Free Market Fundamentalist

Dutch Should Keep Health Care System They Have

Liberalization has been a success.

Leiden Netherlands hospital
Leiden University Medical Center, the Netherlands (LUMC)

Nearly all political parties in the Netherlands call for more government in health care.

The far-left Socialists and Greens would replace private health insurers with public health funds. Labor would keep the insurance companies but take away their power to negotiate prices with health providers. The Christian Democrats and far-right Freedom Party want to end competition between hospitals. Even the center-right VVD believes liberalization has gone too far.

I’m a member of the VVD, but on this point I disagree. (So I’m glad there are few concrete proposals to reverse liberalizations in the VVD’s manifesto.) The Dutch health-care system is one of the best in the world. In a column for Trouw, I challenge the parties that want to uproot it to point to a better example. If there isn’t one, let’s keep the system we have.

High ratings

“Health-care liberalization” doesn’t poll well, but objective analysis finds that Dutch health care is number one in Europe (with Switzerland) and among the best in the world. Dutch consumers give their own health care an 8 out of 10. Before liberalization, that was a 6.7 — and two-thirds were fearful at the time that health care would get worse without reform.

The reasons: long waiting lists and a divide between those who could afford private insurance and those on public health care.

International comparisons

Spain still has such a system. Its public health system isn’t bad, but private health care is better. With private insurance, you can choose your own doctor. In the public system, waiting times are longer: two months on average to see a specialist and three months for surgery.

In the United States, where there is a similar divide between increasingly unaffordable private insurance and government-run Medicaid and Medicare, there is interest in the Dutch approach. Obamacare, with its individual insurance mandate and subsidies for low incomes, was modeled on the Dutch system.

Ezekiel Emanuel, a member of President Joe Biden’s COVID-19 Advisory Board, praises the Dutch combination of private health insurers and powerful primary care physicians, who keep costs down by acting as gatekeepers.

Left-wing fears that people might avoid health care if they need to pay some of the costs — monthly insurance premiums and a yearly €385 deductible — are unfounded. Peter Bennemeer, a former hospital administrator, estimates that 20 to 25 percent of all health care in the Netherlands is medically unnecessary.

Key role

Insurers play a key role in controlling costs and reducing overtreatment. The Socialists and Freedom Party complain whenever an emergency room (ER) or intensive care unit (ICU) is shut down, but they don’t mention that happens only if a unit underperforms or is underutilized.

Few hospital beds have been underutilized since the start of the pandemic, and there is something to be said for maintaining spare capacity. But that still leaves the question of quality.

If the ICU of a regional hospital consistently shows worse survival rates than those of larger hospitals in metropolitan areas, an insurance company can deny full coverage for intensive care in that hospital. If other insurers follow suit, the hospital will be forced to either improve its care or close its ICU; a decision that would still require approval from health authorities, who are responsible for ensuring there are enough hospital beds in every region.

Many politicians believe this gives the insurance companies too much power. But if it were up to them, no ER, ICU or hospital would ever close, and health providers would have less incentivize to stay on top of quality.

Click here to read the column (in Dutch). Come back Wednesday, when I’ll be live-blogging the election results here at the Atlantic Sentinel.

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