In his daily prompt yesterday, Scott Andrew Bailey asks us about the “right to health”. I purposefully put that between quote marks, as obviously no-one has a right to health. We all get sick and die eventually. Okay, that was my autistic brain’s literal thinking acting up again. What Scott means is the right to medical care.
Scott asks whether medical care is something the government should provide for the people or whether it’s best left to the private sector. Are there drawbacks to your choice?
The answer to that last question is, of course, yes. Any system has its drawbacks. My answer to the first question, on the other hand, is: I’d like it to be a little of both. For my Dutch readers, the answer can be short: I like my own system best, despite its drawbacks, such as the mandatory copay and the diagnosis-treatment combinations which dictate that you’ll get care based on a diagnosis, not your needs. Those were a particularly problematic thing in mental health. I believe they’ve been altered to something else this year, but I don’t know whether it’s better or worse.
For my international readers, here is a little explanation of how the Dutch system works and why it has the best of private and public healthcare combined. Basically, what is called basic health insurance is more or less public, even though it is covered through the same insurers that will cover your additional insurance should you get it and the insurance companies are private. The government decides which care is covered under basic insurance and insurers must accept every Dutch resident for this package, regardless of health status. The basic package covers visits to your GP, hospital care, most medications, specialist mental health services (ie. services for people with more severe mental health problems), etc. Things that are not covered include physical therapy, dentistry for adults over 22 I believe, contraception (even though Christian parties have been demanding it gets put into the package to prevent women needing abortions), etc. When I lived with my husband, I had mostly just the basic package (I did have some physio coverage but didn’t use that) and I didn’t have to pay a lot of extra money for things that weren’t covered.
You can decide to get additional coverage for things like dental care, physical therapy, alternative medicine, etc. However, insurers can refuse you for those. They usually don’t for the cheaper packages, but then again getting these hardly outweighs the cost of paying for care out-of-pocket.
Basic health insurance currently costs about €133 a month if you want to have free choice of healthcare providers (I do). You can opt for a cheaper policy where the insurer has contracts with only certain providers and you have to pay 30% of treatment costs if you go to an uncontracted provider. Like I said, there’s a mandatory copay of €385 a year on your healthcare. GP visits do not count towards this.
Like I said, I think our system has the best of both public and private worlds. Before the current system was put in place, low to medium income people were covered under the sick fund, which was similar to the UK’s NHS, including its problems of extreme waiting lists and bureaucracy. People with higher incomes would need to get private insurance, but I don’t think it was much better for them, in the sense that those with private insurance would be treated favorably. That’s a good thing.
A note about those who cannot afford to pay for health insurance at all: as a general rule, basic insurance is mandatory and there are several ways in which the government aids low-income people, but ultimately if a person doesn’t pay at all, insurers have the ability to stop insuring them. In that case, hospitals can refuse care, but not in acutely life-threatening circumstances such as when someone has a heart attack. In that sense, you have a right not to die on the health system, but not an ultimate right to medical care.
A Multitude of Musings 
This is very interesting to read, Astrid! Our health system well what I understand of it works a lot differently. We have a medical card, and gp visits and meds are covered under that. so are most specialist services. xx
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Thanks for sharing. I did read up about the Irish health system a few years ago and from what I know of it, only low income people qualify for a medical card, so it’s like the sick fund we used to have. Higher income people can get voluntary health insurance (VHI) from birth (which if I’m correct can never be revoked based on health status), but I’m assuming your parents couldn’t get it for you because you were a preemie and/or they couldn’t afford it. From what I heard, there’s also a portion of the population in Ireland who have neither a medical card nor VHI. That worried me the most when reading about the Irish health system.
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Yes you are right, that is how it works I don’t have VHI insurance I only have a medical carriage I wouldn’t get insurance now because I have too many previous conditions
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I know and it makes sense in a way. It’s really sad though.
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I am biased, and probably most UK people would say the same but the NHS is from what I can see the best system. Yes, you are right about the bureaucracy and waiting lists – but they are not the product of the system itself. They are the result of years of underfunding and interference from a government that wants a private system.
Study after study has shown that the NHS is cheaper per person to run. All other systems actually cost the government more to run. So why would they want to swap it? Well, because firstly it’s not the government who pay for it – it’s us – our taxes. They don’t care if we have to pay more. But more importantly – the other system makes them more profit. They want us to pay more so they can cream the extra off and line their own pockets.
But all that is just politics and economics. The biggest benefit of the NHS is much simpler. You get ill, you go to hospital. You get injured, up go to hospital.
You don’t sign anything. You don’t have to think about how you are going to pay for it.
You just get treated. Guaranteed.
That’s the element of it that must be preserved!
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I am so glad you are satisfied with the NHS. Honestly, with respect to bias, I think most people who are content where they live, value their own system over anyplace else’s. I’ve even heard people from the United States say their system is the best and that I (a person who relies on disability benefits and long-term care here in the Netherlands) would get far better care there than I get here. I am pretty sure that isn’t true.
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There are all sorts of grey areas here. How should we decide which treatments are included/excluded. For example, cancer or at the other extreme, cosmetic surgery. What about illnesses that are considered to be self-inflicted, e.g. something alcohol-related, or an od.
Deciding how we should fund such a service is relatively straightforward, and either way, the individual pays.
Deciding the scope of treatment is far more difficult.
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This is a great point and I’ve often thought this. For instance the NHS can authorise extremely rare treatments which cost huge amounts, necessarily at detriment to other areas of healthcare. I guess generally the new and expensive treatments are funded by research initially before industry reduces the cost, but not always the case.
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That’s true as well. Here in the Netherlads, there was extensive debate some ten years ago over whether very expensive treatments for several rare neurological diseases should be covered under the basic health insurance policy. They eventually were thanks to lobbying, but this does come at a cost to other healthcare.
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I agree completely. That being said, I am so grateful that, here in the Netherlands, there isn’t a clear-cut distinction between treatment for illnesses that are supposed to be self-inflicted and illnesses which are beyond a person’s control, because otherwise I could’ve died of either of my two medication overdoses. Besides, it is very hard to decide which illnesses are self-inflicted. For example, if someone gets cancer and they happen to be overweight, it may be easy to blame the overweight status, while this is just one risk factor out of many, not a straightforward cause.
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NHS healthcare can be briefly summarised as: NO.
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I feel you. I am so glad we don’t have that here. It sounds ideal in theory, but in practice, it’s quite bad. Like most things that are overly regulated by the government.
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That’s very interesting. We’ve no hope here unless the politicians have to use the same healthcare as everyone else. They have top of the line everything for life once elected to our congress. So many would benefit if they only really knew what it was like.
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I agree. I remember the Republicans compared ObamaCare to the Dutch system back in the day, but quite frankly, it’s a joke.
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Thanks Astrid.
There really are many different cocktails of government sector and private sector provided health care services in different countries all over the world. They have all developed based on the respective national politics and soci-economic conditions. In my opinion a human rights approach would be the best in determining the best mix. Universal access to all should be promoted. Any system should ensure that a human being does not have to abandon himself to fate and wait for death. We all should live dignified lives.
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I agree with your general point. However, the specifics of this are usually hard to determine. I mean, like I said in my post, no-one will die because of having no health insurance here in the Netherlands, but that doesn’t mean people won’t suffer health consequences.
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Bring Politician to the same healthcare system is the most important thing. They are claim there self VIP but they are servant of people.
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