Friday, September 18, 2009

Hassle-Free Healthcare

No one can avoid joining the debate about healthcare happening now in the USA. Not even me, safely healthy in Holland. In our stay here so far, my wife and I have made good use of the system, with sick and well visits to doctors and specialists as well as a complicated childbirth. I can say unambiguously that we are satisfied customers, and I really hope the US gets healthcare straightened out before I come back!

If you don't read anything further, read this: the Dutch healthcare system is better than the American one, costing less per person with better results and 100% coverage. It's not perfect, but the US could plagiarize it wholesale and everyone would be better off.

One important reason the Dutch system is good, if you ignore being cheaper and more effective, is that it is nearly entirely hassle-free. It is a semi-socialized system with obligatory private insurance. That means that everyone has to buy health insurance from a private insurer of their choice, and those who are unable to pay get subsidized premiums (and yes, that means that I am funding some less fortunate people's healthcare, but even so, overall I pay less than I did last year in the US). The result is simple: I go to whatever doctor I want to see, everything is covered, and there are no bills. The premium is deducted pre-tax from my paycheck, with no copays, no prescription costs, no receipts to save, no claim forms, no bills whatsoever. It is amazingly hassle-free! The only exception to this rule is care from non- or atypically-medical services, such as a reflexologist. They fall outside the system, so you pay out-of-pocket and request reimbursal.
Compared to the high-deductible insurance I had my last year in USA, with a Health Savings Account, endless online forms, and the IRS forcing me to save receipts to prove they were medical expenses, I am loving the lack of hassle. Really.

What's that? You don't buy the "cheaper and more effective" claim? If you'd like to have a look for yourself, the World Health Organization makes data freely available here. The database search takes a few steps to configure, so I've saved you the trouble, exporting a list of interesting statistics for a few relevant countries: USA and the Netherlands, of course, plus Canada and the UK, whose systems have been ridiculed by many in the current debate, and France, for some reason always treated as the antithesis to Americanism, whose system received the second-highest user satisfaction ratings in a recent poll. I put the entire data file online here for you, in case you're interested, but my summary is this:

First, cost: per capita total expenditure on healthcare, in 2006, in US$: UK leads with $3300, Holland is next at $3700, Canada & France are both about $4000, and the USA totals up to $6700. Pretty obvious comparison, eh?

Next, effectiveness, which of course is impossible to measure with one number. How about a few numbers, instead? Looking at life expectancy at birth, there is actually a pretty small range among these nations: Canada & France both expect 81 years, Holland and UK follow with 80 and 79, respectively, and USA is not far behind, with 78 years. Two statistics that show a clearer difference and were especially relevant to my wife and baby daughter this year are infant mortality and maternal mortality, in both of which the USA's rate is nearly two times that of the Netherlands. Again from 2006, France and the Netherlands have infant mortality rates of 4 per 1000 live births, Canada and UK 5, and USA posts a 7. From 2005 (the years chosen were "latest available data" for each statistic), the maternal mortality rate, which I assume means death via childbirth, in the Netherlands was 6 per 100,000 live births. In Canada, France, and the UK, the numbers were 7, 8, and 8, respectively, while in USA the rate is 11 maternal deaths per 100,000 births! Not exactly an effectiveness measure, but interesting for well-informed mamas to consider, is that the American c-section rate is 23%, while the Dutch is 14% (2000 and 2002, respectively, and I think the American rate is even higher now, perhaps 30%). This goes along with Holland's emphasis on natural childbirth, which obviously works well for both mothers and babies.

Stepping away from childbirth-related statistics, the American emphasis on oncology does seem to make a difference, because as of 2002, the US has the lowest of all five countries in cancer death rate with 134 per 100,000 population. The Netherlands is the highest at 155, and the other three are all at about 140. The US doesn't fare so well for cardiovascular death rate, possibly related to obesity rates, with 188 deaths per 100,000 population. The Netherlands is mid-pack with 171, and France somehow pulls off a 118. Maybe it's the wine!

Correlating more with effectiveness than cost are some infrastructure statistics. Notably, the USA, despite all the cost, has the fewest hospital beds of the five: 32 per 10,000 population. France leads with 73, and the Netherlands is next with 50. Also interesting, though aggregating data from different years, the Netherlands leads with 37 physicians per 10,000 population, while the USA is mid-pack with 26. Single-payer UK and Canada have 23 and 19, respectively.

Enough statistics for one blog. There's more to say, though, so stay tuned.