Is the Dutch model the right reform for U.S. healthcare?

Summary:The Dutch system combines heavy public spending and private insurance.The government offers subsidies covering dozens of pre-existing conditions so the private market can accept all patients.

Netherlands map image from ThinkQuestAmericans hate their health care system and want major reform.

To many this means Americans are ripe for a single payer system controlled by the government. (Image from ThinkQuest.)

But there's another model which seems to be pleasing its customers, and which retains a large role for the private sector.

In the same survey showing Americans are ready to scrap their system, the Dutch system stood out as a success story. While only 12% of Americans want just minor tweaks with their health care, 42% of the Dutch would be happy with that.

The Dutch system combines heavy public spending and private insurance, according to a 2004 Commonwealth Fund study.

Everyone must have insurance, but employers don't have to provide it. The government offers subsidies covering dozens of pre-existing conditions so the private market can accept all patients.

The biggest difference, the one which would take the most time to implement here, is an emphasis on primary care physicians and nurses.

Everyone has a family doctor who acts as a gatekeeper to the rest of the system. When Massachusetts tried this reform it found it had a dire shortage of such physicians.

Thus any reform like this would have to be phased-in, with incentives for doctors to move toward family medicine and away from other disciplines.

In the Netherlands carrots-and-sticks are used to wean people from unhealthy lifestyles. You can get a refund on a gym membership, for instance, if you actually lose the weight.

A Wall Street Journal feature on the Dutch plan noted that state reform plans like that of Massachusetts place more burdens on employers, and indicated the Dutch plan is closest to a California plan shot down by that state's legislature.

While the original Dutch reform emphasized competition, in practice consolidation occurred quickly, so there are now fewer than a half-dozen insurance carriers there.

It must be emphasized that the Dutch plan has only been in force for two years but there is something in it to please both the left and the right.

For the left it's universal. Everyone can get coverage. Drugs are covered. The wealthy are taxed to assure this.

For the right businesses don't have to provide coverage, costs are controlled, and the new system is loaded with market incentives.

There's a long road to reach a Dutch-style system in the U.S., and even the Dutch system has problems, like its lack of coverage for some conditions and its short track record.

But to many Americans it looks interesting.

Topics: Enterprise Software, CXO, Government, Government : US, Tech & Work


Dana Blankenhorn has been a business journalist since 1978, and has covered technology since 1982. He launched the Interactive Age Daily, the first daily coverage of the Internet to launch with a magazine, in September 1994.

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