fee and doctors who take more. In principle, a doctor must show better qualification in order to belong to the second class. In practice, access to the second class has been very heterogeneous in time, so that the between class II and qualification is not straightforward.

    The first tier of the system reimburses only on the basis of the regulated fees, and there is a small copay. The second tier may reimburse extra fees according to what kind of package the different insurers in the second tier offer.

    If a doctor takes excessively high fees, he is kicked out of the system, and reimbursement comes only on a microscopic scale. The definition of “excessively” is decided in view of the qualification and fame of the doctor.

  12. #12 Calli Arcale
    May 26, 2009

    Echoing what Stu said, I’d be fine if the system didn’t reimburse for acupuncture and other unproven therapies. I’d be more interested to know, and maybe Lodewijk Bos can tell us, is how the Dutch system handles the edge cases. For instance, I have a friend who is legally blind. He inherited the condition from his mother. She had a surgery some years ago which, in conjunction with some really thick glasses, gave her sight. He has not had the surgery, in large part because it’s very expensive and is not covered by any insurance plan that he’s had to date. (She lucked into a policy that would pay for it, which is why she was able to get it.) The thing is, his life doesn’t depend on it. It’s a major quality of life issue, and he’d certainly be able to get better jobs and not have his shins constantly bruised. And he’d love to not have to bring a cane every time he goes someplace unfamiliar. But his insurance doesn’t see that as a big deal. It’s a pre-existing condition, and the procedure would be purely elective in their minds. How are cases like that handled under the Dutch system?

  13. #13 Ronald van Raaij
    May 26, 2009

    Actually in addition to what Lodewijk said, coincidentally there was an article in yesterdays newspaper on an OECD report that stated that in the Netherlands the average income of specialists was 290k USD compared to 236k USD in the United states.

    The OECD report can be found here:
    http://www.oecd.org/dataoecd/51/48/41925333.pdf

    (You can also see that GP’s earn a bit less: 121 vs 146k)

  14. #14 Canadian
    May 26, 2009

    Why is the blindness case an ‘edge’ issue? I am horrified that this person can’t get the surgery! This would be covered in Canada – he may have to wait because it isn’t a life or death surgery but surgery would be done. I know that this post is discussing the Dutch system but I had to comment on this case.
    I have also lived in the Netherlands. I found the systems between Canada and the Netherlands to be similar in practice. However, the Netherlands took into account pre-existing conditions when deciding payment amounts and the Canadian system only looks at income.

  15. #15 Canadian
    May 26, 2009

    Why is the blindness case an ‘edge’ issue? I am horrified that this person can’t get the surgery! This would be covered in Canada – he may have to wait because it isn’t a life or death surgery but surgery would be done. I know that this post is discussing the Dutch system but I had to comment on this case.
    I have also lived in the Netherlands. I found the systems between Canada and the Netherlands to be similar in practice. However, the Netherlands took into account pre-existing conditions when deciding payment amounts and the Canadian system only looks at income.

  16. #16 Patient
    May 26, 2009

    I have a friend who is Dutch with a chronic illness. She often speaks of wanting to come to the US in order to get better treatment–she cannot afford to purchase the higher tier insurance that would cover physical therapy for her chronic illness. The basic plan, in addition to not covering “unproven therapies” also doesn’t cover some proven ones either. Like any socialized system, there is rationing, only it is under the veil of this “tier” system. Basic insurance is required to be purchased by everyone, but what “basic” coverage includes seems to be something that is changing the longer the system is in place. My friend has spoken of certain things being covered initially, but then they were only offered in the higher premium plan later on. She also describes waits of up to three months for a specialist visit.

    Personally, I think insurance has to be wrestled away from employers. People should be able to buy what suits their needs and geographic location. I never liked the idea that I am limited by what coverage my employer offers. Americans probably change jobs more frequently than the Dutch do, and we also have a much larger country with lots of regional differences in populations, diseases, and state laws to contend with. So while the Dutch system may be working on the small scale of 4 million people all with a similar value system and a less diversified population—it remains to be seen if such a system could really work in this country. There are perhaps some good ideas here, but it is still a work in progress from what my friend tells me.

  17. #17 GvG
    May 26, 2009

    @Patient.
    The (Dutch) employer pays part of the insurance bill, you are completely free to choose whatever insurance company you want. That is one of the things that changed some 2-3 years ago. Before that there was an employer-insurance company relation in a lot of fields.

    ooh and btw, your estimate of the population in the Netherlands is more than 4x too low and I’d check Geert Wilders on google before making claims about similar value systems and less diversified populations.

  18. #18 Ronald van Raaij
    May 26, 2009

    @Patient:
    Actually what you say (“My friend has spoken of certain things being covered initially, but then they were only offered in the higher premium plan later on.”) is wrong. In fact the coverage of the ‘basic package” has only been extended.
    What may be the case is that (since insurers are private companies) they to -attract more business- extend the cover in what they offer in the ‘basic package’ (and at a later date change it again).
    Also there had to be an incentive for people to not mus-use the system. Initially you got money back if you had not claimed anything that year. That did not seem to work so it was changed to a deductible. And this was of course not good news for people with a chronic illness…

    As for “unproven therapies” I can understand that if you have a chronic illness you want to ‘shop around’ in the hope of finding something, however most of that stuff (CAM) doesn’t work and only costs money.

  19. #19 William
    May 26, 2009

    I enjoyed reading the graphic entitled “Exhibit 2″. One thing I noticed was that the Netherlands actually has the highest percentage of people reporting that they spent time on paperwork and disputes over bills. Anyone know what is going on there?

  20. #20 Rosiejo
    May 27, 2009

    My husband and I lived in The Netherlands for about 20 years once we retired; we now are residing again in the USA but still spend time in The Netherlands. Our experience with medical care both without insurance in our earlier years when we simply self paid things or once required insurance came in even for foreigners who were residents was super. We had good care at affordable prices. I still go to Dutch doctors and so on for some of my medical tests each year. My husband relies on his American insurance but mine is pathetic (stems from his secondary but effectively shuts out preventive medical care and is aimed at major medical). If we all have affordable preventive care, we may well avoid the high costs of major medical. I think the US insurance companies are missing a major point.

  21. #21 Who Cares
    May 27, 2009

    @Calli Arcale(#12):
    If this is inherited blindness then it will be most likely in the basic care part our healthcare system. I can’t say for sure since I don’t know the type of blindness we are talking about.

    @Patient(#16):
    Generally this is covered in the basic care tier from the 10th session (inclusive) and depending on the insurer they offer a limited to total reimbursement of the costs of other sessions in the higher tiers.

    My own insurer asks €27.60 a month (on top of the basic policy cost of €92.00 a month) for total coverage for treatments for chronic illness (and other things as well).
    Before people start saying that the friend of Patient is being a ninny for claiming not being able to pay this the following. Chronically ill generally means no work, no work generally means receiving a payment of 70% of the minimum wage from the government. This means she earns less then the line of what is considered poverty in the Netherlands. Granted that she can get financial support for a lot of things but it means budget panic when a household appliance breaks, let alone pay half a month worth of income (that is for the entire year) on the extra insurance.

  22. #22 catgirl
    May 27, 2009

    Like any socialized system, there is rationing

    Did you happen to notice that the U.S. system also has rationing? If someone has a chronic condition, they might not be able to get any insurance coverage at all, even if they can afford it. Also, people can get kicked off of insurance plans just for costing the insurance company too much. That type of rationing is worst kind.

    She also describes waits of up to three months for a specialist visit.

    This is also typical in many parts of the United States. I’ve always had to wait at least a month to see a specialist, and I have even had to wait almost three months occasionally. I’m sure it varies by location, but all the problems with socialized health care already exist in certain areas of our country, and we still have to pay more.

  23. #23 Ronald van Raaij
    May 27, 2009

    I just read an article in The New Yorker http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all
    (About why the cost per person in McAllen county is so high.)

    With an interesting insight in the relation between amount (and cost) of healthcare and health.

    “In a 2003 study, another Dartmouth team, led by the internist Elliott Fisher, examined the treatment received by a million elderly Americans diagnosed with colon or rectal cancer, a hip fracture, or a heart attack. They found that patients in higher-spending regions received sixty per cent more care than elsewhere. They got more frequent tests and procedures, more visits with specialists, and more frequent admission to hospitals. Yet they did no better than other patients, whether this was measured in terms of survival, their ability to function, or satisfaction with the care they received. If anything, they seemed to do worse.”

  24. #24 Paul
    May 27, 2009

    @Canadian,

    For a citizen born in Canada, health care coverage begins at birth, so there is no such thing as a pre-existing condition. However, someone who immigrates to Canada with a pre-existing condition may have difficulty with the public, universal health insurance programs. If it can be shown that they moved to Canada for the express purpose of taking advantage of the health care system, they may be denied coverage.

  25. #25 Bram
    May 31, 2009

    Nice post, I’ll show it to anyone complaining about our expensive healthcare here in the Netherlands. Recently there has also been great improvement in length of waiting lists and pushing back quackery.

    Nevertheless we are facing – I think – quite some trouble with the ongoing increase in care (and cure) for the youth and the elderly.

    I am actually a bit scared about the future of elderly care here in the Netherlands, in which coverage by insurance also is a part, but perhaps even more a shortage of well trained staff is frightening, with an ever increasing complexity of care delivered for instance in extramural care.

    Also, I am under the impression that there is some degree of unequal distribution of care and cure among different places and different diseases/symptoms. For instance: Some years ago I ruptured a part of my left meniscus during strength exercises. Within two weeks after seeing my GP, who referred me to a specially designated ‘sports related treatment team’ I was having my knee looked at through an MRI. On top of that: I personally asked for an MRI, since the surgeon who investigated my knee optioned for surgery from the get-go. Another week later I was looking at my surgeon looking in my knee with a tiny camera. (which was actually quite a nice procedure, being able to follow everything on a viewingscreen, in contrast to rehab, which sucked)

    I always feel a bit ashamed when I hear people have to wait for a longer period for getting an MRI or an operation, while I was responsible myself for my own ruptured knee. And I quite often hear that, while working/studying. (I’m a student Nurse, with huge interest in elderly care)

    Nevertheless I am very happy to live here in the Netherlands and being able to receive very high standards of care without having to wonder wether I might go bankrupt on treatment. In some discussions I had over the comparison of different HC-systems one thing is often mentioned: in the Netherlands everyone has his own GP (called a ‘housedoctor’ when translated literally), I believe this is not the case in the US. Anyone familiar with the effects of such a system in comparison to not having your ‘own’ GP?

    Excuses for the (sometimes) dodgy English in this reply.

  26. #26 Patient
    May 31, 2009

    @GVD
    “The (Dutch) employer pays part of the insurance bill, you are completely free to choose whatever insurance company you want. ”

    I was not referring only to the Dutch system, but also to the American one.

    “ooh and btw, your estimate of the population in the Netherlands is more than 4x too low and I’d check Geert Wilders on google before making claims ”

    Excuse me for leaving out a digit. However, my claim is still correct in spite of the missing digit. As I see it– 14 million Dutch and 2 million immigrants/ethnic groups vs. some 280 million Americans comprising over 180 different ethnic groups, is a vastly different demographic to lay a template on and expect it to work.

    @Ronald van Raaij: I only report what was told to me. She has a chronic illness, she is at poverty level. Perhaps her circumstances are different.

    @catgirl:
    “Did you happen to notice that the U.S. system also has rationing? If someone has a chronic condition, they might not be able to get any insurance coverage at all, even if they can afford it.”

    That is capitalism. If one has the money to pay for a procedure, medicine, etc, they can get it in the US even without insurance. If they have enough money to pay for coverage, MORE OFTEN than not, they can also find some company willing to cover them albeit at an extremely high rate, and maybe not covering pre-existing conditions.

    Rationing in the European model means that no matter what the cost, one can not get the procedure, drug, etc. no matter how much they are willing to pay for it. The government decides who gets what and how much. That is why Canadians were flying over the border to get medical care in the US until the Canadian government decided to add a free-market mechanism in their system.

    There is rationing in EVERY system. Scarcity is a fact of life, and we all can’t have EVERY medical procedure that we desire as there is simply not enough money to pay for all of that for everyone. Americans have to decide however, if they want the government making the decision as to what kind of care they get OR would they prefer that they have the freedom to choose based on a mixed model of free market, out of pocket, and a yet to be determined system that limits the government intervention enough so that so that people can still get the care that they desire in addition to the care that they need. It is a tall order to find such a system, but it is imperative that we do so and not be hoodwinked into thinking we can have it all and the government is somehow going to be able to make all these decisions for us. Their track record is not that good.

  27. #27 Mathijs van den Bergh
    June 9, 2009

    Rationing in the European model means that no matter what the cost, one can not get the procedure, drug, etc. no matter how much they are willing to pay for it.

    Coming a bit late here, but this simply isn’t true. I imagine that Americans assume this because it is the case in Canada, but it is not all true anywhere else that I know of. If you want to pay for your care in cold, hard cash in the Netherlands you most certainly can.

  28. #28 Laane
    June 23, 2009

    I’m Dutch and I don’t recognize the happiness with the health care insurances.

    When your meds are not on the list you won’t get them.
    When they’re available in the supermarket, you drugs are not paid by the insurance.
    That means that people with chronic disease are facing high costs.

    I have a metabolic disease. Without certain vitamins I die. In the past they were paid by the insurance. Not anymore.

    My 4 kids with autism can have 10 sessions with a therapist..a year…
    There is no support provided at all. Only meds.

    We don’t have real freedom to choose insurance, because the employer of my husband is linked up with a insurer. Moving to another one means paying far more.
    When he loses his work we won’t be able to afford the basic insurance anymore for all of us. But by law we have to pay.

    Interesting isn’t it?

  29. #29 Wim Prange, Nijmegen, NL
    July 6, 2009

    @Laane

    When your vitamins are prescribed by your doctor, the insurance company will reimburse them.
    When your kids are diagnosed with an autism spectrum disorder, you will be able to get treatment and support etc. by means of the AWBZ. And as I’m working in a clinic with a lot of children who are diagnosed with an autism spectrum disorder, I can tell you that treatment isn’t restricted to “only meds”.

    Your husband works for an employer who has made a deal with an insurance company (usually a deduction on the (basic and/or additional) premium. You are absolutely free to reject that deal and choose another insurance company. When another insurance company provides better coverage for your particular situation, that might still be benificial.

  30. #30 Wim Prange, Nijmegen, NL
    July 6, 2009

    @Patient:

    Americans have to decide however, if they want the government making the decision as to what kind of care they get OR would they prefer that they have the freedom to choose based on a mixed model of free market, out of pocket, and a yet to be determined system that limits the government intervention enough so that so that people can still get the care that they desire in addition to the care that they need.

    I’m not an American but let me ask this: do you want to let the for-profit-market who’s main interest is keeping the shareholders happy, decide what care you get; or the government, who’s main interest is keeping you happy, in order to get re-elected?

  31. #31 Marjan
    July 15, 2009

    USA health care. A big Wall street ponzi joke. Tailored to upper class only now.
    I grew up in Rotterdam and moved to the USA in 1972 at age of 23.
    US health care used to be pretty good in the seventies/eighties. Deductibles were low or none existent at that time.
    I am 62 now, unemployed/uninsured for the past 3 years and hope I can limp along till I am 65 and qualify for medicare. Two trips to the emergency room made a big dent in my savings. Uninsured victims pay a lot more for health care than insured ones.
    Private insurance would cost about half(50%) of my current income.
    Gosh, how I miss Holland.
    Even back in the fifties , there was a mandatory insurance premium in Holland, called ziekenfonds, took care of everybody without ending up in the poor house/or on the street.
    Premium based on income not based on your health status. Nobody goes bankrupt in Holland because of medical bills. Nobody dies of a heart attack because of the terrible shock when cancer or another catastrophic disease is discovered and you will be quickly on your way to being an indigent if you live in the USA unless you are rich.
    Gosh, again, how I miss Holland. For the uninsured/under insured you might as well live in the dark ages.
    Granted, health care might be rationed in Holland but still a hell of a lot better than none at all for many individuals in the good old USA.

  32. #32 Terry
    September 8, 2009

    A friend told me her cousin lives in The Netherlands, moved there a couple of years ago for her husband’s job. The cousin said that some illnesses are specifically not covered there for anyone at any price, for example, breast cancer treatment. If anyone living there gets breast cancer, they will receive no treatment for it, in fact, it is against the law for any physician to treat it! If you need treatment, you will have to go to another country & pay however you can. Is this true?

  33. #33 Tom
    September 9, 2009

    My mother had breast cancer treatment in the Netherlands, it was covered and she survived it. Just for fun I compared my current American insurance against the base insurance in the Netherlands (www.kiesbeter.nl), and my insurance here covers less (basic even covers OI, KI, IUI, IVF and ICSI at 100%).

  34. #34 Martin Hazeleger
    September 15, 2009

    @Terry

    Breast cancer treatment is completely covered. Every illness that is potentionally life-threatening is covered in the basic insurance as well as virtually all treatments that greatly increase quality of life, such as surgery that can cure blindness.

  35. #35 Terry
    September 17, 2009

    Tom & Martin, Thank you both for your answers. Now I have to figure out how to tell my friend her cousin must have “misunderstood” something…

  36. #36 Gertjan Mulder
    September 17, 2009

    Wonderful blog; please keep it going. As a very interested US (but dutch-born) family medicine physician, it has been very interesting to discover the new features of the NL health system as of 2006. Can someone please clarify:
    -So far, does it appear the system is self-sustaining financially, or is it running over budget?
    -I am still fuzzy regarding premiums. Can you break it down again for me in the form of some examples. What about the person with no job, the person with minimum wages, the person with middle income, and the high income lucky bastard?
    -Am I wrong, or is health insurance in Holland still tied to employment? Sounds like there is a contribution from the employer?
    Thanks

  37. #37 James Shaw
    October 20, 2009

    If the American government wants to control medical cost they can do the following: 1. Remove all commercials dealing with heath care providers. 2. Remove all commercials involving drugs. These two items have nothing to do with providing better health care but in feeding the commercial needs of hospitals,doctors, and drug companies. You do not see these on TV in Netherlands.

  38. #38 George Berger
    January 3, 2010

    @Martin
    Your comment that the New Healthcare System provides for “surgery that can cure blindness,” is not fully accurate and explicit. You are not to blame for this, since the incompleteness of your post is the result of a secret to which the insurers (and probably some politicians) are privy. Let me describe one aspect of this.
    I am speaking of trhe quality of replacement lenses for people with cateracts. When the control of the insurance system was given almost entirely to the private insurers, by Hoogervorst and his cronies as a New Years’ present on 1 Jan, 2006, certain restrictions were introduced. I know of one. The insurers ordered eye doctors to use replacement lenses of a lower quality than those used before the takeover. My partner was told this by an excellent eye doctor who quit her hospital practice on grounds of principle. Clearly, the new lenses either performed less well or could become defective more easily than the old, better, ones. One wonders if other restrictions were introduced. I believe myself to have nearly become a victim of one: A secret system of age restrictions that I have described elsewhere in print and online.

  39. #39 George Berger
    January 3, 2010

    Here is another aspect of the Dutch secretiveness. It affected me personally. I cut and paste an article I have published elsewhere.
    DUTCH HEALTHCARE IS A DANGEROUS ‘ANOMALY IN EUROPE’

    George Berger (PhD), Uppsala, Sweden
    21 April 2009

    The Netherlands is often thought to have a system of public healthcare whose generosity and effectiveness approaches those of the Scandinavian countries. Such notions no longer reflect reality. The country once had a mixed, public-private system that guaranteed access to everyone, provided excellent service, and was financed by private policies and taxes. One’s source of coverage (private insurer or government schemes) depended on one’s income and employment situation. It worked reasonably well. I was proud to enter it when I left America to work in the Netherlands in 1972. I had attained an academic position in a society that was far more rationally and decently organized than was the USA.
    Although there were forebodings my enthusiasm ended abruptly in 2007, when my Dutch wife became seriously ill. She was 72, I was 64. Misdiagnoses, 7 appointments cancelled without explanation or apology, and an outright lie straight in her face by the head specialist of a hospital division ruined her health for good. I was furious at what I thought were the failures of individuals: the usual story of uncaring personnel and inefficient bureaucracy familiar to users of the NHS.
    I was wrong. In January of 2006 control over the Dutch medical system (except for a tax-funded system for difficultly insurable expenditures, the AWBZ) was transferred from the State to the private insurance firms by government decrees and legislation. Funding of facilities and staff was divided between tax revenues and premiums. The government guarantees everyone a ‘basic package’ provided by the insurers, but the latter determine the size, quality, and cost of the many remaining care provisions and facilities. State-supervised competition among insurers—called Regulated Competition in the USA—was the officially voiced mantra. Profit maximization, free market deregulation, and future privatization were and are the true motives. The public, whose inordinate respect for any authority has been ingrained in them since the 80 Years War by Calvin’s local henchmen, the Dutch Protestant priests, were easily fooled into thinking that this new system would work to their advantage. I am not of Dutch descent and was not deceived. My study of these changes since the onset of my wife’s illness led me to strongly suspect that her neglect was mandated by rules set by insurers and politicians acting in collusion. I decided that we were dealing with institutionalized age discrimination. I informed people but could do little except describe what had happened and voice my suspicions. Few Dutch persons believed me. My impression was and is that few wanted to believe me.
    Last December I was diagnosed as having aggressive prostate cancer and applied for treatment at the (Calvinist) Free University Medical Center in my city of residence, Amsterdam. The treatment offered seemed to be minimal, and my initial attempts to secure definite dates for tests were disregarded. A highly placed medical friend employed by a leading hospital in Manhattan confirmed the minimalism. I flew in secret to Sweden, for a second opinion and treatment plan at Uppsala Care, a division of the prestigious Academic Hospital (Akademiska Sjukhuset) of the great University of Uppsala. Two highly regarded specialists spoke with me and examined the tests results that I had brought with me. One decided that my condition was so serious that action within six weeks was necessary. They proposed a treatment plan that was far more extensive than the two proposed by ‘my’ Free University urologist, Dr R.J.A. van Moorselaar (I am now undergoing the first component of the plan’s finalized version.)
    I confronted Dr. van Moorselaar and asked him why his plans omitted a certain procedure that the Uppsala specialists said was an important part of their treatment. I did not tell him about my visit abroad. He gave me no medical reason but mentioned a Dutch ‘directive’ governing treatment. It is now official policy. I was shocked when I found that directive’s PDF and saw that its archival name (here translated without abbreviations) was ‘65+ prostate carcinoma 2007.’ Dr. van Moorselaar was one of its writers. (After I voiced my suspicions the archival name was changed. The ‘65+’ is no longer mentioned.) I was 66 and suspected government-sanctioned age discrimination motivated by the cost-cutting superprofit plans of the insurers. I moved quickly to Uppsala, after fruitlessly attempting to publicize this in the Dutch press, and sought proof for my surmise. My fear was and is that such insurer-dominated deadly practices, if now active in the Netherlands, would be adopted by other EU countries. For their politicians could succumb to the influence of national and multinational insurance conglomerates such as AIG, whose corporate connections with my and other Dutch insurers ought to be more widely known and might be the source of the shabby options offered me by Dr van Moorselaar. The EU would lose a major component of its humanitarianism. (The state of Massachusetts has adopted a version of the Dutch system, and an influential American healthcare economist, Professor Alain Enthoven of Stanford University, has been urging its use throughout the USA.).
    Late in March I obtained the needed proof. My source is a medical specialist employed by a hospital in the Netherlands (where most specialists work exclusively for public hospitals). This person is not of Dutch birth. This source told a reliable acquaintance of mine that a secret system of prioritization indeed exists in the Netherlands. It regulates the granting and withholding of treatment, or parts of internationally standard treatments. It is based on at least three factors: age, cost, and relevant statistics. Given my personal experience, research, and discovery of the PDF, I now maintain that this system was inspired by the insurers, developed in secret by government committees set up to study these issues, and then adopted as official but unannounced policy whose ultimate aim is twofold: (1) cost-cutting that increases profits and saves the government money, and (2) consequent service inefficiencies, so that the possibly complicit directors of medical institutions will beg for privatization as an attractive alternative that will have the support of a public desperate for decent healthcare. Something like this has already occurred in one Amsterdam hospital, Slotervaart, which is now owned by big business.
    I hold that this hitherto unknown arrangement was set in motion right after the transfer of power in January 2006. Whatever the details might be, in no other EU country do the insurance companies have such extensive decision-making freedom that national law prevents its government from interfering with most of their activities. (This differentiates the secretive Dutch system from the UK’s, in which NICE [National Institute of Clinical Excellence] does the dirty work but can be publically called to account.) For this reason EU civil servants have called the Netherlands an ‘anomaly in Europe.’ Are elderly persons considered—even in the higher echelons of the EU—economically unproductive and hence financial burdens rather than sources of pride? And who bears these ‘burdens’ in the Netherlands? Not the taxpayer, but the government and insurers, who try to prevent any increase in their expenditures. Dutch citizens and legal residents pay their premiums and healthcare taxes every month, or are granted the basic package, in the expectation of receiving adequate and expert medical attention when necessary. Although many are vaguely aware that something is wrong, few know that and how they are being cruelly deceived. Does the reader want this dangerous anomaly to become the rule in the EU? The danger is real.

  40. #40 DutchinUS
    February 20, 2010

    going back to the comments about health care specialist incomes: there is a big difference in income between specialists working at regional and local hospitals and those working at University Medical Centers (UMC).

    Specialists working at UMCs earn half of what their colleagues in the regional and local hospitals earn…

  41. #41 George Berger
    February 23, 2010

    OK, okey—The notion of being completely covered is ambiguous. Here is another example. It was told to me by a person who deals with certain financial aspects of Dutch insurers almost every day. I was told that the insurers have set “caps,” upper limits to the amount of certain medications that a patient can receive throughout the entire course of his or her treatment. I am nearly certain that there is a key for applying the cap that depends, among other things, on the patient’s age, nature and seriousness of illness, and medically standard length of treatment. If, e.g., your treatment takes longer than the key prescribes, you lose out. Here’s another trick. For certain types of prostate cancer, three years at least of a certain medication (for Adjuvant Hormone Therapy) was world-standard until Jan. 09. Lifelong is now strongly recommended. The Dutch Guideline of 2007 says approximately “six months seems to be sufficient” (my translation). This text appears on the “Oncoline” online version of this guideline. Oncoline is used, for example, by the people manning medical information lines. This can cost lives (see my piece above). When I contacted one such line and mentioned this, the person at the other end got angry and hung up. Draw your own conclusions. I drew mine well before I called the information line, left the country for good, and probably saved my life.

  42. #42 sarah
    June 27, 2010

    So in the Netherlands who decides who can and cannot have surgeries such as organ transplantation, artificial joints, or pacemakers placed? Is every citizen entitled to this regardless of age? Does the individual physician make this call or the government?

  43. #43 George Berger
    July 8, 2010

    Thanks to those of you who expressed appreciation of my work. I returned to this blog several minutes ago and was delighted to see the response. I am now in a position to answer some of your questions. The Guideline I referred to (and others as well) are not legally binding. They are written by specialists and reflect their competences and, I firmly believe given the evidence, the desires/mandates of the insurers. To support the latter claim, here’s the ending of a conversation I conducted in secret with a specialist who deals with prostate cancer. If memory serves me rightly, it was in May of 2009. After discussing the matter of my article above, I ended as follows. ME: Let me see if I understand all this correctly. Dr van Moorselaar is the executioner and the insurers write the laws. Is that correct? DISSIDENT SPECIALIST: Mr Berger, that is absolutely correct (all this in Dutch). I know of hospitals in the Netherlands where this guideline is not adhered to. I won’t speculate yet on the reasons for this doctor’s actions and inactions, e.g. not referring me to the proper hospital, if his hospital was ill-equipped to carry out the necessary trearment (I am still getting it here in Uppsala, so far with complete success).
    Not too long ago a person who works with prostate cancer patients at a Dutch hospital told me, *with no prompting by me at all*, that the 65+ age restriction is for real, although not legally binding. Its use is discretionary under conditions that I am not yet sure of. I probably mentioned my age in 08–66–at the start of our conversation. But the mention of the limit came later, while we were comparing different modalities, and was not at that time elicited by me. Hearing this ‘from the horse’s mouth’ affected me quite powerfully and directly confirms my previous claims. I believe that this partially answers the question of contribution #48.
    I have written a medical and ethical document that supports my case (I’m a retired academic philosopher with a background in math and physics). If the administrators feel it is appropriate I will paste a version here that is fully anonymised. I must protect my sources and do not wish to legally compromise anyone at all. This document is, I hear, fully accurate, both oncologically and in terms of standard professional ethics.

  44. #44 Sarah
    July 11, 2010

    George, I am in Oncology in the U.S who as you know is looking to the Netherlands to model our health care reform bill after.
    For those with prostate Cancer the cut off of 65, is this for any sort of treatment at all? Chemotherapy, surgery, hormonal therapy? This is so interesting because as you know a 65 yr old with no other comorbidities can be a very healthy fellow! Can you tell me where I can find more information on this?

  45. #45 George Berger
    July 11, 2010

    @Sara, First of all, I have no comorbidities. My constitution was excellent and strong before the treatment. The informal, legally nonbinding cut-off of 65 was discovered by me, See #39 and here below. It is *at least* for what I;m getting now, which is an aggressive ‘combination therapy. It is best if I cut and paste what I have written and circulated. That cannot be gotten in 2 hospitals in Amsterdam, but I am getting it right now. I’m one year into a 3 year course of Zoladex, which concludes what I now paste. Then I shall describe what I have learned since I wrote this document.

    My name is George Berger (PhD), I am a retired Dutch-American academic now living in Uppsala Sweden, and I am a citizen of America and the Netherlands. I am a legal resident of Uppsala and was born on 6 Oct. 1942. I resided in Amsterdam from 1 June 1972 until 8 January 2009. On that date I moved to Sweden and live at Dragarbrunnsgatan 44, Apartment 19, 753 20, Uppsala. My email address is bergergeorge@yahoo.com.
    Following a biopsy and an ultrasound investigation at the X1 hospital in Amsterdam at 9:30 am on 4 December 2008, Dr X2 (top urologist) reported the results to me at 11:20 am on 18 December 2008. He claimed that I had prostate cancer with Gleason sum 4+4 and with cancerous locations on both halves of my prostate. (In Uppsala it was staged at T2a). My PSA value was 29. He told me that this complex indicated a cancer of the lowest degree of aggressivity.
    Without giving me any explanation he claimed that I was excluded from brachytherapy. I was then offered the sole options of external beam radiation therapy (EBRT) and a radical prostectomy (RP). Nothing was said about the use of neo-adjuvant and/or adjuvant hormone therapy. Since the bald refusal of brachytherapy aroused my doubts about the effectiveness of EBRT and RP as monotherapies in my case, I flew in secret to Uppsala for a second opinion, on 22 December, 08. On the 23rd I was interviewed by a world-class urological surgeon and a world-class radiologist at the Academic Hospital (Akademiska Sjukhuset) of the University of Uppsala. They consulted and I returned to Amsterdam on the evening of 23 Dec.
    They proposed an extensive treatment that has been standard in America, Germany, and Sweden for some years now. My prostate was to be made suitable for brachytherapy by neo-adjuvant hormone therapy (not advocated in the Dutch guideline mentioned below), during which time EBRT will be applied. Brachytherapy shall then follow and more EBRT will be given. The total radiation will be around 70 Gray, but the use of two radiation sources gives a ‘boost,’ a biological advantage over one source with 70 Gray. Starting with the first EBRT, concurrent and then adjuvant hormone therapy will be applied continually. I agreed and received the treatment (with two sessions of High Dose Rate Brachytherapy). The adjuvant hormone therapy will continue for three years, which is world-standard. (The Dutch guideline says at one point that six months seems sufficient; another section leaves it up to discussion between doctor and patient but says nothing about length). Before starting, the urological surgeon performed a somewhat risky laparoscopic exploratory operation to investigate my lymph glands. No metastases were found there (a state called N0). X2 made no mention of laparoscopic analysis. Specialists in Sweden and Holland told me that the Uppsala method and hence neither X2 option was the most effective treatment for my sort of prostate cancer, since skeletal, CT, and MRI scans had luckily detected no distant metastases (a state called M0). I confirmed this opinion by a study of recent technical oncological literature. X2′s options are known to be less effective than the treatment I received, which is the best currently available for my situation.
    Given the above, I claim that X2 acted morally and professionally incorrectly in four potentially lethal ways. (1) He misinformed me about my suitability for brachytherapy. By doing so he automatically and perhaps intentionally withheld the use of the proper, i.e. Uppsala method for my case. This enabled him to restrict the options to the less effective techniques, EBRT and RP. (2) He did not inform me that I could have gotten the proper treatment at the RISO (Radiotherapeutisch Instituut Stedendriehoek eo) in Deventer, Nederland (communication to me by Dr X3 of the RISO, who at 15:45 on 15 Sept. 2009 telephonically confirmed that the Uppsala method was the best
    choice for me). Nor did he refer me to other Dutch clinics that perform such procedures (I think there is at least one other, and I do not know if X1 offers it. I do know that another hospital in Amsterdam does not offer it). This is a violation of my ‘Right To an Effective Remedy,’ which is actionable at the European Court of Human Rights. (3) He did not inform me that the proper technique could be obtained outside of the Netherlands. Finally, (4) the preceding points could have made it impossible for me to make a rational decision, (i.e. one whose reasoning is based on all available relevant and up-to-date information) as to the treatment(s) most suitable to me, given my preferences and wishes concerning survival and quality of life. In the case of prostate cancer, discussions with the patient that include these considerations are universally considered essential, owing in part to the present uncertainties and incompletenesses in the scientific data. X2 discussed nothing at all with me: he gave an unconditional judgement and it was wrong (Professor Emeritus X4 shared my concern when I telephoned him). Dr. X5 (X1, Nuclear Medicine) and Professor X6 (Hospital X7, brachytherapy) supported X2′s judgement in communications with me: X5 in face-to-face conversation and X6 in one telephone conversation and in one email to me. The grounds offered by both physicians were inadequate.
    Finally, I supplement the four claims of X2′s unethical actions and inactions with the accusation that he was instrumental in establishing a generally applicable structure of age discrimination. He was a member of the ‘central editorship’ (kernredaktie) of the group that wrote the ‘guideline’ (richtlijn) for the diagnosis and treatment of prostate cancer (‘Richtlijn Prostaatcarcinoom: diagnostiek en behandeling’). It was published in 2007 and can be found online as a PDF. I unearthed it several days after getting the second opinion. I was 66 when I first met X2. It almost but not quite requires that I be excluded from brachytherapy (for it permits deviations when necessary and is not legally binding). For its file (archival) name is ‘65+ prostaat_carc_2007.’ I accuse X2 of collaborating with others in setting a cut-off age of 65 years for eligibility for life-saving treatments whose complexity and expense are comparable with the one that I am now receiving.. My four points charge X2 with dangerously unethical behavior and criminal negligence. His role in writing the age-discriminating guideline is a crime against all residents of the Netherlands. He faithfully followed his own guideline, which imposes a life-threatening structural defect on the system of Dutch healthcare. My life was possibly knowingly but certainly needlessly placed at risk.
    Uppsala, 17 September 2009. Updated by me on 21 June, 2010.

    Since you are an oncologist I would be quite interested in your evaluation of my text. All I can sat now is that if the US insurers get as much discretionary power as the Dutch law allows, people’s lives shall be in danger, as was mine. I shall write more as soon as I post this.

  46. #46 George Berger
    July 11, 2010

    @Sarah First, for completeness. I have mainly relied on four articles. (1) American Brachytherapy Society Prostate High-Dose Rate Task Group, I-Chow Hsu MD, et al. August 2008 (a guideline). (2) Interstitial Brachytherapy Should Be Standard of Care for Treatment of High-Risk Prostate Cancer, byNathan Bittner, et al, Omcology, Vol. 22 No 9 (Aug 1, 2008). (3) Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. Anders Widmark et al, Lancet, Vol 373 Jan. 24, 2009. (4) Risk of Death From Prostate Cancer after Brachytherapy Alone or with Radiation, Androgen Suppression Therapy, or Both in Men with High-Risk Disease. Anthony V. D’Amico et al, Journal of Clinical Oncology, vol. 27, number 24, August 20, 2009.
    (4) argues in effect that the treatment I described is more effective than any bimodal treatment that employs Brachytherapy. The Widmark group used only EBRT, and the HDR
    I got shall hopefully at least match te group’s results. Now about 2 months ago I managed to speak with a cancer specialist (I use this term to ensure anonymity) at a special Cancer hospital in the Netherlands. I spoke English with my Swedish accent and said that I needed some information quickly. I said that I had prostate cancer, described my initial data, and asked if I could get the treatment that Swedes had recommended. That was the treatment I am getting here. The person said, quite categorically, “NO.” I was told that I could get either brachytherapy, external beam radiotherapy, but *not* both. When I asked why not, the answer was (still in English) “We see no advantage in it.” I had already read the articles mentioned above ((4) is especially relevant here). Having reached what was clearly a dead end, I ended the conversation. I believe this person to be wrong. If this is true and general, then one cannot get the treatment I got for my specific situation at a highly-regarded Dutch cancer centre. I hope this will be sufficient, when combined with my contributions above. Again, I am not sure of the specific reasons for this. I can speculate, based on evidence, but my aim here is to establish what I am almost certain of and what I am certain of. I hope this helps. Feel free to contact me at bergergeorge AT yahooDOT com.

  47. #47 Swivel
    January 16, 2012

    Hello, I was looking to move to holland to give a better life to my wife and unborn daughter. I want to get away from the soon to collapse education system and economy of the U.S. I was so excited to be moving there. I now question my choice. I do know that I no longer wish to live here. Are there any suggestions as to what country may have be able to provide a good education and healthcare?

  48. #48 Wow
    January 17, 2012

    Given the handle you’ve used here, I doubt whether you’re actually IN the Netherlands at all.

    Compared to the USA, you’re far FAR better off there than you were.

    I guess in the EXTREMEMLY unlikely event of you being genuine, your problem is you want perfect.

  49. #49 Wow
    January 17, 2012

    “So in the Netherlands who decides who can and cannot have surgeries such as organ transplantation”

    Just like in the USA.

    With the added “bonus” in the USA that corporations can decide who can and cannot have such surgeries based on their profit margin!!!

  50. #50 lawrence
    February 22, 2012

    In the US millions of USD has been spend on convincing the public their health is in better hands if it done completely by the corporate sector. As a result millions of Americans can not afford health insurance, as a result one can get the best possible treatments but the costs for health care are insane and they will keep rising. Your sickness is the cash cow for a lot of Venture Capital companies, Insurers and fund managers. Look at the absurd salaries and bonuses paid to CEO’s of Health Insurers.

    By monopolizing the medical profession to a bunch of companies a monster has been created, a monster that will patent everything there is to patent in order to maximize profits, a monster that will simply deny you care as it’s only only legal objective is to be as profitable as possible.

    Who are on the payroll of this monster? Politicians, political parties, health professionals, media professionals, law firms, PR firms…you name it.

    A combination of private and government provided health care that leaves no one out is the only way to provide affordable health care to everyone. The biggest joke in the US system is the prowess about the amount of high tech medicine and procedures they do. Every health professional knows you can provide for everyone at a fraction of the cost. The objective does not have to be to sell the most expensive care but the most effective care…. to everyone.

    Just the term “socialized medicine” makes me sick. How about calling it “public health care system”?

  51. #51 lawrence
    February 22, 2012

    In the US millions of USD has been spend on convincing the public their health is in better hands if it done completely by the corporate sector. As a result millions of Americans can not afford health insurance, as a result one can get the best possible treatments but the costs for health care are insane and they will keep rising. Your sickness is the cash cow for a lot of Venture Capital companies, Insurers and fund managers. Look at the absurd salaries and bonuses paid to CEO’s of Health Insurers.

    By monopolizing the medical profession to a bunch of companies a monster has been created, a monster that will patent everything there is to patent in order to maximize profits, a monster that will simply deny you care as it’s only only legal objective is to be as profitable as possible.

    Who are on the payroll of this monster? Politicians, political parties, health professionals, media professionals, law firms, PR firms…you name it.

    A combination of private and government provided health care that leaves no one out is the only way to provide affordable health care to everyone. The biggest joke in the US system is the prowess about the amount of high tech medicine and procedures they do. Every health professional knows you can provide for everyone at a fraction of the cost. The objective does not have to be to sell the most expensive care but the most effective care…. to everyone.

    Just the term “socialized medicine” makes me sick. How about calling it “public health care system”?

  52. #52 Bob
    March 27, 2012

    Here is another development reported by Trouw, translated by DutchNews:
    “Choose a different hospital and pay the bill yourself -
    Patients who want to be treated by a doctor or at a hospital which has no contract with their insurance company will have to pay at least part of the bill themselves, health minister Edith Schippers says in Monday’s Trouw.”

    http://www.dutchnews.nl/news/archives/2012/03/chose_a_different_hospital_and.php

    I conclude that the Dutch system works well for the insurance companies, but not well for the patients.

  53. #53 Bob
    March 27, 2012

    For the attention of Swivel who posted January 16, 2012 7:13 PM:

    For neonatal care I should recommend Belgium from the entire process. The health system is proactive and easily accessible. There is no gatekeeper process as one may refer oneself directly with the specialist (e.g obstetrician) -You will have to pay the bill and settle with your own insurance company. We live in the Netherlands but ensured that our son was followed by an obstetrician until delivery, where he was delivered in a calm hospital (with epidural and obstetrician present.) He birth was without a hitch :)

    You could contact the CHC Saint Pierre in Brussels as a starting point:
    http://www.stpierre-bru.be/en/index.html
    obstetrician & Gyno., – in French
    http://www.stpierre-bru.be/fr/service/gyneco/gyneco.html

  54. #54 Bob
    March 27, 2012

    //EDIT I forgot to note that we “live in the Netherlands” … but my wife went to Belgium for the delivery and monthly check-ups with the obstetrician/gyno., – In Netherlands the GP refused to refer my wife to a gyno.,

  55. #55 Bob
    March 27, 2012

    //EDIT: Apologies, but the hospital was CHU St.Luc, not St.Pierre.
    http://www.saintluc.be/en/services/obstetrics/index.php

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