Healthcare System in the Netherlands Term Paper

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Specialist doctors will normally examine only those patients who have been referred to their clinic by a general practitioner. (U.S. Department of State, n. d.)

The Government of Netherlands is not responsible or the ongoing management of the healthcare system on a daily basis which is offered by private healthcare service providers. However the government is charged with the accessibility and ensuring appropriate standards of the healthcare. A new healthcare insurance system has been launched since January 2006 under which every citizen is required to purchase a basic health insurance package. Under the basic package, one is covered medical treatment, inclusive of services by General Practitioners, hospitals and also specialists, indoor stay, dental care and different medical appliances. People working in the private sector in the Netherlands might decide buying a collective health insurance policy which can be a good alternative since it is cheaper. The fees of the basic health insurance package are calculated annually by the companies offering health insurance which are generally 95 euros monthly. In case of some people, healthcare in the Netherlands has come to be increasingly costly because of the above charge. The govt. Of Holland reimburses these instances through offering grant care. The Tax Administration calculates whether one is entitled by examining the income. Besides, even foreigners can also avail of this benefit in case they meet the criteria. Children below the age of 18 years are exempted from paying any health insurance and are insured free of charge under the basic package of healthcare. ("Healthcare: The Medical System," 2008)

Review of how the health care system is organized and financed:

As regards organization, the Netherlands healthcare system consists of three divisions for health insurance, managed by three different establishments (i) national health insurance for special medical expenditures (ii) mandatory sickness funds meant for people having low incomes less than a specific stage and private, primarily voluntary health insurance and (iii) voluntary health insurance that acts as a supplement. The first covers expenditures linked with long-term care or high-cost treatment, under an act which includes staying in the Netherlands. The second consists of normal, essential medical care. Under the Sickness funds, anybody whose monthly remuneration is less than 30,700 euros and all social security benefits, and account for 65% of the population. Anyone higher compared to this ceiling is covered under private health insurance, covering 28% of the population. The health insurance schemes for bureaucrats take up another 5% of the total population. The third one covers forms of care considered less emergent, under which are covered dental care, prostheses, hearing aids and so on. Supplementary private medical insurance broadly includes these costs. (World Health Organization, 2006)

Of late, the country has witnessed a changeover from government to the private sector as also shift of competencies from central to local or regional authorities. The growing impact of local and regional governments in planning reveals these changes. Coming to the healthcare financing for extended periods it accounts for 41% of the health expenditure. It is funded through deductions from the monthly salary as also funds given by the government. The sickness funds in the category for general medical care bear 38% of health expenditure. Apart from these important sources of funding, the primary complementary sources of healthcare financing comprises of private health insurance which is 15% and payments made from out of pockets which is 6%. Under the sickness funds, these have a budgeting mechanism wherein they bargain as regards the quality, quantity, and to certain degree, the price of service with providers. This provides the funds some freedom and bonuses to buy care as efficiently as possible, and also to foster market competition. (World Health Organization, 2006)

From the year 2000, payments in favor of hospitals have been linked with performance, which constitutes the debut move in the direction of altering the hospital payment system to a system which is based on a mixture of analysis and treatment. Moreover, hospitals get extra budgets for key capital expenditures. In excess of 90% of the hospitals are private, non-profit facilities, and the rest are primarily public university hospitals. Doctors who have received training as specialist are on the payroll of the hospitals. General Practitioners -- GPs are paid on a per-capita basis in case of patients insured by sickness funds and on payment basis for the people who are insured privately. (World Health Organization, 2006)

Healthcare system in Netherlands has in the past been funded from several public and private sources.

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Since the year 1988, before managed competition reform proposals, mandatory health insurance premiums were responsible for roughly 60%, usual taxation for 14%, voluntary health insurance premiums for 16%, and user charges for patients for roughly 11% of the net health expenditures. Multiplicity in financing is responsible for coordinating and shifting problems of cost. For instance, it has been found difficult for the government to shift resources from secondary care to preventive and primary care since the former is hugely financed by the private sector although the latter is not. The government is unable to directly regulate expenditure on healthcare like that of UK and New Zealand governments which are known as the single payer systems financed mainly from general taxation revenues. Albeit the differences, there is a similarity between the U.S. And that in Netherlands to the effect that in the past reimbursed policy holders for all medical expenditures done have been unwilling to engage in direct contractual negotiation with doctors as well as hospitals. (Flood, 2003)

Judged from a generic sense, it is worth noticing that hospitals which were at a particular time charitable services, have now become profit centers. As a demonstration of their secularization, hospitals at every place have emerged as major problems in shaping the economic policy. Total expenditure on healthcare is more than 10% of the GNP in a lot of developed nations and reaches that percentage in others. Hospitals are responsible or 50% of all healthcare spending implying that it is more in some nations and less in others and account for between 3.5% and 6% of the GNP. Government Finance Officers remained the main constituency for cost control. (Glaser, 1987)

In nations where expenditures intended for patient care was managed through the general treasury like in Canada, Britain, and the Medicaid scheme in U.S., the finance officers were concerned regarding the forthcoming bankruptcy of the accounts and the requirement to save them from subsidies by the Treasury. They also doubted if short-term arrangements like higher cost sharing by patients actually reduced costs and were affordable from the political point-of-view. In case of nations in which health and hospitals were financed by the private carriers such as Germany, the Netherlands and American Blue Cross and insurance offered by commercial companies, it was the task of the govt. functionaries for establishing and agreeing to the premiums as also payroll taxes. There were concerned that a large amount of national income was being transmitted by means of this channel, and that health providers were earning profit without providing an appropriate return and that healthcare services lacked efficiency and were wasteful. Beside, the premiums and payroll taxes would kill the motivation to work and invest. (Glaser, 1987)

Salient ways in which the system differs from the U.S. system

In the U.S., managed care is a broad nomenclature for miscellaneous products. Therefore it is delivered in several shapes. The most extensive format which includes almost half of the managed care population is the Health Maintenance Organization. -- HMOs. People who are covered under the insurance plan of HMs are needed to use just a group of pre-chosen, affordable service providers with whom the HMO has bargained for normal and required fees as regards their services. Availing the services of a specialist care, a stay in a hospital or other expensive medical services is given only following the requirement of these services has been confirmed and sanctioned in an administrative manner by the representative of the HMO. (Verheiide, 2006)

Nevertheless, major differences exist between the U.S. And Dutch reimbursement schemes. For example in the U.S., capitated reimbursement covers not just the consultants but also the expenditures for some of the normal diagnostic examinations and also regular preventive interventions like immunizations. Depending on the demographics of practice population, the expenditure of these services could severely impact the income part of a doctor's capitated annual budget. The most prominent difference between healthcare systems in these two nations is in the bargaining of the rates for capitated care. In the U.S., the managed care scenario depends a great deal on the market-driven aspects of competition and deregulation. In the Netherlands, the balance for reimbursement of service even considers the doctor's practice demographics, income criteria, and overhead costs. (Verheiide, 2006)

Unlike the Netherlands, the U.S. was unsuccessful in carrying out a national health insurance scheme in the 1930s & 1940s. One probable justification was the vehement objection of the.....

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