Healthcare System in the Netherlands

Healthcare System in the Netherlands

The Netherlands has a unique concept of 'family physician' known as 'Huisarts' who the primary Doctor responsible for coordinating physical and mental care of patients in his neighborhood. January 2006 saw the launching of a new healthcare system which requires citizens to avail a basic health insurance package. It covers medical treatment alongwith services delivered by General Practitioners, hospitals, specialists, indoor admission, dental care and different medical appliances. The healthcare system in the country comprises of three divisions for health insurance, managed by three different establishments. They are the national health insurance for special medical expenditures; mandatory sickness funds meant for people having low incomes less than a specific stage and private, primarily voluntary health insurance; and finally the voluntary health insurance which functions as a supplement. Financing Healthcare system has in the past come from several public and private sources. From 1988 onwards, prior to manage competition reform proposals, mandatory health insurance premiums accounted for roughly 60%, usual taxation for 14%, voluntary health insurance premiums for 16%, and user charges for patients for roughly 11% of the total health expenditures.

Important differences exist between the U.S. And Dutch healthcare system as regards reimbursement scheme is concerned. In U.S., the capitated reimbursement includes not just the consultants but the expenditures for some of the normal diagnostic examinations too and also regular preventive interventions like immunizations. In the U.S., the managed care settings depend extensively on the market-driven aspects of competition and deregulation whereas in case of the Netherlands, the balance for reimbursement of service even considers the doctor's practice demographics, income criteria, and overhead costs. The important lesson for U.S. from the Dutch experience is that all properly managed health systems ensure that every inhabitant get access to reasonable health coverage for a structured set of benefits which implies universal coverage. Besides, provision of affordable healthcare to its citizen which is the hallmark of Netherlands is a positive cue which the U.S. might consider adopting since it tops the entire nation on healthcare spending as its percentage of GDP.

Introduction

The Netherlands, although a small nation with not so large population, has a robust economic structure. It boasts of a GDP which is the 14th highest in the world. Soaring economic growth, for instance, has equaled with a considerable rise in the number of job holders. This is regarded to be the success of the Dutch 'poldermodel' indicating the economic order featured by an increased intensity of cooperation and unanimity among the administration, employers and union. The government, since 1993 has slashed public spending as a constituent of GDP from 60% to 50%. The nation has a very low rate of unemployment which stands at a mere 5%. In the Netherlands, attention to the socioeconomic inequalities on the health front has shot up extremely over a comparatively short time frame. Two national research programs on the issue of socio-economic inequalities in health, the first centering on elucidation and the second one on involvement, demonstrate the actuality the decision makers and researchers at the helm of affairs have rendered a systematic endeavor to cope with this matter. On the aspect of health, the nation has a far-reaching social welfare system. About 10% of the working population looks forward to the social security benefits due to long-term sickness. Netherlands has a system wherein a person is entitled for a long-term disability benefit if he is unable to attend to his job following a waiting period of one year. The quantum of benefit is approximately 80% of the employee's last salary. Added to the provision of benefits, a particular poverty policy is implemented in the Netherlands, mainly at the municipal level. A striking feature of the healthcare system which is hard to find parallel anywhere is the coverage of 100% of the population under insurance for healthcare costs. Citizens earning an income lower than a benchmark level comprising 60% of the population are insured as a mandatory measure with the Health Insurance Fund. (Mackenbach; Bakker, 2002)

Major health conditions facing the country:

The major health indicators in the Netherlands are as follows (i) Life expectancy: In Netherlands, women outlive men with women life expectancy being 81.1 years compared to 76 years for men. With increased lifespan, older people are able to respond with changes in lifestyle which is able to raise healthy years of life. (ii) Infant mortality: Infant and neonatal mortality rates are a little higher in Netherlands compared to average of European a nations. (iii) Primary death causes: 81% of all death is due to non-communicable diseases. Cardiovascular diseases (CVD) take the lives of 34% of people, cancer 29% and death due to external reasons account for nearly 4%. (iv) Obesity: 47% men and 36% women have excess weight while 9% of men and 10% of women are obese. (v) HIV / AIDS: During 2002, majority of the fresh cases of HIV infections in the nation were acquired through homosexual and bisexual contacts among men. (World Health Organization, 2006)

The people of Netherlands possess a very high quality of health, both according to their independent subjective standards and also by objective data on important health indicators. This encouraging figure for Netherlands is because of higher living standard, proper nutrition, excellent sanitary and housing conditions and the facility of safe drinking water for the bulk of the population since the starting decades of the century. Since the past five decades, Netherlands had topnotch healthcare services. Because of this, ailments and loss of life are to a great extent impacted by causes associated with a wealthy society i.e. over consumption and degenerative disorders. Coming to the Dutch healthcare system, it has been described as a 'patchwork quilt' as it is devoid of any master plan at its foundation. Instead, it is a complex system which has developed from a regular adding and altering of institutions, rules and responsibilities. This procedure of evolution has been the ideal history of Dutch pluralism. Nevertheless, the system which has surfaced over the years is one in which a high quality healthcare is delivered with practical efficiency, and is equitably distributed over the population. (Banta, 2004)

Netherlands has formed a system in which every citizen is entitled to proper healthcare. From the year 1983, the Constitution contains an article wherein central authorities are duty bound to assume steps for the promotion of healthcare. The administration is given the task of guaranteeing that the entire population of Netherlands receives quality care at a cost which is affordable and delivered through a system that functions across the nation. But this system has not been converted into a "National Health Care System" like the British Healthcare system. Healthcare delivered to the public, control of contagious diseases, environmental safeguards and the control and recognition of the healthcare professions have conventionally assumed a branch of operations of the union government. When the actual provision of care is taken into account, the authorities have concentrated on building supportive conditions wherein the private sector would diversify into the disciplines of hospital care, nursing care as also social services. Hence, it is seen that in the Netherlands the health care system is one where there is a coexistence of public and private endeavor under the broad canopy of the central govt. (Banta, 2004)

The healthcare system in the Netherlands is centered on the family physician known as "huisarts." Every citizen has to be registered with a family doctor who is the vital person responsible for coordinating physical and mental care. Prior to consulting a specialist doctor, it is imperative that a person gets referred from his family doctor and also for the medicines needed for prescription. In case of emergency, one can always dial up the number '112' for immediate assistance. The "huisarts" corresponds to the General Practitioner or a Family Doctor. The doctor has a list of patients residing in the neighborhood of his practice and there are restrictions regarding the area he is supposed to serve as per law. The reason behind such a system is facilitating the doctor to attend emergency conditions within the shortest possible time. It is important for people who choose to settle in the Netherlands to immediately register with a "huisart" at the earliest. (Noordwijk, 2004)

The Netherlands do not pose any special health risk to the people visiting the country, thanks to the excellent health conditions prevailing there. There is no need to take any special inoculations. Any essential vaccination can be obtained at the local level. The medical care in the Netherlands is of high standards and can be comparable to those found across Western Europe. There are Diagnostic labs and experts in every discipline of medicine. The hospitals have all the infrastructure and a lot of clinics are there. One is required to register with a General Practitioner - huisart prior to attempting to get medical treatment of non-emergency nature from a Specialist. In the Netherlands, the medical care system is founded on the referral system which mandates that patients visit a local huisart in the first place. Specialist doctors will normally examine only those patients who have been referred to their clinic by a general practitioner. (U.S. Department of State, n. d.)

The Government of Netherlands is not responsible or the ongoing management of the healthcare system on a daily basis which is offered by private healthcare service providers. However the government is charged with the accessibility and ensuring appropriate standards of the healthcare. A new healthcare insurance system has been launched since January 2006 under which every citizen is required to purchase a basic health insurance package. Under the basic package, one is covered medical treatment, inclusive of services by General Practitioners, hospitals and also specialists, indoor stay, dental care and different medical appliances. People working in the private sector in the Netherlands might decide buying a collective health insurance policy which can be a good alternative since it is cheaper. The fees of the basic health insurance package are calculated annually by the companies offering health insurance which are generally 95 euros monthly. In case of some people, healthcare in the Netherlands has come to be increasingly costly because of the above charge. The govt. Of Holland reimburses these instances through offering grant care. The Tax Administration calculates whether one is entitled by examining the income. Besides, even foreigners can also avail of this benefit in case they meet the criteria. Children below the age of 18 years are exempted from paying any health insurance and are insured free of charge under the basic package of healthcare. ("Healthcare: The Medical System," 2008)

Review of how the health care system is organized and financed:

As regards organization, the Netherlands healthcare system consists of three divisions for health insurance, managed by three different establishments (i) national health insurance for special medical expenditures (ii) mandatory sickness funds meant for people having low incomes less than a specific stage and private, primarily voluntary health insurance and (iii) voluntary health insurance that acts as a supplement. The first covers expenditures linked with long-term care or high-cost treatment, under an act which includes staying in the Netherlands. The second consists of normal, essential medical care. Under the Sickness funds, anybody whose monthly remuneration is less than 30,700 euros and all social security benefits, and account for 65% of the population. Anyone higher compared to this ceiling is covered under private health insurance, covering 28% of the population. The health insurance schemes for bureaucrats take up another 5% of the total population. The third one covers forms of care considered less emergent, under which are covered dental care, prostheses, hearing aids and so on. Supplementary private medical insurance broadly includes these costs. (World Health Organization, 2006)

Of late, the country has witnessed a changeover from government to the private sector as also shift of competencies from central to local or regional authorities. The growing impact of local and regional governments in planning reveals these changes. Coming to the healthcare financing for extended periods it accounts for 41% of the health expenditure. It is funded through deductions from the monthly salary as also funds given by the government. The sickness funds in the category for general medical care bear 38% of health expenditure. Apart from these important sources of funding, the primary complementary sources of healthcare financing comprises of private health insurance which is 15% and payments made from out of pockets which is 6%. Under the sickness funds, these have a budgeting mechanism wherein they bargain as regards the quality, quantity, and to certain degree, the price of service with providers. This provides the funds some freedom and bonuses to buy care as efficiently as possible, and also to foster market competition. (World Health Organization, 2006)

From the year 2000, payments in favor of hospitals have been linked with performance, which constitutes the debut move in the direction of altering the hospital payment system to a system which is based on a mixture of analysis and treatment. Moreover, hospitals get extra budgets for key capital expenditures. In excess of 90% of the hospitals are private, non-profit facilities, and the rest are primarily public university hospitals. Doctors who have received training as specialist are on the payroll of the hospitals. General Practitioners -- GPs are paid on a per-capita basis in case of patients insured by sickness funds and on payment basis for the people who are insured privately. (World Health Organization, 2006)

Healthcare system in Netherlands has in the past been funded from several public and private sources. Since the year 1988, before managed competition reform proposals, mandatory health insurance premiums were responsible for roughly 60%, usual taxation for 14%, voluntary health insurance premiums for 16%, and user charges for patients for roughly 11% of the net health expenditures. Multiplicity in financing is responsible for coordinating and shifting problems of cost. For instance, it has been found difficult for the government to shift resources from secondary care to preventive and primary care since the former is hugely financed by the private sector although the latter is not. The government is unable to directly regulate expenditure on healthcare like that of UK and New Zealand governments which are known as the single payer systems financed mainly from general taxation revenues. Albeit the differences, there is a similarity between the U.S. And that in Netherlands to the effect that in the past reimbursed policy holders for all medical expenditures done have been unwilling to engage in direct contractual negotiation with doctors as well as hospitals. (Flood, 2003)

Judged from a generic sense, it is worth noticing that hospitals which were at a particular time charitable services, have now become profit centers. As a demonstration of their secularization, hospitals at every place have emerged as major problems in shaping the economic policy. Total expenditure on healthcare is more than 10% of the GNP in a lot of developed nations and reaches that percentage in others. Hospitals are responsible or 50% of all healthcare spending implying that it is more in some nations and less in others and account for between 3.5% and 6% of the GNP. Government Finance Officers remained the main constituency for cost control. (Glaser, 1987)

In nations where expenditures intended for patient care was managed through the general treasury like in Canada, Britain, and the Medicaid scheme in U.S., the finance officers were concerned regarding the forthcoming bankruptcy of the accounts and the requirement to save them from subsidies by the Treasury. They also doubted if short-term arrangements like higher cost sharing by patients actually reduced costs and were affordable from the political point-of-view. In case of nations in which health and hospitals were financed by the private carriers such as Germany, the Netherlands and American Blue Cross and insurance offered by commercial companies, it was the task of the govt. functionaries for establishing and agreeing to the premiums as also payroll taxes. There were concerned that a large amount of national income was being transmitted by means of this channel, and that health providers were earning profit without providing an appropriate return and that healthcare services lacked efficiency and were wasteful. Beside, the premiums and payroll taxes would kill the motivation to work and invest. (Glaser, 1987)

Salient ways in which the system differs from the U.S. system

In the U.S., managed care is a broad nomenclature for miscellaneous products. Therefore it is delivered in several shapes. The most extensive format which includes almost half of the managed care population is the Health Maintenance Organization. -- HMOs. People who are covered under the insurance plan of HMs are needed to use just a group of pre-chosen, affordable service providers with whom the HMO has bargained for normal and required fees as regards their services. Availing the services of a specialist care, a stay in a hospital or other expensive medical services is given only following the requirement of these services has been confirmed and sanctioned in an administrative manner by the representative of the HMO. (Verheiide, 2006)

Nevertheless, major differences exist between the U.S. And Dutch reimbursement schemes. For example in the U.S., capitated reimbursement covers not just the consultants but also the expenditures for some of the normal diagnostic examinations and also regular preventive interventions like immunizations. Depending on the demographics of practice population, the expenditure of these services could severely impact the income part of a doctor's capitated annual budget. The most prominent difference between healthcare systems in these two nations is in the bargaining of the rates for capitated care. In the U.S., the managed care scenario depends a great deal on the market-driven aspects of competition and deregulation. In the Netherlands, the balance for reimbursement of service even considers the doctor's practice demographics, income criteria, and overhead costs. (Verheiide, 2006)

Unlike the Netherlands, the U.S. was unsuccessful in carrying out a national health insurance scheme in the 1930s & 1940s. One probable justification was the vehement objection of the American Medical Association. The failure of the national insurance proposal was due to the fact that doctor-dominated Blues insurance proposals were struggled to guarantee access by the middle class to cheap coverage and this approach damaged political support in favor of a national scheme. Not like majority of other developed nations, the U.S. has not in the past depended on general practitioners as the frontline to the access of patients to more costly services such as services of specialist, admission in hospitals and so on. There are three primary categories of managed care organization currently in the U.S. They are the Preferred Provider Organization - PPOs, HMOs as well as the Point of Service -- POS Networks. As against this, judged from a global perspective, the healthcare system in the Netherlands values attention because of its novel managed competition reforms proposal that were launched in the 1987 and employed on an incremental basis since 1992. (Flood, 2003)

The Dutch healthcare system needs close observation by the policy makers of U.S. As the same is able to couple an increased intensity of dependence on private insurance while continuing to insurance coverage for almost the entire population to a wide range of care. Even though mandatory health insurance covering all citizens is not there, under the Dutch system, its population is 100% covered under the full insurance schemes. Three insurance schemes mandated by the government are there. The first one covers all citizens for the special medical expenses. The second one guarantees inclusion for the poorer 60% of the population as regards for general medical expenses. The third one guarantees coverage of every bureaucrat and their families for usual medical expenses. The government also controls the private regulator to check them from risk-taking premiums so as to evade the outcome of costly premiums or without coverage for the individuals who are placed at high risk. (Flood, 2003)