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Health System Comparison
United States ~ Netherlands
Kristin S. Martin ~ November 2013
To make a general comparison on key factors of health care expenditure by country and a detailed comparison of the further statutory U.S. health care program (Affordable Care Act) to the Netherlands universal health care system; specifically what is covered in each system.
Objective
Due to the current transition the United States is experiencing to further move under to the regulations and mandates within the Affordable Care Act I wanted to compare current U.S. data and details of the Affordable Care Act to another country that currently has a health care program with significant governmental oversight, seemingly positive outcomes and similar socioeconomic comparisons to the United States. The country I selected to compare to: the Netherlands.
Introduction
{Medicare, Medicaid, Employer and Private Insurance
United States of America
The United States health care program has been mainly private insurance through an employer or self-purchased and also segregated coverage for those age 65 and over (Medicare) and those with qualifying low income (Medicaid). These programs left approximately 16% of the U.S. population uninsured.
In 2010 the Affordable Care Act was signed into law with phased implementation over a series of years. Currently we are experiencing the implementation of the law that expands coverage to a greater percentage of the U.S. population and increases mandated preventative coverage.Introduction ~ United
States
{Statutory health insuranceVideo: Dutch Health Care System
Netherlands
Within the last decade the Netherlands transitioned to a statutory health insurance system based on government mandates and regulations that requires coverage for all residents, documented workers and foreign students. Leaving approximately 2,000 undocumented workers and visitors without coverage. Although, voluntary and private funds are available to cover that small population.
The government intentionally left the acquisition and administration of insurance to the private sector with the expectation that competition among the insurers would result in a better outcome for the individual.Introduction ~
Netherlands
{ {United States
Prior to the implementation of the Affordable Care Act health care insurance availability through employers, private insurers and Medicare and Medicaid programs for qualified individuals. Gaps in coverage exist where individuals are either not covered due to lack of qualification or by choice.
Under the Affordable Care Act everyone is legally obligated to obtain health insurance.
Medicare and Medicaid programs continue. Medicaid broadens qualifications to cover additional individuals.
Basic medical care is offered through private insurers per federal mandates and regulations.
Penalties for non-participation will be phased with a yearly penalty increase over the next three years for non-participants.
2014 ~ $95/adult or 1% of family income 2016~$325/adult or 2% of family income 2016~$695/adult or 2.5% of family income Penalty fee is whichever is greater
Supplemental private insurance is available to cover additional health care costs not covered under under the law.
Netherlands
Under the Dutch Health Insurance Act everyone is legally obligated to obtain health care insurance.
Basic medical care, as defined by the law, is covered by national health insurance.
Penalties for non-participation are incurred monthly at 130% of the nominal premium.
Insurance is acquired by the consumer directly with private insurers.
Supplemental private insurance is available to cover additional health care costs not covered under national health insurance.
High-Level Comparison
Sta
tisticsUnited States Netherlands
Gross national income per capita (2012 US $)
50,120 48,250
Total expenditure on health per capita (2011 US $)
8,608 5,122
Per capita gov’t expenditure on health (2011 US $)
3,954 4,388
General government expenditure on health as a % of total government expenditure
19.8 20.6
Out-of-pocket expenditure as a % of private expenditure on health
20.9 35.5
Life expectancy – male 76 79
Life expectancy – female 81 83
{What Is CoveredUnder the Affordable Care Act
United States
{ {15 Covered Preventative Services for AdultsUnder the Affordable Care Act
Abdominal Aortic Aneurysm ~ one-time screening for men of specified ages who have ever smoked
Alcohol Misuse ~ screening and counseling
Aspirin ~ for men and women of certain ages
Blood Pressure ~ screening for all adults Cholesterol ~ screening for adults of
certain ages or at higher risk Depression ~ screening for adults Type 2 Diabetes ~ screening for adults
with high blood pressure Diet ~ counseling for adults at higher risk
for chronic disease HIV ~ screening for all adults at higher
risk Immunization ~ vaccines for adults Obesity ~ screening and counseling for all
adults Sexually Transmitted Infection ~
prevention counseling for adults at higher risk
Tobacco Use ~ screening for all adults and cessation interventions for tobacco users
Syphilis ~ screening for all adults at higher risk
22 Covered Preventative Services for Women
BRCA ~ counseling about genetic testing for women at higher risk
Breast Cancer Mammography ~ screenings every 1 to 2 years for women over 40
Breast Cancer Chemoprevention ~ counseling for women at higher risk
Cervical Cancer ~ screening for sexually active women
Chlamydia Infection ~ screening for younger women and other women at higher risk
Contraception ~ Food and Drug Administration approved contraception methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs
Domestic and interpersonal violence ~ screening and counseling
Gonorrhea ~ screening for all women at higher risk
HIV ~ screening and counseling for sexually active women
HPV DNA Test ~ every three years for women who are 30 years old and have normal cytology results
Osteoporosis Rh Incompatibility Sexually Transmitted Infections ~
counseling for sexually active women Syphilis ~ screening for women at
increased risk Well-women visits ~ to obtain
preventative services
{ {Women ~ Pregnancy
Pregnancy ~ Women Anemia ~ screening on a routine basis Bacteriuria ~ urinary tract or other
infection screening Breastfeeding ~ comprehensive support
and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women
Folic Acid ~ supplements for women who may become pregnant
Gestational Diabetes ~ screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
Hepatitis B ~ screening at first prenatal visit
Tobacco Use ~ expanded counseling for pregnant tobacco users
26 Covered Preventative Services for Children
Alcohol and Drug Use ~ assessments Autism ~ screening at 18 & 24 months Behavioral ~ assessments Blood Pressure Screening Cervical Dysplasia ~ screening for sexually
active females Congenital Hypothyroidism ~ newborn
screening Depression Screening Developmental ~ screening under 3 years
of age, and surveillance throughout childhood
26 Covered Preventative Services for Children26 Covered Preventative Services for Children cont’d
Dyslipidemia ~ screening for children at higher risk of lipid disorders
Fluoride Chemoprevention ~ supplements for children without fluoride in their water source
Gonorrhea ~ preventative medication for all newborns
Hearing ~ newborn screening Height, Weight and Body Mass Index
measurements Hemotocrit or Hemoglobin screening Hemoglobinopathies ~ newborn screening HIV ~ screening for adolescents at higher
risk Immunizations Iron ~ supplements for children 6-12
months at risk for anemia Lead ~ screening for children at risk of
exposure Medical History ~ throughout
development Obesity ~ screening and counseling Oral Health ~ risk assessment ages 0-10 PKU ~ newborn screening Sexually Transmitted Infections ~
prevention counseling and screening for adolescents at higher risk
Tuberbulin ~ testing for children at higher risk
Vision screening
{
{What Is Covered
Netherlands
{ {Standard Package ~ All
Medical care ~ general practitioners, specialists, obstetricians and midwives
Hospital admissions and treatments Approved medications Maternity care Postnatal care Limited physiotherapy, exercise therapy,
speech therapy, occupational therapy, and dietary advice
Smoking cessation Assistive medical devices Patient transport ~ ambulances and
transport of seated patients Medical care outside of Netherlands ~
emergency services Dental ~ up to 18 years old
Supplemental Insurance
Additional insurance can be purchased to cover such items as:
Additional physiotherapy treatments Sport-medical care Extended coverage if traveling outside of
the country Extended coverage for glasses or contacts Dental ~ over 18 years old Orthodontic care
{What are the major differences?
Conclusion
The governments of U.S. and the Netherlands spend on health is very similar as a percentage of total government expenditure, 19.8% and 20.6% respectively. There is significant disparity in the amount of total expenditure on health per capita; the United States is spending nearly 65% more per capita and falls behind on life expectancy for both males and females to the Netherlands.
Standard health care in the Netherlands is broader-based coverage that goes beyond the preventative coverage under the U.S. Affordable Care Act. The Netherlands health care includes items such as all visits beyond preventative to general practitioners, specialists, obstetricians and midwives, dental for individuals 18 and younger, and more. Individual out-of-pocket expenditures as a percentage of private health expenditures is higher in the Netherlands at 35.5% where the U.S. is at 20.9% (2011 data).
Conclusion
Slide 5:International Profiles of Health Care Systems, 2013. Table 1-Health Care System Financing and Coverage in Fourteen Countries. Page 6. The Commonwealth Fund. http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2013/Nov/1717_Thomson_intl_profiles_hlt_care_sys_2013_v2.pdf.Slide 6:Video. The costs and benefits of Dutch health care. Dutch Government. November 17, 2010. Slide 7:International Profiles of Health Care Systems, 2013. The Danish Health Care System, 2013. Vrangbaek, Karsten. University of Copenhagen. Page 28-36. The Commonwealth Fund. http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2013/Nov/1717_Thomson_intl_profiles_hlt_care_sys_2013_v2.pdf.Slide 8:The Requirement to Buy Coverage Under the Affordable Care Act. http://kaiserfamilyfoundation.files.wordpress.com/2013/04/requirement_flowchart_3.pdf.ZilverenKruis. National Health Insurance 2013. Financial Penalty. Page 6. December 24, 2012. http://www.zilverenkruis.nl/english/downloadlijst/forms%20and%20brochures/Brochures/Information-for-Impats.pdf.Slide 9:The World Bank. Data. United States. GNI per capita, Atlas method (current US$). 2012. http://data.worldbank.org/country/united-states.The World Bank. Data. Netherlands. GNI per capita, Atlas method (current US$). 2012. http://data.worldbank.org/country/netherlands.World Health Organization. Global Health Observatory Data Repository. European Region: Netherlands statistics summary (2002-present). http://apps.who.int/gho/data/view.country.14600.World Health Organization. Global Health Observatory Data Repository. Region of the Americas: United States of America statistics summary (2002-present). http://apps.who.int/gho/data/node.country.country-USA?lang=en.Slides 11-12:HHS.gov/HealthCare. U.S. Department of Health & Human Services. Facts & Features. Fact Sheets. Preventative Services Covered Under the Affordable Care Act. http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html.Slide 14:Government of the Netherlands. Health Issues. Health Insurance. http://www.government.nl/issues/health-issues/health-insurance.
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