First up is Teresa!
Teresa is in my neuroscience masters and works with Green Fluorescent Protein tagged neurons so (nerds that we are) she's a GFP tagged person :)
Hoi!
My name is Teresa and
I’m happy to follow Brenna’s invitation to write a guest entry to her blog. I
am an Austrian who has lived abroad in the US, Denmark and now the Netherlands,
and I am especially interested in intra-European differences.
I had a lot of ideas,
ranging from gel-indulging Dutch male hair styles to their blindsiding honesty.
But (un)fortunate coincidence has brought to me a topic about which I can now
talk about from personal experience: Gezondheidszorg,
the Dutch health care system.
It started with a
moderate sore throat that I didn’t worry about too much. When it didn’t go away
after a week, I went to the local drugstore for advice. Technically not a
pharmacy, they mainly sell body care products and a wide selection of
relatively high dosed pain medication, many of which wouldn’t be available
over-the-counter or outside pharmacies in other European countries.
A bit to my surprise
they didn’t try to sell my anything, not even symptomatic relief, which they
definitively would have done in Austria. But simply said that it will go away on its
own. ”Maybe get these honey liquorice drops for a euro on sale”, which, a bit
faithlessy, I did.
As the symptoms
worsened and I felt too sick to work, I decided to go to find a GP. Finding
one, making an appointment and bridging the language gap went smooth, she saw
me the same day. Again to my surprise, she discouraged me of taking any
antibiotics but recommended strong pain relievers and faith in my immune
system. With a background in molecular biology, I do generally have the latter,
and I understand the fear of creating multi-resistances, so I decided to wait
the weekend and see.
At that point, Brenna
was the first one to mention to me that the Dutch have the tendency not to give
medication when not absolutely necessary. I didn’t think about it too much,
since in my experience the US American environment was more inclined to give
out medication than my Austrian one.
Without giving too
many details, it wasn’t a good idea to wait and I acquired some unpleasant
stuff. I don’t consider myself a hypochondriac, and I was feeling a certain
degree of urgency, so I was quite sure that when I went back to the GP the Monday
after, that she would give me antibiotics. But still, no. She wasn’t sure what
the effect would be. I should see a specialist first, meaning possibly waiting
for one to two weeks for an appointment. In the meantime, she could give me
stronger pain medication.
Which I was quite sure wouldn’t close my ulcer.
This spurred my
interest in this, in my eyes, bewildering system. What is the philosophy behind
it? How is it organized?
One of the first
things I read was a guideline1 for expats to the health care system.
Some excerpts:
"In general, there is a natural, non-interventionist approach to
medical and maternity care in The Netherlands, reflected in the reluctance
of doctors to prescribe drugs unless absolutely necessary, the general
practice of giving birth without any pain relief and the high
proportion of home births. Additionally, doctors tend to volunteer much
less information to their patients about their conditions than is normal
practice elsewhere, and there is far less preventative health screening than in
many other western countries; it is not, for example, usual for women to
have annual pap smears. Some non-Dutch nationals living in The Netherlands
reportedly find this approach to healthcare a source of concern.“
"Alternative treatments, such as homeopathy and acupuncture, are
very popular in The
Netherlands and the cost of these are sometimes covered by health insurance." (Skeptics – where are you?)
Netherlands and the cost of these are sometimes covered by health insurance." (Skeptics – where are you?)
The guide states that
55% of Dutch births take place at home, apparently the highest rate in the Western
world (a short search in academic literature2 suggests lower rates,
25-35%). The U.S. Department of Health and Human Services estimates the US
American share of home births to be around 0.70%, similar to the rates I could
find for other European countries.
I find it difficult to
embed this non-interventionalist fact, with some homeopathic hagelslag³ mixed
in, into my general picture of Dutch culture. It especially seems to collide
with their tradition and general high esteem of science.
Why give somebody pain
medication, when there is a remedy that might have the same amount or even less
side effects – taking into account that the natural course can take
considerably longer? Do they value “fighting” something through on your own? Do
you get a medal?
-(The popular blog
”Stuff Dutch People like” offers another explanation: Home births are just more
gezellig - cozy, intimate, sociable.)
Another aspect that I
find intriguing: If there is a tendency to “let nature take its course”, which
I read from child birth without pain relief and generally less medication given
– how does this fit with the Dutch liberal attitude towards euthanasia? Is
suffering just a part of it at some, but not other stages of life?
Maybe I expect too
much philosophy behind this. The reasons might be merely economical. Give less
medication unless necessarily needed, save costs. But what about the longer
time courses of disease? The missed days of work?
As a simplification, let’s look at some
statistics: According to the OECD report
”Health at a Glance 2011”4 the Netherlands has the second
highest health expenditure in relation to GDP (following the US) of OECD member
countries, which is roughly synonymous with the Western World. When looking at
expenditure on pharmaceuticals per capita as a share of GDP, it scores a lot
lower, 17th place out of 32 OECD member countries. While generally giving less
than average medication, the Netherlands is the country of the Western world
distributing the least amount of antibiotics, half of average. There seems to
be a commission just dedicated to the decrease of usage, which in general seems
legitimate – as long as people don’t start hesitating to use them when there
really is a need for them.
So apparently, there is a difference in
allocation of health care spending in the Netherlands compared to other
countries, with less spent on medication. Then what do they spend it on? They
score average for all measures I could find, such as doctors consultations per
capita and length of stay in hospitals.5
Final outcomes: In life expectancy at age 65,
it only scores 19th, and 10th (out of 32 countries each) in population aged 65
years and over reporting to be in good health, according to the same report.
OECD’s ”Society at a glance”6 from
2006 places the Netherlands slightly above average for work days lost to
sickness and disability.
Thus, there seems to be a lot of spending with
moderately satisfying outcomes. And some frustrated expats!
References
1 „Dutch Health Care System“ by Bronovo
Hospital, Den Haag. (http://www.bronovo.nl/NR/rdonlyres/9C846A53-22AD-40BB-9B92-E9242A123053/0/dutch_health_care_apr2011.pdf)
² Maternity Care in
the Netherlands: The Changing Home Birth Rate. Wiegers et al, 1998. BIRTH 25:3.
³ http://stuffdutchpeoplelike.com/2011/03/06/hagelslag/
4 OECD: Health at a glance
http://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2011_health_glance-2011-en
5 Interesting detail: The report also states that approx. 66% of adult
females are screened for cervical cancer (pap test), so I guess the person of
the guide mentioned above prided the Netherlands a bit too much on
non-interventionalism.
6 OECD. Society at a glance
http://www.oecd-ilibrary.org/social-issues-migration-health/society-at-a-glance-2006_soc_glance-2006-en
