Health Care Lessons from the Netherlands
The Dutch health care system is a high performing, equitable system in which wait times are not considered to be a problem. A careful examination of the Dutch health care system may provide insights to help inform the Canadian debate over the future of Medicare.
Health care expenditures in Canada are comparable to those in the Netherlands and are considerably higher than in the average universal access nation. Compared to the Netherlands, Canada has higher ratios of nurses to population and CT scanners to population, but the Dutch health care system has higher ratios of physicians to population, MRI machines to population, and hospital beds to population. The Dutch also wait less time for emergency care, primary care, specialist care, and elective surgery than do Canadians.
The Dutch health insurance system is markedly different from Canada’s. Rather than relying on a tax-funded monopoly government insurer, the Dutch system provides universal coverage in an insurance premium-funded system characterized by competition between private insurers and competition between providers, alongside personal financial responsibility for patients. Though government plays an important role in terms of funding, regulation, and oversight, the operation of the health care system is largely left to private competing insurers and providers.
There is much Canada can learn from the Dutch approach. The Dutch health care system departs from the Canadian model in its cost sharing for non-primary medical services, private provision of acute care hospital and surgical services, permissibility of direct private purchasing of health care, and its system of independent private insurers providing universal services to their insured populations on a largely premium-funded basis. Some Dutch policies would violate the CHA. This said, these reforms have been shown to provide superior access to, and outcomes from, the health care process.