How Americans view Dutch healthcare

March 25, 2015

A group of American students from Tuck School of Business spent one week comparing the second most expensive healthcare system in the world (US) with the most expensive one (Netherlands).Nardo van der Meer wrote a blog about what he heard during this week. 

Image: © Nationale Beeldbank

A comparison of the second most expensive healthcare system in the world with the most expensive one. That was what a group of MBA students from Tuck School of Business (Dartmouth University, Hanover, NH, U.S.A.) recently undertook in the context of a TIAS-Tuck exchange.  The guiding principle of the program was: ”Same problems ... .different solutions?"  What is interesting about this exchange is that people who are well established in their own healthcare system gave a fair assessment of the Dutch healthcare system from a different cultural perspective. The Dutch healthcare system is one that we know to be very expensive (13% of GNP). But it is also the number 1 in the European Healthcare Index.

 After a number of lectures on the content and organization of the Dutch healthcare system, including institutions, regulators, government, the research field, the innovative technical sector and two “company visits” (to UMC Utrecht and Philips Healthcare), the American students were given time for reflection at the end of the week. Remarkably, they found the system more similar to their own than they could have imagined. “They are becoming more and more alike regarding important aspects.” The main visible difference was that they saw that our system is based on a very far-reaching sense of solidarity, whereas the US system is based more on “individual responsibility with a safety net."  The Dutch, they said, “take care of each other from the cradle to the grave.”  But they also concluded that this system is “unsustainable” and that there will be “important upcoming changes.” 

Innovative strength of our teaching hospitals

Just some reflections: the solidarity made an impression on the students and seems to work well considering the high life expectancy of the Dutch. The basic health insurance benefit package is so complete that it is almost misleading to call it “basic.” The innovative strength of our teaching hospitals is striking, including the distribution of priorities. They see the regulated market (managed competition) as interesting, but uneven and complicated.  Are the Dutch health insurers powerful? They are much more powerful in the USA because there the health insurer determines which hospitals their policyholders can go to. They think the WNT (Public and Semi-Public Sector Senior Officials Standard Remuneration Act) for hospital administrators and the increased desire for accountable management are in real conflict with each other. “No one will take a risky, high demanding job with a low payment" was their conclusion. Last but not least, the social changes were striking: the deductible being (carefully) built in, changes in the pension system, an aging population, and a shift from care by the institution to care by volunteers. Is Dutch society becoming more individualistic? More American?

Future of our system rated a 7 out of 10

The discussions regarding solutions to problems were the most interesting ones. Some problems have been dealt with in the past in the US in a similar way as we are now tackling them. In the US, these solutions did not prove to be successful. “So why go on the same track then?” they wondered in amazement. On a scale of 1 to 10 they rated the future prospects of our system a 7. The main reason for this somewhat mediocre rating is the fact that they are afraid that our system is hard to change given that the majority of the Dutch see healthcare as a right acquired at birth and that we are making some changes in an ambivalent manner.

That makes change even more difficult than it already is. "A hell of a job," they concluded, which is true. Can we learn something from people with a healthcare system that we consider so far from perfect? I myself am sure of it! Same problems, different solutions and learning from mistakes made by others.
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