Seen in the Wall Street Journal (subscriber link) last week:
The Dutch system features two key rules: All adults must buy insurance, and all insurers must offer a policy to anyone who applies, no matter how old or how sick. Those who can’t afford to pay the premiums get help from the state, financed by taxes on the well-off.
The system hinges on competition among insurers. They are expected to cut premiums, persuade consumers to live healthier lives, and push hospitals to provide better and lower-cost care.
Some are already taking unusual steps. The insurance company Menzis has opened three of its own primary-care centers to serve the patients it insures, and plans to open dozens more in a move to lower costs. Rival UVIT offers discount vouchers to customers who buy low-cholesterol versions of yogurt, butter and milk.
To prevent insurers from seeking only young, healthy customers, the government compensates insurers for taking on higher-risk patients. Insurers get a “risk-equalization” payment for covering the elderly and those with certain conditions such as diabetes.
Of course, a big difference in the system described and what we have in the U.S. is that in the States, health insurance is most commonly an employee benefit, while in the Netherlands, acquisition of health insurance is an individual/family decision.
The article mentions that that difference introduces a buffering effect, where health care costs end up seeming to be paid “with someone else’s money”, making it more difficult to incent cost-saving behavior.
I’ve got to admit that I love some of the ideas mentioned in the article—the above-quoted couponing strategy, for example, or another tale told by the article, of one insurer rebating an obese individual’s gym membership, provided she met a fairly aggressive weight-loss goal.
Two other provisions described by the article—the idea of the government’s “risk-equalization” payment to make high-risk individuals more attractive to insurers, plus subsidization of low-income individuals’ health insurance—seem on the surface at least to be decent ways of addressing the social concerns without infringing on the operations of the free market.
I like it. If you could ease some of the regulatory burden in certain jurisdictions in the U.S., and convince employers to bump employee’s paychecks by an amount equivalent to the subsidy currently received when transitioning from an employer-provided to an individual-purchase system, it might be an interesting idea to explore on this side of the pond.
1 response so far ↓
1 Dr Mike Esposito // 11 Sep 2007 at 2:05 pm
I’d like to tell John Edwards, or any other candidate who really wants to start connecting with America, that it’s time to talk plainly about Universal Health Care in America. Right now it’s just a “hot air” political topic that sounds good, but they are avoiding the realities of the problem. The health care system, like the military industrial complex of the cold war, is predicated on corporate profits and not the well being of the patient. The CEO’s of the large HMO’s and pharmaceutical companies have the same agenda as any other corporate leader. Raise their company’s stock price or lose their job which pays their obscene salary and bonus. Health care corporation’s focus is financial and they are not concerned with access to care or the quality of care their patients receive.
These same companies will push for tort reform because it limits their liability in medical malpractice lawsuits. They want to limit patient access, reduce their costs and not have any responsibility. The trial lawyers will not tolerate these unconstitutional limits and are fed by the victim’s misfortune. We have all heard the advertisements asking, “Has anything bad ever happened to you. Someone else should pay. Call us now. Time is running out.” How would they survive if they could only make a few hundred dollars an hour? (Assuming, of course, that they are not double billing). However, without these legal wolves patrolling the health care system even doctors would be at risk to corporate domination.
Where does this leave the doctor? Right next to the patient in the over-crowded emergency room wondering how things have gotten so out of control.
Posted by Dr. Michael Esposito M.D.
Radiologist and Author of “Locked In,” a new medical thriller.
http://www.mikeespositomd.com