The Healthcare System of the Netherlands

1
The Healthcare System of the Netherlands

• Lecture 6
• Tracey Lynn Koehlmoos, PhD, MHA
• HSCI 609 Comparative International Health Systems

2
The Kingdom of the Netherlands

• Population 16.5 million (2006 est.)
• Capital Amsterdam, but The Hague is the seat of
  government
• Government Constitutional Monarchy
• Nationality Dutch

3
Background Information

• 12 provinces
• Prosperous, stable, open economy heavily
  dependent on foreign trade. Low unemployment
• 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

4
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

5
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

6
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

7
Organization

• 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
• Poldermodelpolitical tradition of negotiation
  and consensus building

8
Big Changes to the System

• Health Insurance Act went into effect 1 Jan 2006
• All Dutch citizens and all people working in the
  Netherlands MUST contract and carry health
  insurance
• 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

9
3 Compartments of the new program

• Health Insurance Fund
• Self-selected/contractual health insurance
• Mandatory w/ variable cost and levels of coverage
• Some use cost containment co-pays, higher
  premiums
• Exceptional Medical Expenses Fund
• Long term, mental illness, chronic disability
• Mandatory
• Supplemental Insurance--optional

10
Financing the Health Insurance Funds

• 50 Employer contributions
• Employee or insurance enrollee paid nominal
  premiums
• The IRS (Inland Revenue Service) assists the low
  income and the young (lt18 years)
• Previously, some 63 of Dutch citizens qualified
  for some form of public assistance

11
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 plan
• Insurers cannot turn away applicantsno cherry
  picking, no exclusions

12
2005 Expenditures

• In 2005, under the old system the Dutch spent
  approximately 45,895,000 Euros on healthcare
• 37.7 curative care
• 24.9 elderly care
• 9.7 medications
• 2.7 administration
• .5 was on prevention and promotion

13
Health Services Workforce

• More than 1 million people work in the healthcare
  sector
• 3.1 physicians per 1000 per population
• 21 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

14
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
• gt18 male nurses
• Many work like PA or in high-tech
• No mid-level practitioners

15
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

16
Hospitals

• Like US, Canadaswitched from lengthy inpatient
  stays to more ambulatory and outpatient care
• lt400 hospitals in the Netherlands
• Most are private, not-for-profit (religious
  affiliation)
• Traditionally paid through annual global
  budgeting, but the new system will allow for
  market competition between hospitals

17
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

18
Could we go to Amsterdam and not talk about drugs?

• Drugs!?!
• Ministry of Health, Welfare and Sport controlled
  policy to prevent drug use and trafficking
• 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

19
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 US
• General practitioners make ½ of US GPs

20
Summary

• The Netherlands entered into a completely new
  healthcare system in 2006
• Everyone must carry two types of private
  insurance (long term/catastrophic curative)
• Emphasis on managed market competition in the
  health sector
• It will be years (2009?) before we can accurately
  measure the results of this change