It’s time to reconsider how we fund our NHS
Our frontline healthcare workers are currently the saviours of our country, but empty claps and cheers every Thur
sday at 20:00 through windows and front doors isn’t the applause they deserve. They deserve the best equipment in the world, in the best environment and most innovative working conditions across the globe. Never in our time has such a virus caused so much economic and social devastation, its an extremely challenging time for us all during this unprecedented period of uncertainty.
Having lived in the Netherlands I wanted to explore and discuss their model of funding public health services, since its also considered one of the best in the world – this is something we should aspire to in considering the capital framework of funding our loved NHS.
How it works in the Netherlands?
- All residents in the Netherlands are required to purchase health insurance (I paid approximately 100 euro per month)
- The health insurance is provided by private health insurers and are tightly regulated by central government
- The insurers can be other for-profit or non-profit
- The current system was created through a 2006 health policy reform
- The government provides larger subsidies to insurers for participants who are sicker, elderly or have pre-existing conditions
- Tax credits are given to low income patients
- Children are insured for free
- People who don’t take out insurance risk a fine
The government will firstly assess your health requirements and then direct you to insurers who will are obliged to offer your insurance. The government will also set out the standard requirements which all insurers will have to provide including; GP appointments, emergency hospital treatment, maternity care, lab tests and medicines.
Division of Health Care System
These can be divided into 3 different systems:
1) Three different echelons
2) Physical health vs mental healthcare
3) Cure (short term) vs care (long term)
Types of Hospitals
- University hospitals
- General hospitals
- Top clinic specialist hospitals
Government expenditure on health in the Netherlands made up 80% of health spending in the entire country. The standard insurance premiums are often financed by a mixture of income related contributions and flat rate premiums. The individual hypothecated contribution is set at 6.5% of income.
Dutch medical system: Public, private, universal, national, state, single payer - which is it?
The Netherlands has a universal healthcare system. It’s managed by the government and supplemented by private insurers. Anyone living or working in the Netherlands must obtain basic level health insurance (with or without additional coverage) from a Dutch provider.
The Dutch state healthcare system
The state offers mandatory insurance that is funded from the state and managed by private insurance companies. The insurance companies receive funding from a regulator’s fund. All primary care and long-term care services must be offered at a fixed price. It’s illegal for companies to refuse coverage for anyone or to impose punitive fees or conditions based on someone’s financial or health situation.
Why the Dutch ended up with private health insurance for everybody
Before 2006 the country had a two-tiered health care system: About two-thirds of the country was covered by a social health insurance program, and the remaining third was covered by private insurance. Disparities developed between the two tiers; wealthier people got better access to doctors with their private coverage.
By 2006, the two-tiered system teetered on the brink. Health care was becoming very expensive for the middle class, who faced high out-of-pocket costs. Yet private insurance was more attractive to doctors, because it paid better, than the public program that was covering people with lower incomes. And about 2 percent of the population still lacked insurance.
So the Dutch decided to overhaul their health insurance. The ruling centre-right government compromised on a program to achieve universal coverage, which both sides agreed was essential, without abandoning the private market.
Their solution: Everybody would have to purchase private health insurance individually, through a strongly regulated market. The public program would disappear. The Dutch system’s rules presaged the rules in the Affordable Care Act on pre-existing conditions: guaranteed issue (nobody could be denied health insurance because of their medical history), community rating (nobody could be charged higher premiums for their health status), and an individual mandate (everyone must carry insurance or pay a penalty).
The Netherlands fines people who don’t carry insurance for up to six months and then auto-enrols them in an insurance plan, with premiums that are about 20 percent higher than they would have paid if they signed up during the regular enrolment period. A small number of people — about 200,000, or around 1 percent of the population — default on their premiums, and their wages are garnished to cover the cost of their insurance.
The average cost to a Dutch citizen for health insurance is about 1,400 euros annually. People with lower incomes get additional government assistance to reduce their payments. The government also collects contributions from employers to help fund the insurance scheme and covers the cost for children; revenues are spread among the insurers based on the health status of their customers. Public financing covers about 75 percent of the system’s costs; the insurers have also generally operated as nonprofits.
The benefits are designed to encourage cost-efficient use of medical care by patients. Dutch patients can visit a primary care doctor for free. For a visit to the hospital, they will need to pay toward their deductible. The annual deductible is today capped at €385, although people can choose to pay a lower monthly premium in exchange for a higher deductible — up to €885. The system has more or less delivered universal coverage. More than 99 percent of Dutch people have insurance; people with conscientious objections are exempted from the mandate to buy insurance. The Dutch ethos of smartly managed health care extends beyond just the provision of health insurance. Doctors and hospitals are tightly regulated, too. The strict rules facilitate simple solutions to problems like after-hours care. Every insurer pays primary care doctors the same flat rate, 75 euros an hour, for care at the general practitioner co-ops. No one insurer’s patients get preference over another.
NHS – protection, responsibility and integrity
The NHS is our nations pride and joy, its need protecting from external shocks – from people who abuse the system thinking money is no object or has no influence. I am not calling for the NHS to be privatized, the collaboration and heavy tight regulation means this is an affordable alternative (such as a hypothecated tax taken from your income). This system would ensure the integrity of our healthcare is universal, that coverage reaches everybody, that individuals take responsibility. I don’t think it’s asking for a lot that we all pay a bit extra to ensure this beloved institution is protected – preserving it from the “American like genius” of free markets and no state involvement. Healthcare is something we all need, society benefits from; a protection when we are vulnerable and ill and something we must protect for future generations. This is the true applause that the NHS deserves, by funding it!