R. Grol, Quality Development in Health Care in the Netherlands, The Commonwealth Fund, March 2006.
While no nation can be deemed "the best" in terms of its health care system, the United States is consistently outperformed in such areas as the prevention of medical errors, the provision of timely care for all citizens, and coordination of care. The U.S., it would seem, could learn from models and best practices used in countries that have achieved these higher levels of performance. One such country is the Netherlands. In 2003, this nation of just over 16 million people spent 9.8 percent of its gross domestic product on health care, below the spending levels in Germany, France, and Canada and more than one-third less than the percentage spent in the United States (Table 1). Even under the constraints of this budget, the Netherlands has implemented a number of health sector reforms that have led to important quality improvements.
This report discusses several Dutch initiatives, including the establishment of a central focus on primary care; the reorganization of after-hours and emergency care; utilization of clinical guidelines, performance indicators, diagnostic treatment combinations; local collaboratives; and introduction of more stringent accreditation and evaluation procedures. The report identifies lessons that may help the United States further its goal of enhancing the performance of its health system.
|Table 1. Health Care Spending and Physician and Nurse Ratios, 2003|
|Health Expenditure as Percent of GDP||Total Expenditure on Health Care per Capita (USD PPP)||Public Expenditure on Health Care per Capita (USD PPP)||Private Expenditure on Health Care per Capita (USD PPP)||Physicians per 1,000 Population||Nurses per 1,000 Population|
|Note: PPP = Purchasing power parity—an estimate of the exchange rate required to equalize the purchasing power of different currencies, given the prices of goods and services in the countries concerned.
Source: Organization for Economic Cooperation and Development (OECD) Health Statistics 2005.
Features of the Dutch Health Care System