TOPICS > Health

Netherlands Health System Balances Cost With Quality

October 7, 2009 at 12:00 AM EDT
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In the last of a series on health care in the Netherlands, Ray Suarez reports on how the European country maintains low health care costs while delivering a high standard of care.

JIM LEHRER: Late today, the Congressional Budget Office offered its estimate for the Senate Finance Committee plan. The total bill will be about $830 billion over 10 years and will reduce the budget deficit by $81 billion.

Committee Chair Max Baucus had this to say.

SEN. MAX BAUCUS, D-Mont.: Soon it will come down to the Senate. My colleagues, this will be our opportunity to make history. Just think of it. Our actions here will determine whether we will extend the blessings of better health care to more Americans or not. Ours is a balanced plan that could pass the Senate. Our bill should win the support of Republicans and Democrats alike. And now the choice is up to senators.

JIM LEHRER: Now, cost-cutting abroad. Last night, Ray Suarez began his reporting on the approach in the Netherlands. Here’s Ray’s part two.

RAY SUAREZ: When the Netherlands reformed its health care system four years ago, everyone over 18 was required to buy coverage from a private insurance company. In turn, the insurers were required to accept every customer and offer the same price, regardless of age or medical history.

The Netherlands faces two challenges: strong expectations of continued high-quality care and a graying population that’s entering a very expensive time of life for health care at the same time. So how do you keep costs down?

One way to keep costs down: keep people healthy, particularly people who are approaching retirement, like Frans Doppegieter.

Last spring, Doppegieter was diagnosed with type-two diabetes, a condition that can lead to more serious health problems and much greater expense, if not properly controlled, conditions like heart disease, failing eyesight, and the threat of lost limbs.

To keep patients like Frans healthy, insurance companies now offer incentive lifestyle programs, even pay for gym memberships. Roger van Boxtel is CEO for Menzis Insurance.

ROGER VAN BOXTEL, chief executive officer, Menzis Insurance: We make programs for how to quit smoking, how to train your body, how to eat healthy, and we see more and more interest with our insured to deal with these programs. It’s individually. Many times, you can use Internet and the doctor behind it. It’s confidential. People are willing to work on their own health care, and that’s something we have to promote.

Doctors finding time and savings

RAY SUAREZ: In fact, Frans is a model Menzis patient. He dropped a lot of weight after his diagnosis. He records his blood sugar level at home and sends his data by Internet to his general practitioner, saving on costly clinic visits. His doctor is part of a collective of private doctors and therapists who've set up under the same roof.

DOCTOR: We have divided it in three to four teams here.

RAY SUAREZ: This care center, in the town of Tiel, is funded in part by the insurance company, Menzis. The doctors are relieved of administrative burdens, and the insurance company says it gets better, cheaper care.

ROGER VAN BOXTEL: If you start up a center like this, we help them with the management, we help them with their I.T. organization. It's not just the euro or dollar extra. It's more how to facilitate it, to let them become really the doctor again, who is capable of all day dealing with the patient, and don't have to think of, how do I run this business here? Who's dealing with the garbage? Who is dealing with cleaning up the toilets? That's something we help them with.

RAY SUAREZ: The Tiel pharmacy uses robotics to dispense prescriptions, but the real savings comes from prescribing generic drugs. The Dutch spend half of what the United States spends on medication per person. In fact, Menzis insurance company rewards doctors for using generics.

ROGER VAN BOXTEL: We gave doctors extra money if they were strict in prescribing medicine. We said to doctors, If 70 to 80 percent is generic and only 10 percent or 15 percent, 20 percent is the more expensive medicine, then we'll give you a bonus.

We finally are now up to the point that most of the GPs are really consequently thinking about, where can I give a generic? Will the patient understand that? And last year, only in one year, we saved in the Netherlands 400 million euro in one year.

RAY SUAREZ: The G.P., or general practitioner, is the key to cost control in the Dutch system. Patients must go to their G.P. in order to get a referral to a specialist.

Jako Burgers is a general practitioner. Like most primary care doctors, Burgers makes house calls. He says the strong relationship built between a primary care doctor and a family leads to fewer trips to specialists.

DR. JAKO BURGERS, general practitioner: We know how to treat people. We know how to treat the children. We know how to treat the elderly patient. And we have a stepwise protocols which you can follow and then, after step three or step four, there's a time to consider a referral.

Guides for new parents

RAY SUAREZ: A huge cost-saver for the Dutch, which may have more to do with culture and custom than reform, starts the day you're born. The great majority of Dutch children are born at home, much cheaper than a hospital maternity ward. Only 8 percent of women here get epidurals during childbirth.

And new parents, like the Van Dijkens, are not all on their own. A maternity aide nurse must visit all new mothers and babies. Nurse aide Patricia Stift helps out in the house, teaches newborn care, and watches for health problems. She's paid by and reports back to the Van Dijkens' insurance company. The idea is to keep new parents and babies from trips to the doctor's office for minor issues.

PATRICIA STIFT, maternity aide nurse: I come in, and I listen to them, listen to their worries, help them understand their baby, help them to get a handle on how to handle the babies.

RAY SUAREZ: The Netherlands has an infant mortality rate 25 percent lower than the United States.

The reforms also allow insurance companies to negotiate prices with hospitals for services, and hospitals can aggressively market their services, and that worries some doctors, like Dr. Johannes Borgstein. Borgstein is an ear, nose and throat surgeon. He's wary that cutting costs for services could lead to cutting patient care.

DR. JOHANNES BORGSTEIN, otolaryngologist: We're in a little bit of a slippery slope with the introduction of marketing effects in the medicine, the haggling the marketplace, the haggling the discussions, the trying to reduce costs. Marketing effects in medicine generally have a detrimental effect for the patients and often for the doctors.

E.R. alternatives

RAY SUAREZ: Finally, the Dutch seem to have found an answer to one area of care which is a huge driver of costs in the United States: the emergency room.

To avoid expensive E.R. visits, every neighborhood has an after-hours care clinic, like this one in Amsterdam. The clinic gives emergency treatment after a cycling mishap, treats late-night illnesses, and the doctors, GPs who pull 20 night shifts a year, make house calls and dispense advice over the phone.

DR. JOHN KAAL, general practitioner: About half of them will be solved over the telephone.

JOURNALIST: Just advice?

DR. JOHN KAAL: Just advice. And some of them by the triage assistant, and some of them later on by the doctoral on call. I suppose about 40 percent of total would be seen on the post here. They will be invited to come and to check out. And 1 out of 10 will be a house call.

RAY SUAREZ: Of those who access care at after-hours facilities, only about 3 percent end up being sent to the hospital. But with a stream of new immigrants entering the health care system and an economy which is not as robust as it was when reforms were implemented, government and insurers here are working hard on finding new ways to save on health care costs.