Despite its
number one ranking and its many admirers both here and abroad, the Dutch health
care system is still a work in progress, writes Dan Buckley
WELL-ORGANISED
chaos is, perhaps, the best way to describe the Dutch health service, which has
been consistently ranked as one of the best in the world by many indicators.
At least,
that is how Dr Arne Björnberg sees it.
He is
chairman of Health Consumer Powerhouse (HCP), a Swedish company that conducts
an annual evaluation of European health care systems.
For the
third year in a row, the Dutch service has been judged the best in Europe by
the Euro Health Consumer Index, the survey carried out by HCP.
According
to Dr Björnberg, the rest of the EU could learn a lot from the Dutch.
“The
Netherlands has what we call ‘a chaos system’, meaning patients have a great
deal of freedom in choosing where to buy their health insurance to where they
get their healthcare service.
“The
difference between the Netherlands and other countries is that the chaos is
managed. Health care decisions are being made in a dialogue between the
patients and the health care professionals.”
In 2006,
the Dutch launched a major reform of their health service which, like Ireland,
was creaking at the seams. Under the old system, the patient was secondary to
that of the doctor or hospital. They sought to make that more patient focused —
or customer driven, to borrow a phrase from private industry.
They also
wanted a system with the potential to harness the benefits of real competition
and real choice through private insurance arrangements, while maintaining
health care for public benefit.
They have —
by and large — succeeded in this to such an extent that Dutch healthcare is
regarded as a reference for health reform elsewhere. It has been favoured by
James Reilly, the former minister for health, even while he was in opposition.
From 2010
to 2014, he made numerous trips to the Netherlands to see the system for
himself and was impressed by what he saw. Dr Reilly’s universal health
insurance system remains the centrepiece of the Government’s ambitious health
service reform plans although his successor, Leo Varadkar, has decided to delay
its introduction which had been scheduled for 2019.
Under the
current Dutch system, health insurance must be purchased for every citizen from
highly-regulated private providers. Described as “private health insurance with
social conditions”, insurers are tightly regulated for quality, provision of
basic services, and they are required to accept everyone in their coverage area
at a flat rate, no matter what their health status.
The “basic
package” is the minimum health insurance deal that must be offered by insurers
and must cover for all essential health care.
To prevent
loss of profitability from recruiting chronically-ill patients, they have a
risk equalisation system so that insurance companies are compensated for
providing service to those patients who need it most.
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 deny
health care provision to sick people.
The Dutch
system is not without its critics, both within and outside of the Netherlands.
While it
has reduced waiting lists, health costs have doubled in the past nine years. In
addition, patients can wait up to a week to see a family doctor and
consultations are regularly limited to 10 minutes of the doctor’s time.
The creaks
were outlined to delegates attending the 2011 annual general meeting of the
Irish Medical Organisation.
Dr Wim
Heres, a GP in the Netherlands, said: “I would like to spend more time with my
patients but to do so would see my income fall… We have less than 10 minutes to
spend with the average patient. We hardly do any social visits we spend so much
time on quality-related issues.”
Although
the system provided greater equity, the patient could “always get what you
need, you can’t always get what you want”.
The doctors
are not always getting what they want, either, according to the results of a
survey of Dutch GPs released last Friday.
“Family
doctors are very unhappy about the contracts they are being asked to sign by
health insurance companies and many feel they are being forced to accept them,
according to research by the doctors’ association LHV,” reports DutchNews.nl,
an online journal.
“Doctors
want to offer the best possible care to their patients,” said LHV chairwoman
Ella Kalsbeek. “They want to be listened to and taken seriously and if that
does not happen, they feel powerless and angry.”
Even the
system’s inventors concede that it is still a work in progress. At a health
conference in Cork in 2011, delegates also heard a note of caution from Wynand
Van de Ven, who helped spearhead reform of the Dutch health care system in the
1990s.
Outlining
the evolution of the health service in the Netherlands in the past 30 years,
Prof Van de Van said that, although the current system is a huge improvement on
what went before, there are still problems and it was too early to fully assess
its effectiveness. “The jury is still out,” he told delegates.
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