Mark Hoofnagle has a MD and PhD in physiology from the University of Virginia, and is now a general surgery resident. His interest in denialism concerns the use of denialist tactics to confuse public understanding of scientific knowledge.
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).
And then compare the costs
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.
Medicine & Health
Comments
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.
Posted by: Jos
| May 26, 2009 8:35 AM
@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).
Posted by: LAB | May 26, 2009 8:47 AM
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?
Posted by: Paul | May 26, 2009 9:03 AM
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.
Posted by: Zeroth | May 26, 2009 9:35 AM
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.
Posted by: MarkH | May 26, 2009 9:45 AM
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.
Posted by: Lodewijk Bos | May 26, 2009 10:35 AM
Thanks a lot.great blog.
Posted by: dış cephe | May 26, 2009 10:46 AM
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 www.Medtipster.com
http://medtipster.com/search.php
Posted by: Uninsured American | May 26, 2009 11:18 AM
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.
Posted by: Stu
| May 26, 2009 11:43 AM
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.
Posted by: Comrade PhysioProf | May 26, 2009 12:28 PM
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.
Posted by: Michelle Schatzman | May 26, 2009 2:25 PM
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?
Posted by: Calli Arcale | May 26, 2009 2:57 PM
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)
Posted by: Ronald van Raaij | May 26, 2009 4:09 PM
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.
Posted by: Canadian | May 26, 2009 4:15 PM
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.
Posted by: Canadian | May 26, 2009 4:18 PM
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.
Posted by: Patient | May 26, 2009 4:36 PM
@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.
Posted by: GvG | May 26, 2009 5:11 PM
@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.
Posted by: Ronald van Raaij | May 26, 2009 5:28 PM
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?
Posted by: William | May 26, 2009 7:08 PM
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.
Posted by: Rosiejo | May 27, 2009 1:06 AM
@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.
Posted by: Who Cares | May 27, 2009 8:22 AM
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.
Posted by: catgirl | May 27, 2009 1:57 PM
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."
Posted by: Ronald van Raaij | May 27, 2009 5:07 PM
@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.
Posted by: Paul | May 27, 2009 7:59 PM
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.
Posted by: Bram | May 31, 2009 9:14 AM
@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.
Posted by: Patient | May 31, 2009 10:57 PM
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.
Posted by: Mathijs van den Bergh | June 9, 2009 12:28 PM
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?
Posted by: Laane | June 23, 2009 5:35 PM
@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.
Posted by: Wim Prange, Nijmegen, NL | July 6, 2009 6:44 PM
@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?
Posted by: Wim Prange, Nijmegen, NL | July 6, 2009 7:10 PM
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.
Posted by: Marjan | July 15, 2009 10:00 PM
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?
Posted by: Terry | September 8, 2009 10:36 AM
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%).
Posted by: Tom | September 9, 2009 10:46 PM
@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.
Posted by: Martin Hazeleger | September 15, 2009 6:34 AM
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...
Posted by: Terry | September 17, 2009 10:15 AM
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
Posted by: Gertjan Mulder | September 17, 2009 5:18 PM
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.
Posted by: James Shaw | October 20, 2009 2:39 PM