POLICY/INTERNATIONAL: The new health care system in the Netherlands

It would be great if we could get the US to a system of health insurers competing over the right things. With a universal individual mandate that worked, risk adjustment between insurers, and social solidarity mixed with market incentives — the best of both worlds. The Dutch (pound for pound) have better football, beer and drug laws than anyone else.  And now a very sensible health care system too.

Here’s a video on the new health care system in the Netherlands.

Categories: Uncategorized

Tagged as: , ,

5 replies »

  1. The healthcare system in the Netherlands underwent significant changes in 2006 with the introduction of a new system known as the Health Insurance Act (Zvw). The new system was designed to be more patient-centered and promote competition among health insurance providers, as well as ensure universal access to health care. The new system has been praised for its success in providing high-quality healthcare to all citizens of the Netherlands, regardless of their income or pre-existing conditions. I am write my discussion post about the health care system in the Netherlands and this point is more interesting than other historical changes.

  2. Advertising and Alcohol
    Alcohol manufacturers use a variety of unscrupulous techniques to advertise alcoholic beverages to children. Perhaps the worst example is Anheuser-Busch Co., the world’s largest brewer, which uses child-enticing cartoon images of frogs, dogs, penguins and lizards in ads for Budweiser beer. These Budweiser cartoon characters are hugely popular with children, just like Joe Camel ads. A KidCom Marketing study once found these Budweiser cartoon character ads were American children’s favorite ads. This is no accident. Anheuser-Busch is conducting an advertising campaign to get children to start drinking beer. These Budweiser ads are unconscionable. So are Phillip Morris’s Miller Lite “twist to open” commercials, which are among children’s top 10 favorite ads, according to another study by KidCom.
    Hard liquor ads on television are equally unconscionable. In June, 1996, Joseph E. Seagrams & Sons Co. broke a 48 year old voluntary ban on advertising hard liquor on television. Five months later, the Distilled Spirits Council of the United States (DISCUS) re-wrote its Code of Good Practice to allow its member distillers to advertise on radio and television. Even if these TV ads are aired only after 9 or 10 PM, they will still reach millions of American children.
    Alcohol advertising may increase alcohol consumption, including drinking by minors. Based on this effect, various municipalities around the country have attempted to ban alcohol advertising. These attempts have met with mixed results in the courts. This section will attempt to explain how a municipality can legally ban alcohol advertising.
    Commercial Speech
    The only constitutional impediment to banning alcohol advertising is First Amendment freedom of speech. Alcohol producers and their advertising companies will usually bring suit against a municipality which bans alcohol advertisements, arguing that the ban is an unconstitutional abridgement of the freedom of speech. Advertising, however, is only “commercial speech,” which is protected by the First Amendment 1. but not to the extent that political speech is protected. Therefore, a municipality can regulate advertising much more than it can regulate “pure” First Amendment speech.
    Types of Alcohol Advertising
    Alcohol is advertised on billboards and other signs, in print, and on radio and television. It is also advertised on public transportation, in athletic stadiums, in bars, and on delivery vehicles. Because the Supreme Court believes that some types of advertising have effects unlike other types of advertising, the law regarding each is different. A municipality may not, therefore, simply pass a law saying “All alcohol advertising shall be prohibited.” This would clearly be an unconstitutional infringement on commercial speech, as well as vague and overly broad. Municipalities must be selective and regulate those types of advertising which they can prove are linked to increasing minor consumption of alcohol.
    Billboards are a major forum for alcohol advertising. Children and teenagers are regularly subjected to these types of advertisements, but parents cannot effectively control their children’s exposure to alcohol billboards. Billboards cannot be “turned off” like other types of advertising. A municipality probably may ban billboards advertising alcohol, if it can demonstrate that these billboards have an adverse effect on minors. The Supreme Court has found that billboards are a unique form of advertising and subject to extensive regulation. The City of Baltimore recently banned outdoor alcohol advertising and defeated the advertiser’s free speech argument in court. A federal circuit court upheld the ban on alcohol advertising on billboards as not an unconstitutional infringement of the advertiser’s right of free speech.
    Warning Labels
    Children and teenagers are adversely affected by advertising that glamorizes alcohol consumption. Unlike cigarette advertising, alcohol advertising does not carry any mandatory health warnings. Federal law regulates warning labels on cigarette advertising, but not on alcohol advertising. The Federal Alcohol Administration only requires warning labels on alcohol containers and packaging, not on pure advertising. Therefore, state and municipal governments have no power to impose their container or packaging warnings. They may, however, be able to impose warning labels on advertising, because federal law does not address this question.
    Advertising increases alcohol consumption, which increases alcohol abuse right? WRONG. There is no solid evidence from either scientific research or practical experience that this theory of advertising is correct. A study by the Federal Trade Commission found that there is “no reliable basis to conclude that alcohol advertising significantly affects consumption, let alone abuse.” Advertising does not increase consumption. For example, alcohol brand advertising was first introduced in New Zealand in 1992. While advertising continues to increase, consumption continues to fall.
    If advertising doesn’t increase consumption, why bother to advertise? The answer is simple: to increase market share.
    Alcohol is a “mature” product category in that consumers are already aware of the product and its basic characteristics. Therefore, overall consumption is not affected significantly by advertising specific brands.
    Instead of increasing total consumption, the objective of advertisers is to create brand loyalty and to encourage consumers to switch to their brand. Thus, effective advertisers gain market share at the expense of others, who lose market share. They do not try to increase the total market for the product. An example can illustrate why they don’t. The total retail value of beer produced annually in the U.S. is about $50 billion. If a producer’s advertising campaign increases its market share by one percent, its sales would increase by $500 million. However, if the total market for beer increased by one percent, a brand with a 10% share of the market would only experience a sales increase of $50 million.
    Clearly, a producer has a great incentive to increase market share, but little incentive (or ability) to increase the total market. For this reason, advertisers focus their efforts on established Consumers. They seek to strengthen the loyalty of their own consumers and induce other Consumers to try their brand.
    One of the main arguments against alcohol beverage ads on television is that they “normalize” drinking in the minds of young viewers. To the extent that this is true, the ads may be performing a positive role.
    The commonplace nature of alcohol ads on TV serves not to glamorize the products, as some critics suggest, but to cast them as mundane consumer products, right alongside aspirin, cookies, and alkaline batteries. That’s a constructive way for young people to view them.
    On the other hand, if we treat beverage alcohol as a dangerous substance to be avoided and not even advertised, we inadvertently raise it up from the ordinary into the realm of the powerful, the tantalizing, and the desirable Big Deal. In so doing, we slip into the familiar, failed pattern of demonizing the substance of alcohol rather than discouraging irresponsible behavior.
    We should help young people regard the substance of alcohol as neutral — neither inherently good nor inherently bad. What matters is how it is used, and we must convey by word and example that the abuse of alcohol is never humorous, acceptable, or excusable.
    Do alcohol ads portray the products being enjoyed in the most appealing settings and by the most attractive people? Of course they often do — no less than do ads for cars, instant coffee and anti-fungal sprays. That normalcy of alcohol ads helps demystify the product — which is a good place to begin encouraging realistic, moderate, and responsible attitudes about it.
    Responsible attitudes toward alcohol are based on the understanding that such beverages are yet another part of life over which individuals have control, like exercise, personal hygiene, or diet.
    If alcohol beverages are to be used moderately by those who choose to consume them, then it’s important that these beverages not be stigmatized, compared to illegal drugs, and associated with abuse. They aren’t dangerous poisons to be hidden from sight and become a subject of mystery and perhaps fascinating appeal. But that would be the message sent if alcohol commercials were banned from TV.

  3. The Dutch use Euros, not Guilders any more. After visiting the Netherlands last fall to study its health care system, I can tell you that the most important feature is that catastrophic care is paid for by the national government, through national income taxes – which go up to a rate of 52% for the affluent. If we had that type of taxation in the U.S., we could certainly afford universal health care – but Americans do not want to pay such high taxes.

  4. I’ve tried to figure out some nuts’n bolts of the system. I used Oanda Currency Converter to equate Dutch Guilders to U.S. Dollars. If anyone can find out more about the actual system that would be great. The video paints a good picture.
    Here are the basics.
    The basic package:
    The government has put together a basic package that covers about the same as the previous system. Health insurance companies are legally obliged to offer at least this basic package and can not reject anybody who is applying for it. With the basic package you are covered for the following:
    1.Medical care, including services by GP’s, hospitals, medical specialists and obstetricians
    2.Hospital stay
    3.Dental care (up until the age of 18 years, when 18 years or older you are only covered for specialist dental care and false teeth)
    4.Various medical appliances
    5.Various medicines
    6.Prenatal care
    7.Patient transport (e.g. ambulance)
    8.Paramedical care
    You can decide to purchase additional insurance for circumstances not included in the basic package. However, in this case insurance companies can reject your application and they have the right to determine the price.
    Fees of the basic package:
    The fees for the basic health insurance package are annually determined by the health insurance companies and are normally approximately €95($63.44usd)per month. Although the Ministry of Health (Ministerie van Volksgezondheid, Welzijn en Sport) determines a standard premium, the insurance companies determine the additions fee you will have to pay in the end by charging a certain rate and a no-claim charge. It is with these additional fees that the insurance companies compete with each other. There are various health insurance companies and a new law will make it easier to change between health insurance companies.
    If you are required to purchase health insurance and are earning a salary, you will also pay a supplementary contribution from your income (rated 6.5% ($1311.00usd) up to the first €30,000 ($20,032.50usd)of earnings; 4.4% for self-employed individuals).
    For some, healthcare in the Netherlands has become more expensive as a result of the changes. The Dutch government compensates these cases by offering a care grant (zorgtoeslag). The Tax Administration (belastingdienst) determines if you are eligible by examining your income. Foreigners are also entitled to this grant if they qualify.
    Children under the age of 18 years do not have to pay any health insurance and are insured for free for the basic package of health care.

Leave a Reply

Your email address will not be published. Required fields are marked *