Dutch Health Care System Cost-Efficient

ROTTERDAM, Netherlands — Holland delivers a system of health care to its 14 million residents that is both comprehensive and affordable. The Western European nation not only distributes services more equally, it does it at less than half the cost per capita of the United States.

On the front lines of the Dutch health-care system are general practitioners, who handle a wide array of routine treatment, including the type of care normally assigned to internists, pediatricians and gynecologists in the United States.

Dutch general practitioners receive most of their salary based on the number of patients they have on their rolls, not by the number of office visits. That lessens the financial incentive doctors might otherwise have to bring patients in for unnecessary visits and office procedures.

Dr. G. Th. van de Poel practices with three other physicians in a Rotterdam working-class neighborhood. The four of them have 6,000 patients. For each of his patients, Van de Poel gets about $56 per year, he said, whether he sees the patient or not. But under recent salary reforms that some say were needed to discourage doctors from knocking off from work early on Fridays, he also gets an additional $20 per office visit.

Specialists are paid on the fee-for-service formula common to the United States and Canada. They generally earn more than general practitioners, although not the high-end gross incomes of $500,000 pulled in by some American heart surgeons.

With a patient volume more than twice that of an American doctor, Van de Poel’s workday moves quickly, allowing him an average of 10 minutes with each patient.

“You have to work fast, but not too fast. You have to spend time real good,” he said.

On the front line, doctors have to make decisions about who gets treated first and, sometimes, who will have to wait for elective procedures. But Dutch officials insist that health care is not rationed.

Dr. Jan Both, a gynecologist who serves on the National Board on Hospital Facilities, said the “queuing,’ his term for lining up to wait for treatment, is not burdensome and corresponds inversely to the urgency of a patient’s problem.

Open-heart surgery, bone marrow transplants and liver transplants are all done in Holland.

Kidney dialysis is offered, too, but is allotted one site in each of the 27 health regions in the country, which is slightly larger than Connecticut and Massachusetts combined.

There are 13 hospitals in the country with complete trauma and brain surgery units. Except for the North Sea islands, helicopters are not used to ferry critically injured patients to trauma centers. Ambulance teams decide whether to take a patient to a trauma center and there is no intermediate transfer to a smaller hospital.