Guest Post: Healthcare in NL

So I've decided to get ambitious and possibly lazy and asked my friends if they would like to join in and write up their experiences moving abroad.  All of us do somewhat different things and come from different countries and perspectives and I thought it would be cool to share that with all of my readers.

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?)

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