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.
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).
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.