A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Dutch Treat II: Are We the New Netherlands?

Dutch Treat II: Are We the New Netherlands?

August 8, 2006

This morning a presentation at the Blue Cross Foundation by economist Piet de Bekker, Policy Advisor for the Directorate of Macro-Economic Affairs and Labor Relations of the Netherlands Ministry of Health, Welfare and Sport (yes, sport – can you imagine blaming state government when the Red Sox lose?).

An august audience of about 50 including Sen. Dick Moore, MA H&HS Sect. Tim Murphy, Chris Hager and Emily Sherwood from the MA House, David Friedman from the MA Senate, Dem. State Committee Chair Phil Johnston, Partners CEO Jim Mongan, Rosemary Day from the Connector, and a lot more. Nancy Turnbull was the MC. This is my second session on the Dutch system, and lots still escapes me.

“Solidarity and competition” is their curious reform bi-theme. The Netherlands has about 16.5 million people and now about 180,000 uninsured (vs. 6.4 million and 550,000 in MA). In GDP spent on health, they are 13th among nations (we’re #1, of course).

Their system triangle includes health care providers, patients/insured, and health care insurers. Missing are employers who pay payroll taxes to finance the system, and otherwise are only observers. Individuals have a mandate to purchase coverage (effective 1/1/06) and pay a penalty of 130% of the monthly premium if they go without coverage. Dutch no longer refer to “uninsured” opting for the curious term, “defaulters.”

It’s a system based on private insurance sold to individuals with strict and rigorous government regulation of benefits, plans, and providers. Private insurers compete with each other, and 18% of insured swapped plans this year in the search for better value (yearly right to switch). Insurers and providers compete to attract business based on price and quality. Individuals can lower their premiums by accepting deductibles between $0 and $1200, and individuals who use no health services in a given year except for seeing their general practitioner save $300 the following year.

Kids are taken out of the equation and covered fully by government up to 18. Premiums for adult basic coverage are around $1100. About 60 percent of the public get income-based sliding scale subsidies. General principle – premiums should never exceed five percent of income. Individuals can purchase “voluntary supplementary private health insurance” beyond basic, and long term care is financed outside of this system. Individuals can opt out of the mandate as religious or other “conscientious objectors” but they still have to pay the tax which goes into a fund that finances their medical services when needed.

Piet’s more pithy comments: “There’s no ideal system.” “You (we) can do better with all these expenditures.” “Boston is the most European place I’ve ever been.”

Believe it or not, Massachusetts’ health system is looking more and more like that of the Netherlands than any other place. Like it or lump it.

Did I leave anything out?