Essay on Healthcare System in the Netherlands
The Netherlands has a unique system of health care, in which the qualities of universal coverage and managed competition have been combined in an attempt to offer its citizens the most comprehensive style of insurance while also preserving a limited amount of choice. However, the current system was implemented by the Dutch government in 2006, after rising medical costs had caused the previous system to become increasingly difficult to manage. Hence, this shift in policy was designed to counter these financial challenges by incorporating the aspects of negotiation and competition. “In health care systems based on managed competition, insurers are expected to negotiate with providers about price, quantity, and quality of care (Stolper et al., 2019, p. 293).”
Unfortunately, administrators were unable to foresee how a disparity in knowledge between insurers and providers could lead to a plethora of issues within this system. As medical practitioners are more familiar with the many ailments of their patients and practices associated with their treatment, the ability to “game” the system frequently comes into play. This type of interference could involve increasing or decreasing prices to match one’s competition by including unnecessary treatments, lengthening the prescribed time needed for rehabilitation, or grouping therapies together in an effort to match individual costs. “For these reasons, effects of managed competition on the price of health care services may differ from the neoclassical response to competition (Dijk et al., 2014, p. 1).”
Nevertheless, there are many positive facets regarding the Netherlands’ current health care system, which finds itself ranked amongst the top in the world on almost every list available. Furthermore, these recent changes offer numerous opportunities for research, as copious amounts of data become available with every passing year. Thus, we have a number of studies for examination, as we review the following research that has already been performed.
When the Netherlands first implemented its current health care system, appointments were readily available for those seeking checkups and other types of services that are generally thought of as “preventative” treatments in medical field. This, along with choices involving coverage, led to the public’s expectations of fairness seemingly being fulfilled, as their needs now seemed prioritized. Additionally, these results provided a stark contrast to the former system that was in place from 1941-2005, as wait times were lengthy and choice of coverage was nonexistent. However, as the associated costs and the volume of appointments continued to increase, insurers found themselves in an unsustainable position. This led to the following reaction: “After 2012, however, insurers shifted their focus to negotiating expenditure caps and the growth of healthcare expenditure started to decline (Stolper et al., 2019, p. 293).”
As medical cost and consumer demand began to level, a competitive model formed that found insurers and medical providers entwined with consumer expectation. However, all parties soon discovered how only one feature was involved as part of the negotiation: “In price-regulated markets, quality is the only dimension on which one can compete (Croes et al., 2018, p. 7).” These circumstances led to a marketing war among insurance providers, as the promise of garnering a large percentage of subscribers within the current population would allow such a company to corner the market. Essentially, this resulted in a small number of insurance companies controlling a majority of the market, as funds for advertising proved crucial in this achievement. Subsequently, while there are approximately 60 insurance companies in the Netherlands, the top four currently write over 60% of the policies, which leaves a little to be desired in the sense of true competition (Statista, 2020).
The Netherlands has one of the most comprehensive medical systems in the world, but this does not come without its challenges. Among these is a vicious cycle of negotiation as medical providers and health insurers vie for control of the market by maintaining control over its patients or subscribers. Therefore: “Today, the Dutch system can be characterized as a system of managed competition in which health insurers compete for subscribers and healthcare providers compete for contracts with health insurers (Croes et al., 2018, p. 5).” However, the short history of the current program shows how presently leans toward the influence of the insurer, as their coveted contracts demand that providers shape their pricing plans accordingly. This led to the results of a recent study where providers agreed on three essential changes that included: “increasing the transparency of health insurance policies on quality, costs, and accessibility of care… increasing investments in prevention and early detection,… and compensation of evidence-based innovations by care providers (Vries et al., 2021, p. 31).”
“While healthcare insurers negotiate with providers about price, quantity and quality of care , evidence shows that quality only played a limited role in negotiations between insurers and providers , which are mostly cost-driven  (Vries et al., 2021, p. 31).”
While the Netherlands’ efforts at offering universal coverage along with its form of managed competition seems to bear many successful qualities, we feel further study should be conducted to gather information regarding how this system might work in a country with a greater population, such as the United States. Thus, a comparison of these two countries offers promising results, as the U.S.’s attempt at blending a capitalist system of competition with the institutionalization of government control has led to astronomical medical costs for its citizens. Furthermore, the Netherlands’ former system of public health insurance for the majority of its population eventually led to an untenable situation that involved increasing costs, extensive wait times, and a lack of choice regarding care. Consequently, an assessment of these two systems seems fruitful, as both are currently exercising various forms of managed competition after evolving from two distinct historical frameworks.
With this in mind, we would like to focus on one aspect of health care that is gaining importance and evolving as the world population continues to age: home health. This component of the health care system is becoming increasingly vital as the older adult population continues to grow. Furthermore, medical providers and experts agree that the increasing medical costs associated with older adults will persist as the populations in developed countries continue to age – thereby leading to unavoidable issues involving the circumstances of their medical care and the potential impact it might have on their ability to maintain a life of independence.
While there have been a plethora of studies performed on the health care system of the Netherlands and the United States, very few have conducted analysis on the attributes home health and its impact on older adults. However, medical practitioners will often claim that patients are much better off at home, so this seems to be a gap in research that’s worth investigating. Furthermore, patients are frequently adamant about upholding their independence – which typically involves the ability to maintain one’s residence – so providing data that could assist in such an endeavor would prove meaningful.
Now, we must discuss our method of study, as cost and available resources will be the determining factors in how our research is performed. Therefore, we propose a longitudinal study, where a specific number of older adults (N=100) would be chosen to partake in the exercise. Of course, their selection would be based on a medical assessment, with their current and future living conditions taken into consideration. The preferrable method would include four groups, with two of these including individuals who were placed in care facilities (Na=25, Nb=25) and the two including those who were capable to maintaining their residence (Nc=25, Nd=25). Our examination of these groups would then incorporate a double-blind study, where researchers and participants were unaware of who was being included in the study. If resources permitted, we would propose one research group for the Netherlands and another for the United States, as this would be optimal for contrasting and comparing these two systems of health care once the studies were complete. Finally, these studies would need to occur over a period of at least a year, with the possibility of conducting follow-up research within a three-to-five-year period.
Naturally, we would hope to conduct further experiments and research over a period of years, with the intention of building a meaningful database that could improve home health among older adults. However, varying conditions will demand extensive follow-up that could include a period of years, as this study and others that might follow could be critical for increasing the amount of quality years an older adult might experience. With health care in the Netherlands currently thriving and that of the United States presently struggling, such a study might be crucial for the benefit of all.