Medical Tuesday Blog

Comparing International Health Care Systems

Jan 9

Written by: Del Meyer
01/09/2018 1:31 PM 

Ray Suarez and a NewsHour reporting team traveled to the Netherlands in September to explore the country’s innovative universal health care system, which has gained attention as a potential model for U.S. health care reform.

Compare the health care systems in the Netherlands, Japan, the United States and its neighbors — Canada and Mexico– below and learn what experts had to say about each of the health care models. To be continued . . . 



All Netherlands residents are required to purchase health insurance, which is provided by private health insurers that compete for business. The insurers can be either for-profit or non-profit, but are tightly regulated by the federal government, and are required to accept every resident in their coverage area, regardless of preexisting conditions.

The current system was created through a 2006 health policy reform, prior to which the country had a social health insurance system and a separate private health insurance alternative, which no longer exist.

The government provides larger subsidies to insurers for participants who are sicker, elderly or have preexisting conditions. Tax credits are given to low income patients to help them purchase insurance. People under age 18 are insured at no cost.

Patients can choose among the available insurers, but often get their insurance through group plans administered by their employer. The Netherlands has a separate universal national social insurance program for long-term care, known as the AWBZ, or Exceptional Medical Expenses Act.


Legally required standard benefits for insurance in the Netherlands include general practitioners, hospitals, maternity care, lab tests and medicines. Insurers offer a choice of policies at a range of costs. In some of the plans, the insurer negotiates and contracts with the health provider, while more costly plans allow patients to choose their health provider, and be reimbursed by the insurer.

Most people also purchase additional private health insurance for services not covered, often from the insurer providing the basic coverage.


Government expenditure on health in the Netherlands made up 80 percent of health spending there in 2006, according to the World Health Organization. The required standard insurance is financed by a mixture of income-related contributions and flat premiums. The individual contribution is set at 6.5 percent of income, which is contributed by employers if the patient is enrolled through their job or by the patient if they are self-employed or unemployed.

The insured also pay a flat-rate premium to their insurer for a policy. Everyone with the same policy pays the same premium, and lower-income residents receive a healthcare allowance from the government to help make payments.

How the Netherlands compare:

“What makes it most interesting from a U.S. perspective is that it uses private insurers,” said Michael Borowitz, a senior health policy analyst at the Organisation for Economic Co-operation and Development in Paris.

“[Instead of Medicaid and Medicare] the public insurance part is actually covered through private insurance, through the government regulating private insurers,” he said.

Listen to Borowitz’s analysis:

He points to the Netherlands’ strong system of high quality general practitioners that act as gatekeepers to specialized care as a success in helping to keep costs down.

The Netherlands system also has a large degree of choice for consumers, said Francesca Colombo, also a senior health policy analyst at OECD.

“It does provide access for everybody, it does not leave people out of the system and it does achieve good outcomes in the end,” she said. However, both agree the system is new enough that the jury is still out on its long-term success.

Read the entire article from the WHO . . .

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