After years of spiraling health costs, change was needed to the Dutch Health Care System. A dual system was introduced January 2006 comprising of compulsory private health insurance and government provided health care.
Compulsory private health insurance finances all primary and curative care (i.e. the family doctor service and hospitals and clinics). Social insurance funded by earmarked taxation covers long term care for the elderly, palliative care, and the long term mental health patients needs.
Primary Health care is provided by family physicians, district nurses, home care givers, midwives, physiotherapists, social workers, dentists and pharmacists. Each person must be registered with a local family physician. The general practitioner makes referrals to specialists or hospitals.
The Netherlands has world class hospitals, including eight university hospitals. Each of the university hospitals offer services such as neurosurgery, cardiac surgery, a high-level emergency department, advanced oncology, departments for infectious diseases, and other services generally not found in smaller hospitals.
A level and type of care similar to that offered by university hospitals is offered by a number of large hospitals which are not directly affiliated with a university, though these hospitals tend to be somewhat smaller. These hospitals are frequently referred to as “top-clinical” centers. Most of the hospitals in The Netherlands are private not-for-profit institutions.
This compares well with the Australian health care system. Although Australia has a strong private health care system, it is not compulsory. Government funded health care provides excellent care in public hospitals, primary health care included visits to gps, and discounted pharmaceuticals.
Role of Government
Dutch Health care is regulated by the Ministry of Health, Welfare and Sport, and the current Minister is Edith Schippers. Marlies Veldhuijzen van Zanten-Hyllner is State Secretary for Health, Welfare and Sport.
The Ministry of Health, Welfare and Sport de¬nes policies that aim to ensure the wellbeing of the population to lead healthy lifestyles. One of the main objectives of the Ministry of Health, Welfare and Sport is to guarantee access to a system of health care facilities and services of high quality where all citizens have private health care. The Ministry has acts within the Exceptional Medical Expenses Act (AWBZ) and the Sickness Fund Act (ZFW).
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Local authorities work with the Ministry of Health, Welfare and Sport to provide public health care to the community. Local authorities are involved in public safety policies, including the the implementation of the Medical Assistance (Accidents and Disasters) Act.). The Ministry also coordinates the National Institute of Public Health and the Environment, a major knowledge centre for public health care.
The Ministry of Interior and Kingdom Relations is responsible for:
standards in public administration
policy on urban areas
the integration of minorities
coordinating integrated public safety and security policies
Finance Minister Jan Kees de Jager reported on 12 May 2011 that the rising cost of healthcare is the biggest challenge facing the Netherlands and the rest of the world. This increased spending on Australian health care reflects this trend.
Over the past decade, the cost of healthcare has risen by 4% a year, while the economy has only grown 2%, he said. ‘That is unsustainable,’ he said. ‘At some point that single category will eat up the entire economy.’
The Netherlands spent â‚¬60bn (A$80bn) on healthcare in 2010..
De Jager said the solution does not lie in increasing premiums or cutting coverage. ‘In the long term you cannot avoid looking for solutions within healthcare itself,’ he said. ‘How we approach this is the biggest challenge that we have to deal with, for both the Netherlands and the rest of the world.’
Australia is facing the same issue of rising health care costs. The government has implemented incentive schemes to encourage a higher percentage of Australians taking up private health insurance (30% private health insurance rebate) as well as a 3% ??? medicare levy for those earning over $70 000 who do not have private health insurance.
The Dutch Health Care system is facing a universal issue with its health workforce. The ease of travel through EU and geographic proximity of countries has created a very mobile health workforce.
The report xxxxxx Health Worker migration from Western Europe, may increase, adversely affecting health system performance in other countries, particularly those that have joined the EU since 2004.
The Netherlands Ministry of Health, Welfare and Sport is responsible for the development of policies to ensure the health and social wellbeing of the residents in this small densely populated country. The Netherlands is similar to the United States in having a health system based on private providers with government responsibility for the accessibility, affordability and quality of health care. Health insurance is compulsory and the government contributes for those unable to pay.
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General practices are private businesses which enter into a contract with insurers to supply services to the customers of the insurance company. GPs are paid a capitation fee per patient registered with their practice, a fee per consultation and a negotiable reimbursement for practice costs, depending on services offered, staff employed, and the achievement of quality and efficiency indicators. These fees are paid to the GPs by the insurance companies.
Most GPs are independently established and self-employed. Patients in The Netherlands choose their own family physician, but are required to register with a practice. Many practices employ a practice nurse to provide chronic disease management and most GPs employ doctor’s assistants who can perform simple medical procedures such as taking blood pressure, syringing ears, giving injections and performing vein punctures under instruction from GPs. Out-of-hours centres or cooperatives provide access to PHC services from GPs, nurses or doctor’s assistants from 5pm to 8am.
The report indicates a ‘pull’ from health works in countries further east and south seeking better pay and career opportunities.
There are large disparities in health expenditure across the EU, as well as skill
shortages (actual and projected) in many health systems in western Europe, which may
exert a ‘pull’ on health workers in countries further east and south seeking better pay
and career opportunities. This raises important questions – what is the evidence that
health workers are migrating, and is any migration temporary or permanent? If health
worker migration is an issue, what are the options for policy makers? What are the
‘push’ and ‘pull’ factors and how can they be addressed?
It is critical that the issue of migration is examined in the broader context of the
dynamics of health care labour markets, and that any policy solutions focus on
improving monitoring as well as ‘managing’ what is happening. It is also crucial to
understand migration trends in relation to existing ‘stocks’ and ‘flows’ of health workers.
In order to do this, better and more complete data are needed to monitor the situationso that policy decisions can be made from an informed perspective.
In summary, The Netherlands are facing the same health care themes as the rest of the world, including Australia. A mobile workforce has led to a health care worker shortage. Increasing health care costs has led the government to rethink private health insurance and the Dutch government implemented a compulsory system in ???.
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