Dutch Health System study tour - Tuesday

Tuesday morning was focused entirely on meetings with representatives from the Dutch Ministry of Health, Welfare and Sport.  We were met by Annemarieke Taal and Paul Thewissen who took us through the organization, financing and delivery of health services in the Netherlands.  Among the key facts shared with us were:

The Netherlands has some 16 million persons living here and there are 83 general hospitals of which 28 are more specialized along with 8 academic health centers. The Netherlands has some 26,000 physicians and 82,000 support staff.  Just under 1/3 of all physicians are general practitioners. There are just under 20 commercial health insurance companies that cover every Dutch citizen.  The Netherlands spends about 60 billion Euros per year representing just over 10% of their GDP.

Hospitals are run as non-profit entities most of which are 100 beds or more in size.  In the Netherlands, primary care physicians play a central role as the gatekeepers to the system.  24/7 access is provided through a series of "posts" that are manned by general practitioners.  Physicians are paid a fixed price quarterly based on the number of patients in their practice and will get additional negotiated monthly compensation based on providing consultations. 

The Dutch health insurance system provides care to everyone under the terms of an individual mandate. A basic group of services are provided to everyone including physician and hospital care including long term care. In 2006, The Health Insurance Act effectively expanded insurance coverage to everyone.  Insurance companies must cover all citizens regardless of preexisting conditions.  Health insurance is paid by a combination of taxes and a yearly deductible of 350 Euros.

Cost control continues to be a major problem in the Netherlands as they try to get a handle on reducing a 4-5% annual increase in health costs and health expenses are rapidly crowding out spending on other public expenses.

The bottom line for me is that despite the concerns expressed about the costs of the system, the Netherlands has an individual mandate that provides health insurance for each and every person at a GDP and per capita cost significantly less than the United States coupled with outstanding health status indicators.

Our afternoon took us to The Hague, site of the seat of government for the Netherlands.  We took the time to explore, Knights Hall (http://en.denhaag.nl/en/residents/culture-and-arts/to/Knights-Hall.htm). This one time hunting lodge was converted to the site of the Queen's annual address the third Thursday in September.  The Hague is a thoroughly charming city and I would recommend it to anyone considering a trip to the Netherlands.