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  1. 1

    Doctor Whom

    The Netherlands has spent close on 15 years or more debating and tweaking and getting ready to implement their insurance system. We haven’t even begun to debate Medicare Select here yet.

    It’s wrong to compare the Netherlands system to our Private Health Insurance (PHI). Out existing PHI is a strangely subsidised system that gives the ability to jump waiting lists and choose times of hospitalisation for elective surgery. Thats about it except for the marginal nonsense offerings of non-evidence based care like chiropractic.

    The Netherlands system provides for mandated universal care. For all.

    If can afford it you pay around 50% of the total cost of the insurance – if you can’t for various reasons the Gov. pays the premium. But you must be in a fund and the fund must cover you. The Gov. equalises /risk balances /tops up each fund each year based on chronic disease, high cost treatment etc loads of funds.

    Since its introduction about 3 years ago the Dutch system has gone from 8 insurers to 5. Insurers do pay for programs of prevention and early intervention for their own patients and they do it quickly, targetted, locally and without all the red tape that a Canberra can wrap initiatives in.

    Hospitals can and do ramp up throughput without being constrained by Gov. imposed caps on the upper limit of throughput like here in Oz. Waiting lists in Netherlands are so low in many procedures in Netherlands that anyone looking at the figures has to re-check to see if they read correct.

    80% of health expenditure in Nl. is public and around 8% is out of pocket.

    GPs have a hybrid capitation payment and a fee for service. Insurance can pay for
    extra primary care services such as practice nurses etc.

    Sure Netherlands is a small country with roughly the same population as Oz but to suggest there are no issues of access is the same as suggesting that Victoria has no access issues because its not WA or NT.

    Regional fundholding in Australia has many attractions however one drawback is that it is people who would be forced to move if they want to swap providers or insurers.

    With a combination of regional models and Dutch type insurers we may get he best of a few worlds. Already Catholic Healthcare in Oz has floated the idea that under this model they could in fact be one of the insurers. The other ones that immediately come to mind is the Industry super funds might want to combine into insurers – one idea that has many benefits for members.

    The Dutch have a strong tradition of supporting what we would call fairness and equity in their society and health care – we shouldn’t dismiss what they have created in healthcare after 15 years of strong thinking and debate across a wide political spectrum.

  2. 2

    Doctor Whom

    I think Germany has about 200 insurance companies/schemes for around 80m people. They compete but as far as I recall are all Not-for-profit.


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