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Netherlands Healthcare

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May 20, 2009 – Comments (13)

Netherlands healthcare switched from a fully public version to a public/private version in 2006. costs.

My understanding is that less than 2% of people were dissatisfied with quality in 2006, the switch was an effort to control costs.

Their system is mandatory purchase of insurance from private companies, subsidized by a portion of a 6.5% income tax. Average per capita salary is 23k, as compared to the US at 33k.

The Gov't decides on a minimum coverage, at a cost of $1600/year. There is also a $250 deductible which many insurers wave if you go "in-network".

The public/private insurer model is very young in the Netherlands. It remains to be seen if the insurers will pressure Doctors/hospitals etc to the point of lowering quality to save costs as they have here. There is already pressure to reduce hospital stay lengths.

Notable cultural differences:

Most GP's in the Netherlands are reluctant to prescribe drugs, and usually prescribe the lowest dosage for the shortest possible time.

Most births are natural and at home, under professional care. About 10% go to a hospital.

Assisted suicide is a socially acceptable end of life choice.

Link from the Burril Report 

An American expatriate, Russell Shorto, writes about living in Amsterdam for the NY Times, the shock of income tax, and the relief of many other missng taxes, and the quality of healthcare in "Going Dutch". It is a good read for many reasons, besides healthcare. 

Nobody thinks the Dutch health care system is perfect. Many people complain that the new insurance costs more than the old. “That’s true, but that’s because the old system just didn’t charge enough, so society ended up paying for it in other ways,” said Anais Rubingh, who works as a general practitioner in Amsterdam. The complaint I hear from some expat Americans is that while the Dutch system covers everyone, and does a good job with broken bones and ruptured appendixes, it falls behind American care when it comes to conditions that involve complicated procedures. Hoogervorst acknowledged this — to a point. “There is no doubt the U.S. has the best medical care in the world — for those who can pay the top prices,” he said. “I’m sure the top 5 percent of hospitals there are better than the top 5 percent here. But with that exception, I would say overall quality is the same in the two countries.”

Indeed, my nonscientific analysis — culled from my own experience and that of other expats whom I’ve badgered — translates into a clear endorsement. My friend Colin Campbell, an American writer, has been in the Netherlands for four years with his wife and their two children. “Over the course of four years, four human beings end up going to a lot of different doctors,” he said. “The amazing thing is that virtually every experience has been more pleasant than in the U.S. There you have the bureaucracy, the endless forms, the fear of malpractice suits. Here you just go in and see your doctor. It shows that it doesn’t have to be complicated. I wish every single U.S. congressman could come to Amsterdam and live here for a while and see what happens medically.”

Healthcare expenditure per capita in 2007 in US$:

$3092 Netherlands
$6096 United States

13 Comments – Post Your Own

#1) On May 20, 2009 at 10:21 PM, vmh104 (< 20) wrote:

Actually I am Dutch... oddly I thought we always had a public private system... but then I left the Netherlands in my early 20's so maybe I'm wrong.

But the point is simple. All this idiotic whining about rationing being bad is silly. You give everyone a basic health plan which of course has limits... it has to... and if someone wants a 2 million dollar pancreas transplant to increase their life span by a few months they better have supplemental insurance. Everyone wins.

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#2) On May 20, 2009 at 10:38 PM, soycapital (< 20) wrote:

I don't pretend to know how proficient the Dutch government is however I am quite up to date on track record of the U.S. government.

 I'm convinced that I do not want any part of the US government involved in our healthcare. I admit there are problems but more and bigger government has never brought a solution and in my opinion it never will.

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#3) On May 20, 2009 at 11:13 PM, ajm101 (32.27) wrote:

Don't get your hopes up, this Congress is bought and paid for on the issue.  Robert Reich is right that they're giving away the farm... very disappointing.

It's obvious that the US is being taken over a barrel by the drug and health insurance industries, but some people will continue to insist that the status quo is better than the obvious improvement (single payer w/ optional supplemental) because of ideological blinders or their financial interests.

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#4) On May 20, 2009 at 11:16 PM, devoish (99.07) wrote:

soycapital,

I hear that sentiment endlessly repeated.

vmh104,

Thanks, I missed an edit.

In actual fact you always did have a public/private system, where the taxes paid for a basic (and very satisfactory) plan for everyone, with optional private coverage available. The majority of citizens chose and were happy with the public system, so effectively it was public. I meant to remove the word "fully" because "mostly" would be more accurate. I apologize to all readers for my error.

If you could add anything else of value, especially to correct any other errors it would be appreciated.

I linked to the article because I believe it is misrepresentative of Single Payer systems to suggest quality has to suffer. I modeled the Dutch system because prior to switching it had a very high satisfaction level, and I also found the anecdotal story I linked to describing life in the Netherlands. I thought it would be an illuminating read.

I do not consider the current version a good model because I do not believe the insurers have had enough time to force "cost controls" on physicians and caregivers, and the subsequent quality problems they have caused here. I hope they are succesful, but I believe quality will fall.

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#5) On May 20, 2009 at 11:36 PM, devoish (99.07) wrote:

ajm,

I wonder what it will take for Americans to call their Congressman at 202 224 3121 and just ask for Single Payer. To appropriate Deej's father's quote, no matter how far from Hell we are right now, we are definitely moving closer.

And yes, I agree that Congress is afraid of being called names by insurance executives and their marketing departments.

 

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#6) On May 21, 2009 at 12:12 AM, motleyanimal (93.53) wrote:

devoish, you might be interested in this.

 

http://caps.fool.com/Blogs/ViewPost.aspx?bpid=198183&t=01006438803569275438

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#7) On May 21, 2009 at 1:05 AM, vmh104 (< 20) wrote:

There are things that are drastically different in NL that involve more than a just switching to single payer, here are a few that come to mind;

1) The whole malpractice issue is absent. Doctors are judged by other doctors when they make mistakes. If the mistake was deemed to be due to incompetence or neglect they lose their license. They are not sued by patients, nor are hospitals or drug companies

2) Defensive medicine, pharma advertising, pharma bribing doctors, that whole mess doesn't exist

3) Doctors do not deem themselves to be some sort of sub-royalty expecting enormous salaries as some of their US counter parts do.

4) Education system is practically free. Doctors do not start their careers with a huge debt 

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#8) On May 21, 2009 at 2:52 AM, portefeuille (99.56) wrote:

I have lived in Germany for most of my life (and very close to Belgium and the Netherlands for quite a few year (I know, most Germans live rather close to those countries, but I could easily make a 1 h trip on my bike spending 20 minutes in each of the 3 countries mentioned (it should be fairly easy to spot the town that I am talking about))).

This is comment #2 of this earlier blog post:

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#2) On May 04, 2009 at 9:55 AM, portefeuille (99.98) wrote:

(I think at the time my top3 reasons not to live in the U.S. were Bush, the death penalty and the way the Dow Jones is calculated ...)

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I guess reason #4 might have been the health care system ...

(also see my comment on the German system here (comment #3))

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#9) On May 21, 2009 at 2:53 AM, portefeuille (99.56) wrote:

quite a few year

quite a few years

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#10) On May 21, 2009 at 9:17 AM, devoish (99.07) wrote:

There are things that are drastically different in NL that involve more than a just switching to single payer, here are a few that come to mind;

vmh,

Thanks for the additional points.

1) The whole malpractice issue is absent. Doctors are judged by other doctors when they make mistakes. If the mistake was deemed to be due to incompetence or neglect they lose their license. They are not sued by patients, nor are hospitals or drug companies

I view the Hospitals and Doctors as seperate from the drug companies because the Dr's follow drug company recommendation. I think most Americans understand that accidents happen. They also know if you are unable to work and on SSI, you are scraping by in poverty. If the US citizen had universal healthcare and SSI that could deliver a clean apartment I think the need for million dollar judgements would be gone. Right now if you are 40 and suddenly unable to work for any reason, $1 mil will not last you 40 years and without decent "safety nets" people get desperate.

American drug companies seem to have been playing fast and loose with safety and testing, and seem to control the FDA the way banks control the SEC. That becomes a whole different level of problem.

2) Defensive medicine, pharma advertising, pharma bribing doctors, that whole mess doesn't exist

That is a serious concern for the Netherlands. You have let the insurers institute "cost controls" in your hospitals and lower cost "networks". The "network" physician has to charge a little less, and make it up by seeing 1-2 more patients each day. Next year, he will have to do it again. That means a half hour visit becomes 20 minutes. 90% of physicians are not in the top 10% and need to spend a little longer, but now their pay cuts become the insurer's profit, but you see no savings. Welcome to the USA. You will soon learn that drug companies need to see the Doctors to explain when and how to prescribe their drugs safely and effectively. Three years later you will see pens, and notepads with Pfizer written all over them. Your Doctor will prescribe expensive acne treatments for your son, as suggested by the pharmas, and after two years of no improvement you will go on the internet and have success with milk of magnesia. Bribery does not exist without the potential for profit.

3) Doctors do not deem themselves to be some sort of sub-royalty expecting enormous salaries as some of their US counter parts do.

The issue for most Dr's here is not being overpaid, it is keeping their practices open. In another post I was told of a Dr who closed his practice to sign on with the armed forces, for financial reasons.

4) Education system is practically free. Doctors do not start their careers with a huge debt 

Seperate but related issue we also need to correct. President Obama has stopped lending money to banks at 3% who then lend to college kids at 7%. He is lending directly to the kids for the lower rate. He  has also proposed trading a couple years of work at a hospital for a Dr's education. Small steps in the right direction.

Not enough to make me happy with him as President though. Just relieved we don't have another Republican mandate.

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#11) On May 21, 2009 at 10:12 PM, vmh104 (< 20) wrote:

I view the Hospitals and Doctors as seperate from the drug companies because 

Sure but I was looking purely from an expense point of view. The medical industry here supposedly pays 60 times more on lawyers and insurance to prevent litigation then they pay out on litigation settlements. This is a chunk of money that is pure waste.

If the US citizen had universal healthcare and SSI that could deliver a clean apartment I think the need for million dollar judgements would be gone.

I think you may be a bit naive here. Ppl don't sue because they need to they sue because they can. It takes a noble soul to not sue given the opportunity.

You have let the insurers institute "cost controls" in your hospitals and lower cost "networks".

I know and I'm sorry I did it ;) ....Yes that's the flip-side of the problem.

The "network" physician has to charge a little less, and make it up by seeing 1-2 more patients each day. Next year, he will have to do it again

In my experience that is done here but out of greed. I rarely get 5min of face time with a specialist, they fill up their required minimum minutes with interns and nurses basicaly asking me the same questions. This is with good insurance.

The issue for most Dr's here is not being overpaid, it is keeping their practices open. In another post I was told of a Dr who closed his practice to sign on with the armed forces, for financial reasons.

Yes I know there are cases like that. Not sure if it's the norm. Maybe only for PCPs? A friend of mine is a PCP in the Boston area who is unable to find partners for his practice; "Why would they work with me and make $150k a year when they can make $350k a year as a specialist"

President Obama has stopped lending money to banks at 3% who then lend to college kids at 7%. He is lending directly to the kids for the lower rate.

That's not enough by a long shot. I can't quite remember the numbers. It's been a while since someone shared them with me. But these guys spend 6-8 years in school, then have to intern for little to no money, then when they finally start are looking at yearly malpractice fees in the tens of thousands while they have to pay of hundreds of thousands in debt... you can see where 150k yearly is not that much here.... while in NL it would be a fortune.

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#12) On May 21, 2009 at 10:41 PM, devoish (99.07) wrote:

I do not disagree with your points, but I see some of them a little differently.

 I think people would not be awarded huge judgements if there basic needs were taken care of. It is not a question of suing as much as a question of winning a huge judgement. Once the huge judgements are gone the lawyers go too.

Why would any doctor work for $150k? Ask www.doctorswithoutborders.org and while that may be more than most Dr's are willing to give it has to kill them to be constantly fighting to get paid at all. There is a lot of room to compensate Dr's a little better if the insurers cut is gone.

We agree President Obama and Congress has to do more for helping pay for college. President Obama's campaigned on a plan to trade college for two years intern service, or something similar. With H.R.676 Dr's would balance the value between the specialists and the GP's, by setting fees. And spcialists would be on the panel that sets fees. Cosmetic surgerys would likely not be covered unless it was to correct a disfigurement as opposed to just wanting puffier lips. Then it would be free market.

Thanks for your help.

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#13) On May 21, 2009 at 11:14 PM, NOTvuffett (< 20) wrote:

The dead and dying that can't pay for medical attention litter the streets in the USA, lol.  But we have a free market solution- soylent green.

How about we do something sensible like mandating catastrophic coverage which is cheap, and let those with the sniffles pay for their own care?

Oh, remember that soylent green now comes in diet form...

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