Thursday, October 8, 2009

U.S. Health Reform: Should We Go Dutch?

For the last 2 nights, the NewsHour of PBS has been visiting the Netherlands to see if that nation’s health system might serve as a model for the U.S. The Dutch visit interests me because a Royal Dutch TV team interviewed me this July to ask what I thought would happen in reform. I told them I thought President Obama would get something – perhaps 1/3 of what he wanted – an individual mandate perhaps, but not a public option.

Here are the highlights of the Netherland system, which is three years old and with which Dutch citizens so far express a high level of satisfaction.

As you read the follwoing bullet points, keep in mind the Dutch culture differs from that of the U.S. – for example, it is much more tolerant about drug use and prostitution, and it has legalized assisted suicide. At the same time, like the U.S., its society is pragmatism, its mercantile flexibility, andits ability to organize multinational corporations.

• The Dutch government covers 80% of health costs vs 49% of the U.S, devotes 9.4% of its GDP to health care vs 15.3% for the U.S., has an infant mortality rate of 4 per 1000 vs 7 for the U.S., and has a life expectancy of 80 vs. 78 for the U.S.

• All Netherlands residents are required to buy health insurance provided by competing private plans. The plans must accept all comers, regardless of pre-existing conditions.

• Sicker patients, or those with chronic conditions, get larger subsidies from the government, and premiums are risk-adjusted.

• The Netherlands rely heavily on high-level general practitioners, who among other things, rotate in serving in 24 /7 health clinics, which help keep the traffic down in ERs. Only 3% of those seen in these clinics are referred to ERs.

• The government rewards GP who prescribe generic drugs with bonuses.

• To see specialists, citizens must be referred by GPs.

• The system offers a large degree of choice among competing plans, which the government tightly regulates.

• They system provides access to all.

• The system is relatively new, the result of national reforms instituted in 2006, and it is still uncertain whether competing private plans are the way to go.

It seeks to insure all citizens, increase competition, and keep costs low.

I have run two previous blogs on the Netherlands system; July 29, 2009, “An Interview on Royal Dutch TV; and September 16, 2007, “Should the U.S. Go Dutch?” You may read these blogs by typing in “Dutch” in the medinnovation search box.

In concluding, I would note Americans have tried and rejected the gatekeeper model. We like to pick our own specialists. Also the shortage of primary care doctors make the Dutch system difficult to carry out here. Our legal system is different too, and I wonder how restricting access to specialists would play here.

Dr. Richard Reece is author, blogger, speaker, and innovation and reform commentator. Dr. Reece’s latest book, Obama, Doctors, and Health Reform ( is available at,, and for $31.95 (hardcover), $21.95 (softcover), and $6.95 (electronic). For information on speaking fees and arrangements, call 860-395-1501

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