THe Dutch health service v the Irish health service

[patslatt]

The Dutch health care system rates close to the top in Europe,so its features should be of interest. Some informative articles on it,
"Profiles of six health care systems..." and "Quality Development of Health Care in the Netherlands" are at www.parl.gc.ca/37/1/parlbus/commbus/sen ... ver1-e.pdf and www.commonwealthfund.org/usr_doc/Grol_q ... ction=4039

Some points of interest largely paraphrased from the articles:

[]Government mandated insurance financed out of employer and employee payroll taxes are paid over to 25 non-profit regionally based insurers,with a single insurer covering 100% of the population in a specific region. They can compete on price and quality and offer packages with different services. These insurers can lose their business in the competitive process apparently,but no data was given on that.

[]About 30% of the population with the highest incomes are free to buy their own insurance plan.

[]High risk groups must be offered insurance with a cap on premiums and a government operated scheme spreads the risk of covering them over all
age groups.

[]Most of the country's more than 100 acute care hospitals are privately owned, non-profit organisations. Their medical specialists include both employees and private practitioners working within hospitals.

[]Negotiations of hospital budgets were based on estimates of efficient operating costs,changes of population and volume of operations performed.

[]This is gradually being changed to a new system of diagnostic treatment combinations (DBCs) which assign a price to each product or service. This increases transparency and competition among hospitals. It is different from the comparable diagnostic-related group payments in America in that it includes specialists' salaries.

[]Payments to primary care physicians include a capitation fee per patient (based on age?) and a fee per consultation, plus other payments,including incentives for meeting quality and efficiency indicators.

[]After-hours emergency care is provided by cooperatives with between 100,000 and 400,000 patients assigned to them.

[]An inspectorate for health care develops performance indicators for health care providers. Clinical indicators include data on prescriptions, ordering of tests,referrals to hospitals and preventive measures (influenza shots,pap smears).

[]The inspectorate in recent years requires hospitals to collect data on 20 performance indicators,including mortality and myocardial infarction or stroke,wound infection,pressure ulcer incidence and medication errors.The results are reported on a freely accessible web site. This initiative demonstrably identifies gaps in quality.

In conclusion, the Dutch insurer system coupled with strong government regulation is far preferable to the HSE model. An insurer presumably must be competitive or risk losing the business of covering its region,unlike the HSE with its jobs for life culture.

However,given that Ireland's population is about a quarter that of the Netherlands, it may not be feasible to copy that system exactly here for two major reasons. First, doing so would lead to duplication in all regions of very expensive services better provided by monopolies or oligopolies eg cancer treatment centres. To avoid this duplication, insurers could separately insure a monopoly service on condition that the service could only be provided within the designated regions of the monopoly (say within 100 miles radius of a cancer treatment clinic) or the oligopoly. The monopoly service could comprise departments of several hospitals, so a situation could arise in a hospital where one insurer works with the monopoly department,with another insurer working with the rest of the departments.

Second, Ireland's population could probably efficiently support no more than five insurers,which would not be very competitive, especially if competition forced two of them to cease business. Still,this would be preferable to the unaccountable HSE monopoly.In the event of insurers ceasing business, the government could offer tax incentives to attract new insurers.

The Dutch sytem of appointing a single insurer for a specific region may be absolutely essential to control costs of marketing as well as overhead percentage costs in thinly populated areas outside of Greater Dublin and Cork.

The system of DBC pricing would improve the economic efficiency of hospitals. This is better than just dropping money into the laps of hospitals based on arbitrary budgeting criteria.

Finally, the articles don't comment on whether the Dutch system's inspectorate does enough auditing of patient treatments to prevent cutting of corners on expensive treatments and whether insurers make sufficient use of evidence-based medicine to curb doctors' unnecessary treatments. There may be an assumption that non-profits can be trusted more than for profit providers. That overlooks the risk that non-profits may pad their own wages and salaries at the expense of patients' treatments.

[El Matador]

I can't believe what people in the south accept as a 'health service'. The NHS up here has its problems, and those with money often pay to go private to get operations done more quickly, but we can visit a doctor anytime and its doesn't cost a penny; prescriptions are about six quid regardless of the cost of the medication needed (and there's talk that the Assembly may abolish the charge altogether) and dental care for children is absolutely free.

The formation of the NHS by the post-war British Labour Government was perhaps the biggest social revolution in modern UK history. The health service in the south seems to be more like that in the USA.

I can't understand why people in the south are happy to accept a system that is so dependent on private insurance, especially given that income tax is on a par with that which workers pay in the north.

Healthcare should be universally free and wholly independent of private business involvement.

[patslatt]

I can't believe what people in the south accept as a 'health service'. The NHS up here has its problems, and those with money often pay to go private to get operations done more quickly, but we can visit a doctor anytime and its doesn't cost a penny; prescriptions are about six quid regardless of the cost of the medication needed (and there's talk that the Assembly may abolish the charge altogether) and dental care for children is absolutely free.

The formation of the NHS by the post-war British Labour Government was perhaps the biggest social revolution in modern UK history. The health service in the south seems to be more like that in the USA.

I can't understand why people in the south are happy to accept a system that is so dependent on private insurance, especially given that income tax is on a par with that which workers pay in the north.

Healthcare should be universally free and wholly independent of private business involvement.

Private hospitals and insurers are involved in the UK health care.

The Dutch system which provides coverage for all and uses non-profit private insurers and private hospitals ranks near the top in Europe,unlike the NHS which is near the bottom in Western Europe.

In the Republic of Ireland, we are like New Yorkers,who, as former Mayor Koch joked, would put up with anything.

[El Matador]

As I say, some people choose to go private to get seen to more quickly. The point is that everyone has the right to universal free healthcare. Again, health insurance is available to those who want to use it- it's not necessary. The NHS is far from perfect and needs investment, but the principle of free access to healthcare is at its core.

[qtman]

How do the Dutch feel about retaining inefficient, union run, mrsa infested county hospitals?

[Dee Four]

I can't believe what people in the south accept as a 'health service'. The NHS up here has its problems, and those with money often pay to go private to get operations done more quickly, but we can visit a doctor anytime and its doesn't cost a penny; prescriptions are about six quid regardless of the cost of the medication needed (and there's talk that the Assembly may abolish the charge altogether) and dental care for children is absolutely free.

Nothing in life is free. The NHS doesn't find its funds growing from trees.

[patslatt]

As I say, some people choose to go private to get seen to more quickly. The point is that everyone has the right to universal free healthcare. Again, health insurance is available to those who want to use it- it's not necessary. The NHS is far from perfect and needs investment, but the principle of free access to healthcare is at its core.

The Dutch system provides free access through prepaid insurance.It is a far superior system to the UK's as shown by international rankings of country health care systems,thank to the use of efficient private sector providers.

[qtman]

I can't believe what people in the south accept as a 'health service'.

2 things:

1.
According to the EU, our Health Service is better than the NHS

2.
We don't have the benefit of a Sugar Daddy Government that funds our every whim and desire because we can't agree what road we can walk up and down and what logo appears on the front of our passports. Down here, we have to work for our money.

[patslatt]

How do the Dutch feel about retaining inefficient, union run, mrsa infested county hospitals?

What is your source for this claim? The acute hospitals are all private sector operations, so it would be surprising if they were union run. Union organised,maybe?

Even if there is some truth in your claim, the fact is that the Dutch system ranks close to the top in Western Europe in international surveys, so they must be doing many things well to make up for it.

[patslatt]

I can't believe what people in the south accept as a 'health service'.

2 things:

1.
According to the EU, our Health Service is better than the NHS

2.
We don't have the benefit of a Sugar Daddy Government that funds our every whim and desire because we can't agree what road we can walk up and down and what logo appears on the front of our passports. Down here, we have to work for our money.

Regarding point 1, it may be better but it neglects those who fall between the cracks-those making modest salaries just above the upper threshold for medical cards but not making enough easily to afford doctors' visits at €50 to 70 a pop plus prescription charges. This group could be anywhere from 15 to 25% of the population.

You are right about Sugar Daddy. The NI economy is 70% government spending,a few percentage points higher than Wales, NE and NW England. One major consequence is that the private sector in these regions is greatly weakened by the competition from government for the best qualified employees.