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Let's go Dutch: A look at the Netherlands's healthcare

Jim O'Neil
Perusing through my favorite health-related websites this week brought me to a new blog post from the Commonwealth Fund that got me thinking about our overall healthcare system. We all know it needs improvements and that many people who desperately need care don't get it, for whatever the reason. I certainly don't pretend to have all--or any--of the answers to this complex dilemma, but the one thing I do know is that learning about other country's health systems helps us conceive of potential solutions to our own problems and visualize how some ideas may play out in the marketplace.

So with that in mind, let's go Dutch. According to the aforementioned blog, the Netherlands provides virtually everybody with high-quality and convenient medical care, with only 1.5 percent of its people uninsured. Per capita health spending in the Netherlands in 2009 was $4,914, compared with $7,960 in the United States. Dutch healthcare is generally convenient and timely as evidenced by a 2008 survey that found 60 percent of Dutch adults could get same-day doctor appointments, compared with only 30 percent of Americans.

Every January, Dutch adults choose from their private insurance options, all of which include basic benefits for medically necessary services and are regulated by the government. Each plan is available to everyone, regardless of preexisting medical conditions.

Dutch health plans have two types of premiums. Everyone must pay the flat-rate or "nominal" premium, which in 2007 averaged $1,400 per person in U.S. dollars. The "risk-adjusted" premiums are paid by the Dutch government and funded by income-based payroll taxes. Health plans with patients with severe medical needs get more money to cover the necessary additional services, while plans with healthier patients get less. Insurers can offer additional benefits through supplemental coverage, which isn't as heavily-regulated, so they can choose to vary rates and offerings based on medical conditions, with some limits.

This healthcare system results in some of the lowest out-of-pocket payments for patients worldwide. A 2008 survey of people with chronic illness found that only 8 percent of Dutch adults had out-of-pocket expenses greater than $1,000.

Additionally, the Dutch government has worked to improve urgent care access by establishing a web of urgent care centers with help from medical societies. Staffed by physicians and nurse practitioners, the centers offer phone consults and walk-in care to people outside of regular office hours.

I'm not in any way endorsing the Dutch healthcare system--I would have to do a lot more research and reading about all the inevitable and all-too-important nitty-gritty details--but I do think sitting back and considering the whole instead of just the parts has its advantages. As members of the healthcare industry, insurance companies have a responsibility to serve the people, if you will, and that involves thinking outside of the box, opening their minds to new possibilities, and always searching for innovative ideas to solve the problems they understand on such an intimate basis. Knowledge of other healthcare systems helps formulate successful policies that improve our own healthcare system overall. And isn't that all any of us wants? - Dina (@HealthPayer)

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