The Healthcare System of the Netherlands by keara


									The Healthcare System of the
               Lecture 6
   Tracey Lynn Koehlmoos, PhD, MHA
 HSCI 609 Comparative International Health
   The Kingdom of the Netherlands
• Population: 16.5 million
  (2006 est.)
• Capital: Amsterdam,
  but The Hague is the
  seat of government
• Government:
• Nationality: Dutch
      Background Information
• 12 provinces
• Prosperous, stable, open economy heavily
  dependent on foreign trade. Low
• Located at mouths of three major European
  rivers: Rhine, Maas, and Schelde
• Founding member of NATO and the EU (now
  and participated in the introduction of the
  Euro in 1999
     Updated Health Information
•   Life Expectancy: 76.4 m/ 81.7 f (2006)
•   Population over 65: 14.2 % (2006)
•   Infant Mortality: 4.96 per 1000 (2006)
•   Healthcare consumed 9.8% GDP (2003)
•   $ 2,976 (US) per capita health exp. (2003)
•   Major change took place in 2006, we must
    wait three or four years for the results
         General Concepts
• Long term, early adaptors of nationwide
  health education, healthy living and health
  promotion policies and ideals
• Health (hence, healthcare) is universally
  regarded as a primary necessity
• The Dutch healthcare system is a complex
  mix of public and private funding
        Catalyst for Change
• In former iterations the ―Supply Driven‖
  Dutch system was considered less than
  satisfactory by its users despite having
  relatively low cost and producing some of
  the BEST health outcomes measures in
  the world
• Ministry of Public Health, Welfare and
  Sport (VWS)
  – Central planning authority
  – Responsible for implementing policy
• Four basic ―values‖ or characteristics
  – Strong supply side controls (wait lists)
  – Private character of supply
  – Mix of public and private financing
  – ―Poldermodel‖—political tradition of
    negotiation and consensus building
      Big Changes to the System
• Health Insurance Act went into effect 1 Jan
  – All Dutch citizens and all people working in the
    Netherlands MUST contract and carry health
  – Only one period each year to switch enrollment
  – Established a Health Insurance Board to oversee
    the day-to-day running of the newly established
    ―Health Insurance Fund‖
    3 Compartments of the new
• Health Insurance Fund
  – Self-selected/contractual health insurance
  – Mandatory w/ variable cost and levels of
  – Some use cost containment co-pays, higher
• Exceptional Medical Expenses Fund
  – Long term, mental illness, chronic disability
  – Mandatory
• Supplemental Insurance--optional
  Financing the Health Insurance
• 50% Employer contributions
• Employee or insurance enrollee paid
  ―nominal premiums‖
• The IRS (Inland Revenue Service) assists
  the low income and the young (<18 years)
  – Previously, some 63% of Dutch citizens
    qualified for some form of public assistance
       Health Insurers? NO!
• In order to get the social message to health
  insurance companies, they have been
  renamed as ―care insurers‖
• The insured have a ―vote‖ in the
  corporation and changes
• Insurers can offer a US style ―managed
  care‖ plan or a traditional fee-for-service
• Insurers cannot turn away applicants—no
  cherry picking, no exclusions
        2005 Expenditures
• In 2005, under the old system the Dutch
  spent approximately 45,895,000 Euros on
• 37.7% ―curative care‖
• 24.9% ―elderly care‖
• 9.7% medications
• 2.7% administration
• .5% was on ―prevention and promotion‖
    Health Services Workforce
• More than 1 million people work in the
  healthcare sector
• 3.1 physicians per 1000 per population
• 2:1 GP to Specialists
• Physician supply is controlled by a lottery
  system for medical school appointments
• Most physicians are in private practice
• Primary care physicians serve as gate
  keepers to hospital-based specialists
• Physicians are paid via fee-for-service,
  capitation, or a mix
       Health Services Workforce
•   12.8 Nurses per 1000 population
•   Considered a full-fledged profession
•   Low salaries, dissatisfaction with low status
•   Hospital specialists and community nurses
•   >18% male nurses
    – Many work like PA or in high-tech
    – No mid-level practitioners
   Health Services Workforce
• Health Administrators
• Long standing tradition
• Several universities offer undergraduate
  and graduate degrees
• With the collective approach to deciding
  any issue, it is important to have
  administrators who have a wide-expanse
  of knowledge: policy, problem solving,
  social science, law & economics
• Like US, Canada—switched from lengthy
  inpatient stays to more ambulatory and
  outpatient care
• <400 hospitals in the Netherlands
  – Most are private, not-for-profit (religious
  – Traditionally paid through annual global
    budgeting, but the new system will allow for
    market competition between hospitals
           Long-term Care
• Combination of social and health services
• More emphasis on home based care
• Care providers work with manpower
  services, welfare agencies and industry
• Dutch municipalities provide transportation
  and special equipment (like wheelchairs)
  to elderly and disabled residents
Could we go to Amsterdam and not
        talk about drugs?
• Drugs!?!
• Ministry of Health, Welfare and Sport
  controlled policy to prevent drug use and
• Distinction between cannabis and hard
  drugs (lowest drug death rate in Europe)
• Prescription drugs?
  – Mostly covered under ―care insurer‖ formularies
  – Some co-pays, option to pay more for different drugs
          Compared to US
• Long-term Care: Dutch have the best
  system in the world for taking care of the
  elderly also well-equipped for mental
  illness and substance abuse
• Universal, private insurance of choice
• All access system
• Higher Physician to Population ration than
• General practitioners make ½ of US GP’s
• The Netherlands entered into a completely
  new healthcare system in 2006
• Everyone must carry two types of private
  insurance (long term/catastrophic &
• Emphasis on managed market competition
  in the health sector
• It will be years (2009?) before we can
  accurately measure the results of this

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