When Equal Isn't Fair

The Netherland Healthcare System is a two-part system: private insurance for primary and curative care and social insurance for “long term” care. Their reform is based on the policy of risk sharing where the high cost of insuring the at-risk population is negated by the lower cost of insuring the healthier population. The universal coverage plan theoretically allows for risk equalization but the fact that there are multiple insurance companies prevents this from occurring since there won’t be an equal spread of high risk and low risk customers among each company.
In addition, the Dutch wanted to implement market-based competition for the private insurance, which is also funded through government subsidy and payroll taxes. The premise of such a system is to create competitive pricing for the consumer to choose from. The problem arises from the fact that the system is not sustainable. Since the government standardizes the basic plan, insurance companies must offer the plans at minimum profit for themselves to attract customers. This creates the possibility of the company not being able to stay in business since that’s what they are: corporations that put the dollar before the person. When companies go under, it’s feasible for patients to become lost in the shuffle or all together uninsured for a gap of time. What happens when they become ill during that transition phase without insurance? In my opinion, that is the scariest part of the Dutch insurance system.

another take

The Netherlands Health System, from the short reading on the health systems seems to operate well, however this little blog shed some good light on the situation: http://www.thehealthcareblog.com/the_health_care_blog/2008/06/going-dutch.html
A great point the author made was pointing out the Dutch mandate for all citizens to purchase private health insurance. Companies are not allowed to cherry pick, the system does not inhibit anyone for “free-loading” off the system. What laws exist to keep the Dutch people from abusing the system?
Another downfall of the reformed Health System of Netherlands would be a financial pit- fall. The new HIA created marked-based competition between private for-profit health insurance companies, by privatizing the insurance industry. They instituted cost and quality controls by forcing hospitals into monetary battles amongst one another for their “sick” customers. It appears the Dutch health reform legislation has turned hospitals into businesses and no longer public service; this is a concern, in my opinion, because it leads hospitals to concentrate on marketing tactics to attract enough sick patients to keep in business.

Sounds familiar

The downfalls includes too many loopholes and too many hidden risks (even with their risk equalization and CTZ board), especially when there's additional voluntary coverage that the Dutch citizens can attain on the side in addition to the statutory coverage. Some people might get the shorter end of the stick as a result of this system, if they don't pay attention to the details (and if you're working many jobs, of course you don't have the capability to pay attention to the details). The private insurers have a large say in the premiums and additional coverage they offer, as this lack of regulation might cause people people to get caught up in the complex intricacies of the health care market-based system. It is just awfully interesting to apply the Dutch system to what we are looking for in our own US System because we also want similar things in our health care reform.

I do have to praise the Dutch for attempting to constantly press the "edit" button on their health care system to see what works for them and what doesn't. Sometimes simply trying is better than not trying at all.

The Dutch Want it All

The Dutch system is very interesting in that it tries to combine so many different models. They want partially publicly funded health insurance as well as the free market. They mandate that everyone must have coverage, yet let the wealthy 35% choose where to buy insurance. They utilize private hospitals and try their best to cover vulnerable populations. I am wondering how they ration health care in this system since all systems must ration based on something.

The recent reform movement combining public and private markets divides their health care system. I do agree that market-based competition may not have the upper hand compared to public models. If the government does not enroll enough healthy people, especially amongst the wealthier proportion, they are at risk for entering a deficit. The private sector is also profit-based so they may offer different perks like more coverage to attract more customers. If the public model fails with the new implementation of the private sector, the consequences could be very grave. The Dutch government could re-evaluate their current health care infrastructure to determine the

From the article, it seems like the Netherlands government try to provide the well-designed comprehensive health care services to their people; the basic coverage are thoughtful for the people and the coverage for vulnerable population are also included. The Netherlands government allowed the free market-based insurance companies to provide profit-based insurance and are under watch by the Supervisory Board for Health Insurance (CTZ); I think that’s the alternative way to deal with the regulation of total expenditure on health care, which could also be the stimulation of the health care industry and insure the medical providers perform better to compete with each other. But there still would have some weaknesses of this approach; the payment plan of Netherlands health care system are base on the patient numbers and health services which make the quality of care is difficult to measure. Even with the national inspectorate, it’s still hard to define the quality of the private hospital, clinics, and medical providers are good enough or not. The health industry will have to provide enough number of services to get enough operation funds; the balance between overall quality and economic efficiency become the central issue and would have a huge impact on both aspects. The distribution of the operation funds within the health industry will also be more profit orientated, there could be more emphasize on the services which are expensive instead of primary care services. It seems really hard to tell the new reform of Netherlands health system will work significantly or alter the basic of health system.