The Dutch health care reform implemented in 2006 showed that introducing regulated competition in a typically government-run sector was feasible. The rationale of the change was that the government would stimulate competition rather than strongly regulate the supply of health care. ...
Prior to the reform, the Dutch system had strong government regulation and an inefficient dual system of public and private insurance. This led to several issues. First, long waiting lists were the rule of the day because of the strict rationing implemented by the government. Second, there was no information available on the quality of health care delivery. Third, patients falling under the sickness fund scheme – roughly two thirds of the population – could not switch across health care providers, and high-risk privately insured patients had limited access to health insurance. The 2006 reform had several goals: cost containment, efficiency, better quality of care, and accessibility to the health care system.
..A quick scan of the 2006 reform, seven years after its implementation, shows significant improvements in the accessibility of health care services and the availability of health (quality) information. It has been, however, less successful on other fronts such as cost containment and efficiency. The individual health insurance mandate guarantees full coverage to the whole population. Every person living or working in the Netherlands has to take out insurance – the only exception is people younger than 18 who are automatically covered and entitled to receive health services. Financial accessibility – measured in out-of-pocket expenditure – is among the lowest across OECD countries, at less than 7 percentage points of total health care spending. Waiting lists were consistently reduced from the year 2000 and most of them are now below the so-called ‘agreed acceptable standards’..
Perhaps one of the most unexpected – and unwanted – trends following the reform is the steady growth of health care spending. The latest OECD figures show that 11.9 per cent of GDP is spent on health, which is second only to the United States (17 per cent). Long-term care and hospital care caused health care expenditures to increase dramatically. In 2011 a total of € 90 billion were spent on health care. Most of the spending was on hospital care and long-term care: € 23.6 billion and € 16.1 billion respectively. Between 2000 and 2011 four sectors significantly increased their share in the national health spending budget: hospital care (from 24 per cent to 26.2 per cent), dental care (from 4.8 per cent to 5.1 per cent), mental health care (from 5.5 per cent to 6.1 per cent) and care for the handicapped and disabled (from 8.5 per cent to 9.3 per cent). The profits of self-employed doctors, such as medical specialists with their own practice as well as GPs, rose by 8 per cent and 5.7 per cent respectively between 2001 and 2009. The government’s answer to these cost overruns has been – in some cases – to set a legal ‘macrobudget instrument’ to guarantee that the total hospital expenditure does not exceed a certain amount in a year. Needless to say, the constant growth of health care costs received significant attention in the elections in the Netherlands last September. The financial sustainability of the Dutch health care system is at risk and no day passes by without news on the health care agenda.
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VANCOUVER, BC/ Troy Media/ – Those opposed to market-based healthcare reform do their best to scare Canadians, suggesting that the introduction of private competition will lead to longer wait times, higher costs, and poorer quality, particularly for lower-income individuals and families.
Reality, however, is considerably different. International experience suggests that
private competition is a fundamental feature of a high-performing, universal access healthcare system.
This is a key insight: private competition and the noble goal of universality aren’t incompatible. In fact, private competition in the healthcare system supports universality, leading to better performance including shorter waiting times.
For evidence, consider the Dutch healthcare system where private (and even for-profit) insurance companies, private providers, activity-based funding and cost sharing combine to provide more timely access to high (if not higher) quality care than Canada’s system for similar cost.
How much more timely?
In 2010, 31 per cent of Canadians reported waiting four hours or more in emergency before being treated, compared to just three per cent in the Netherlands. A third of Canadians reported waiting six days or more for access to a doctor or nurse, compared to just five per cent in the Netherlands. Canada also underperformed in waits for specialist care and elective surgery: 41 per cent of Canadians waited two months or more for a specialist appointment and 25 per cent of Canadians waited four months or more for elective surgery compared to 16 per cent and 5 per cent in the Netherlands.Key to understanding those substantial differences in timeliness is the much larger role for the private sector in financing and delivery in the Netherlands.
Unlike Canada, there is no monopoly government insurer in the Netherlands. Rather, the Dutch are required to purchase standardized universal health insurance policies from a private insurance company of their choosing. While insurance premiums do vary among insurers, government regulations require that each company offer all individuals the same premium regardless of age and medical history. Lower income individuals receive premium assistance from government to ensure they have access to the same insurance as higher income individuals.
Insurance companies must accept all applicants. But they also compete for subscribers through premiums and other competitive factors including services that reduce wait times. Some Dutch insurers even guarantee access to select treatments in as little as five working days...
Notably, the Dutch system incorporates all of the policies Canadian defenders of the status quo say would destroy medicare. Yet the Netherlands has a far more accessible, high quality healthcare system for those who fall ill, regardless of their ability to pay.
..If Canada is to ever get the world-class universal access healthcare system we’re already paying for, it is imperative that we pay more attention to healthcare models that actually work. False claims that misrepresent the realities of sensible reform, causing Canadians to be fearful of policies that work well in top-performing universal systems around the developed world, do us all a disservice.
When it comes to getting the care they require, Dutch residents take their private universal insurance coverage to private care providers of their choosing (insurance companies may limit choices for subscribers in search of higher quality, lower costs, or both). Patients must share in the cost of care consumed through deductibles, which can be voluntarily increased if they wish to reduce their health insurance premiums.
Finally, if Dutch residents would prefer to look after their own healthcare with their own resources, they are free to do so. There is no requirement that the universal insurance system pay for all medically necessary care in the Netherlands.
Combined, these policies have created a world-class healthcare system in the Netherlands. Just as important, reforms in recent years focused on competition and activity-based funding have successfully dealt with concerns about delays in accessing medical care, unlike in Canada where throwing a lot of money at the problem resulted in little success.
а это писано в январе 2015.
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