Dutch Healthcare

In the new Euro Health Consumer Index 2009 (PDF), the UK comes a middling 14th despite having a relatively high income.  All of the countries that score below us are significantly poorer.  The best performing country is the Netherlands, which has become the first country to top the list for two years in a row.


The reasons for that Dutch success given (via ConHome) by the authors of the report are revealing:


"The research director, Dr Arne Bjornberg, said, "As the Netherlands is expanding its lead among the best performing countries, the index indicates that the Dutch might have found a successful approach."

She said the secret of its success is that is "combines competition for funding and provision within a regulated framework".

"There are information tools to support active choice among consumers. The Netherlands have started working on patient empowerment early, which now clearly pays off in many areas. And politicians and bureaucrats are comparatively far removed from operative decisions on delivery of Dutch healthcare services."


When we wrote Wasting Lives: A statistical analysis of NHS performance in a European context since 1981 (PDF), we set out the following priorities for reforming British healthcare:


"In order for British healthcare to match the performance seen in other European countries several key differences will need to be addressed:

Centralisation.  Local NHS organisations have very little room for independent decision making.  In other European countries, in particular Switzerland and Spain, healthcare policy is highly decentralised.

Political management.  Healthcare provision in the UK is managed by politicians.  Secretaries of State responsible for healthcare have rarely had management experience and none have had specific subject knowledge in healthcare.  European healthcare systems, in Germany, France, Switzerland and the Netherlands, have genuinely independent providers of hospital care and social health insurance that are not managed by politicians.

Monopolistic.  The NHS is a monopoly.  It not only has unique access to taxpayers’ money but does not allow patients to receive part of their treatment for a certain condition for free while purchasing the rest from the private sector.  In the Netherlands, in particular, insurance companies compete to offer the best value.  In almost all of the European healthcare systems a diversity of hospitals competes to offer value to insurance funds."


Our recommendations for reform of the NHS are pretty strikingly similar to the reasons given by Dr. Bjornberg for the Dutch healthcare system's success.  That isn't some astonishing feat of prescience on our part.  It's just that the basic principles that lead to good healthcare aren't that complicated.  Unfortunately, our politicians are more interested in a competition to see who can spend more of our money than trying to make sure that money is well spent.  Anyone who was really serious about investing in Britain's healthcare, rather than posing at the public's expense, would be interested in creating the kind of NHS that can really deliver value for money and compete with the best in the world, our European peers.

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