The quality of healthcare is a hot topic of discussion but what makes a healthcare system effective? There are strong arguments for both private healthcare and for a publicly funded NHS. It’s easy to look at other countries and identify successes and failures. However, the Dutch system is recognised as the best in Europe.
So, what is it that makes it so successful and how does it compare to our NHS?
The Healthcare system in Holland - how does the NHS compare?
There are obvious similarities and differences between the two systems. Important factors need to be considered when making a comparison, such as the size of the healthcare systems; how they are funded; and the range of services available under each.
According to current figures available from NHS England, 64.6 million UK residents access free healthcare, and that in England alone, 1 million people use the service within a 36-hour period. The current Dutch population is recorded as 17,032,460 – just 36% of the size of the population of the UK. Statistics also suggest that while 100% of the UK are covered by public healthcare insurance, 99.9% are covered in the Netherlands. In 2015, public funding accounted for 79% of the expenditure on the NHS in the UK with the government funding the remaining 21%. In comparison, 7% of Dutch healthcare expenditure was covered by additional private medical insurance, 81% by compulsory public insurance and the remaining 12% covered by the government. In 2014, there were 2.8 doctors per 1000 inhabitants in the UK compared to 3.4 per 1000 in the Netherlands. Nurses were at 8.2 per 1000 inhabitants in the UK, while in the Netherlands there were 10 per 1000.
The Dutch Healthcare System is directly funded by its users. Everyone working or living in Holland is required by law to have a basic healthcare package, with the option of additional insurance for non-standard healthcare. However, all residents under the age of 18 are automatically insured by the government. Similarly, the NHS is funded by compulsory taxation and private health insurance is an optional extra. For those residents not earning enough, or not earning at all, NHS services remain freely accessible. In comparison, a means-tested healthcare benefit assists low-earning Dutch residents with healthcare costs.
Everyone in the UK has the same level of service available to them whether or not they make contributions. Private healthcare insurance doesn’t necessarily give access to extra treatments but can speed up treatments or give access to private hospitals with better resources. Providers decide the level of service they give clients. In contrast, the standard Dutch healthcare insurance provides access to basic services. No insurance company is legally able to refuse applications for standard healthcare insurance, and all premiums are equal. Additional insurance provides access to treatments such as physiotherapy or dental care. Standard healthcare is free for every child under 18s but parents must register the child with an insurance company. Healthcare benefit is available for low earners.
Strengths of the Dutch Healthcare system
Strengths are obvious in the Dutch Healthcare System. Ratios of population to skilled staff are clearly higher than the UK. An article featured in Dutch Review suggests that the biggest strength lies in acute medical care. The case discussed involves treatment from several professionals while costs are kept low. However, is also implied that basic medical treatment is a not so good, stating that a GP will give tablets rather than a diagnosis. Funding appears to be well-structured with minimal government expenditure, allowing for the easier provision of quality care. Visitors to the Netherlands can access basic treatments with their EHIC, and costs of hospital stays can be covered by the government.
Strengths of the NHS
Born from an ideal of equal healthcare treatment for all, this is arguably the NHS’ biggest strength. Providing free services to all UK residents, and emergency treatments non-residents, it meets that ideal. As well as being accessible to all, the free treatments range from basic GP visits through to routine screenings, long-term treatments and palliative care.
Similarities and differences between the Dutch healthcare system and the NHS are evident. Perhaps the most prevalent similarity being the drive to provide accessible healthcare to all. However, the final delivery of care appears to be cost-dependent. Although recent reports from the Netherlands suggest that hospital waiting times are rising - as they are in the UK - they are ahead with staff-patient ratios. With a wider range of services provided to all users, the NHS arguably provides a more comprehensive free healthcare service. The question must be posed then, if funding was organised in a more sustainable manner, would NHS services improve and surpass the Dutch Healthcare System?