Learning from Germany’s blood management system

It makes sense to take a look at the German model concerning blood management as an alternative to the Dutch model, says Distinguished Professor Rob Slappendel.

Image: © Nationale Beeldbank

Dutch blood is the most expensive blood in Europe. Dutch care institutions pay 214 euros for one bag of blood (red blood cells) compared to the German price of 85 euros per bag.

For hospitals this price difference is huge. Look at the Amphia Hospital in Breda, which annually uses 9,000 bags of blood. The cost of blood for Amphia amounts to 1.9 million euros. With the German price it would go down to 0.7 million euros - a difference of 1.2 million euros per year.

The reason for the cheaper price in Germany is not due to the quality of the blood, as that is similar to our own. It is also not down to the efficiency of the Dutch doctors. The number of blood transfusions has been decreasing since 2000, while the number of surgeries is growing in the Netherlands. Dutch patients receive the lowest number of blood transfusions in Europe, owing to the high level of Dutch efficiency (the highest in Europe).

Blood transfusions have a negative impact on recovery

The efficient use of blood can be highly beneficial. Several - often Dutch - studies indicate that a blood transfusion has a negative influence on the patient’s recovery process. When someone receives a blood transfusion after surgery, there is a greater risk of a wound disorder, the risk of an infection is larger, in-patient time is an average of 2.5 days longer, and the risk of death increases. The amount of blood administered does not affect these increased risks.

The reason for Dutch blood being so expensive has to do with the monopoly of the Dutch blood bank Sanquin Blood Supply. Following scandals with HIV-contaminated blood, Minister of Health Els Borst decided in 1998 to reserve the collection and distribution of blood products to a national blood bank, Sanquin. That was the right decision at the time. Meanwhile, the Dutch system has become outdated, especially now that the government is committed to market forces in healthcare.

The price of a bag of blood has increased

Sanquin is self-sufficient and needs to recoup all its service costs from the price. When the number of blood transfusions decreases and subsequently hospitals buy less blood, Sanquin increases the price of a bag of blood. The self-sufficient organization must maintain the same revenue.

The blood bank has no competition. Hospitals can purchase all the products that they need (medicine, energy, organs) freely in Europe, but there is a restriction on buying blood in the Netherlands as the collection and distribution of blood products is reserved to Sanquin.

Dutch hospitals therefore are not allowed to buy their blood in Germany or Belgium, where market forces allow for the cheaper price. Germany has two commercial blood banks for the collection and distribution of blood: the Red Cross and about 10 university hospitals. These institutions must practice efficient organization due to market forces. One of these commercial institutions told me that the price per bag of blood is 50 euros - what a difference when compared with Sanquin’s prices.

Tax goes back to society

There's more: the German commercial blood collector makes a profit. They pay a 30 percent tax rate on blood and that tax money goes back to society. A German blood donor receives a compensation of 20 euros for donating a bag of blood (parking, travel expenses, etc.). In the Netherlands, the donor receives nothing.

Sanquin’s monopoly position is outdated. It makes sense to take a look at the German model concerning blood management. The economical use of blood there makes healthcare not only safer and better for the patient, but, in the long term, also cheaper. The triumvirate in healthcare that the Netherlands is waiting for.