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Comparing US and Dutch Healthcare Systems
- 1. Health System Comparison { United States ~ Netherlands Kristin S. Martin ~ November 2013
- 2. To make a general comparison on key factors of health care expenditure by country and a detailed comparison of the further statutory U.S. health care program (Affordable Care Act) to the Netherlands universal health care system; specifically what is covered in each system. Objective
- 3. Due to the current transition the United States is experiencing to further move under to the regulations and mandates within the Affordable Care Act I wanted to compare current U.S. data and details of the Affordable Care Act to another country that currently has a health care program with significant governmental oversight, seemingly positive outcomes and similar socioeconomic comparisons to the United States. The country I selected to compare to: the Netherlands. Introduction
- 4. { Medicare, Medicaid, Employer and Private Insurance United States of America
- 5. The United States health care program has been mainly private insurance through an employer or self-purchased and also segregated coverage for those age 65 and over (Medicare) and those with qualifying low income (Medicaid). These programs left approximately 16% of the U.S. population uninsured. In 2010 the Affordable Care Act was signed into law with phased implementation over a series of years. Currently we are experiencing the implementation of the law that expands coverage to a greater percentage of the U.S. population and increases mandated preventative coverage. Introduction ~ United States
- 6. { Statutory health insurance Video: Dutch Health Care System Netherlands
- 7. Within the last decade the Netherlands transitioned to a statutory health insurance system based on government mandates and regulations that requires coverage for all residents, documented workers and foreign students. Leaving approximately 2,000 undocumented workers and visitors without coverage. Although, voluntary and private funds are available to cover that small population. The government intentionally left the acquisition and administration of insurance to the private sector with the expectation that competition among the insurers would result in a better outcome for the individual. Introduction ~ Netherlands
- 8. { United States Prior to the implementation of the Affordable Care Act health care insurance availability through employers, private insurers and Medicare and Medicaid programs for qualified individuals. Gaps in coverage exist where individuals are either not covered due to lack of qualification or by choice. Under the Affordable Care Act everyone is legally obligated to obtain health insurance. Medicare and Medicaid programs continue. Medicaid broadens qualifications to cover additional individuals. Basic medical care is offered through private insurers per federal mandates and regulations. Penalties for non-participation will be phased with a yearly penalty increase over the next three years for non-participants. 2014 ~ $95/adult or 1% of family income 2016~$325/adult or 2% of family income 2016~$695/adult or 2.5% of family income { Netherlands Under the Dutch Health Insurance Act everyone is legally obligated to obtain health care insurance. Basic medical care, as defined by the law, is covered by national health insurance. Penalties for non-participation are incurred monthly at 130% of the nominal premium. Insurance is acquired by the consumer directly with private insurers. Supplemental private insurance is available to cover additional health care costs not covered under national health insurance. Penalty fee is whichever is greater Supplemental private insurance is available to cover additional health care costs not covered under under the law. High-Level Comparison
- 9. Netherlands Gross national income per capita (2012 US $) 50,120 48,250 Total expenditure on health per capita (2011 US $) 8,608 5,122 Per capita gov’t expenditure on health (2011 US $) 3,954 4,388 General government expenditure on health as a % of total government expenditure 19.8 20.6 20.9 35.5 Life expectancy – male 76 79 Life expectancy – female 81 83 Out-of-pocket expenditure as a % of private expenditure on health Statistics United States
- 10. United States { What Is Covered Under the Affordable Care Act
- 11. { 15 Covered Preventative Services for Adults Under the Affordable Care Act Abdominal Aortic Aneurysm ~ one-time screening for men of specified ages who have ever smoked Alcohol Misuse ~ screening and counseling Aspirin ~ for men and women of certain ages Blood Pressure ~ screening for all adults Cholesterol ~ screening for adults of certain ages or at higher risk Depression ~ screening for adults Type 2 Diabetes ~ screening for adults with high blood pressure Diet ~ counseling for adults at higher risk for chronic disease HIV ~ screening for all adults at higher risk Immunization ~ vaccines for adults Obesity ~ screening and counseling for all adults Sexually Transmitted Infection ~ prevention counseling for adults at higher risk Tobacco Use ~ screening for all adults and cessation interventions for tobacco users Syphilis ~ screening for all adults at higher risk { 22 Covered Preventative Services for Women BRCA ~ counseling about genetic testing for women at higher risk Breast Cancer Mammography ~ screenings every 1 to 2 years for women over 40 Breast Cancer Chemoprevention ~ counseling for women at higher risk Cervical Cancer ~ screening for sexually active women Chlamydia Infection ~ screening for younger women and other women at higher risk Contraception ~ Food and Drug Administration approved contraception methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs Domestic and interpersonal violence ~ screening and counseling Gonorrhea ~ screening for all women at higher risk HIV ~ screening and counseling for sexually active women HPV DNA Test ~ every three years for women who are 30 years old and have normal cytology results Osteoporosis Rh Incompatibility Sexually Transmitted Infections ~ counseling for sexually active women Syphilis ~ screening for women at increased risk Well-women visits ~ to obtain preventative services
- 12. { { Women ~ Pregnancy Pregnancy ~ Women Anemia ~ screening on a routine basis Bacteriuria ~ urinary tract or other infection screening Breastfeeding ~ comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women Folic Acid ~ supplements for women who may become pregnant Gestational Diabetes ~ screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes Hepatitis B ~ screening at first prenatal visit Tobacco Use ~ expanded counseling for pregnant tobacco users { 26 Covered Preventative Services for Children 26 Covered Preventative Services for Children cont’d 26 Covered Preventative Services for Children Alcohol and Drug Use ~ assessments Autism ~ screening at 18 & 24 months Behavioral ~ assessments Blood Pressure Screening Cervical Dysplasia ~ screening for sexually active females Congenital Hypothyroidism ~ newborn screening Depression Screening Developmental ~ screening under 3 years of age, and surveillance throughout childhood Dyslipidemia ~ screening for children at higher risk of lipid disorders Fluoride Chemoprevention ~ supplements for children without fluoride in their water source Gonorrhea ~ preventative medication for all newborns Hearing ~ newborn screening Height, Weight and Body Mass Index measurements Hemotocrit or Hemoglobin screening Hemoglobinopathies ~ newborn screening HIV ~ screening for adolescents at higher risk Immunizations Iron ~ supplements for children 6-12 months at risk for anemia Lead ~ screening for children at risk of exposure Medical History ~ throughout development Obesity ~ screening and counseling Oral Health ~ risk assessment ages 0-10 PKU ~ newborn screening Sexually Transmitted Infections ~ prevention counseling and screening for adolescents at higher risk Tuberbulin ~ testing for children at higher risk Vision screening
- 13. Netherlands { What Is Covered
- 14. { Standard Package ~ All Medical care ~ general practitioners, specialists, obstetricians and midwives Hospital admissions and treatments Approved medications Maternity care Postnatal care Limited physiotherapy, exercise therapy, speech therapy, occupational therapy, and dietary advice Smoking cessation Assistive medical devices Patient transport ~ ambulances and transport of seated patients Medical care outside of Netherlands ~ emergency services Dental ~ up to 18 years old { Supplemental Insurance Additional insurance can be purchased to cover such items as: Additional physiotherapy treatments Sport-medical care Extended coverage if traveling outside of the country Extended coverage for glasses or contacts Dental ~ over 18 years old Orthodontic care
- 15. Conclusion { What are the major differences?
- 16. The governments of U.S. and the Netherlands spend on health is very similar as a percentage of total government expenditure, 19.8% and 20.6% respectively. There is significant disparity in the amount of total expenditure on health per capita; the United States is spending nearly 65% more per capita and falls behind on life expectancy for both males and females to the Netherlands. Standard health care in the Netherlands is broader-based coverage that goes beyond the preventative coverage under the U.S. Affordable Care Act. The Netherlands health care includes items such as all visits beyond preventative to general practitioners, specialists, obstetricians and midwives, dental for individuals 18 and younger, and more. Individual out-of-pocket expenditures as a percentage of private health expenditures is higher in the Netherlands at 35.5% where the U.S. is at 20.9% (2011 data). Conclusion
- 17. Slide 5: International Profiles of Health Care Systems, 2013. Table 1-Health Care System Financing and Coverage in Fourteen Countries. Page 6. The Commonwealth Fund. http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2013/Nov/1717_Thomson_intl_profiles_hlt_care_ sys_2013_v2.pdf. Slide 6: Video. The costs and benefits of Dutch health care. Dutch Government. November 17, 2010. Slide 7: International Profiles of Health Care Systems, 2013. The Danish Health Care System, 2013. Vrangbaek, Karsten. University of Copenhagen. Page 28-36. The Commonwealth Fund. http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2013/Nov/1717_Thomson_intl_profiles_hlt_care_ sys_2013_v2.pdf. Slide 8: The Requirement to Buy Coverage Under the Affordable Care Act. http://kaiserfamilyfoundation.files.wordpress.com/2013/04/requirement_flowchart_3.pdf. ZilverenKruis. National Health Insurance 2013. Financial Penalty. Page 6. December 24, 2012. http://www.zilverenkruis.nl/english/downloadlijst/forms%20and%20brochures/Brochures/Information-for-Impats.pdf. Slide 9: The World Bank. Data. United States. GNI per capita, Atlas method (current US$). 2012. http://data.worldbank.org/country/unitedstates. The World Bank. Data. Netherlands. GNI per capita, Atlas method (current US$). 2012. http://data.worldbank.org/country/netherlands. World Health Organization. Global Health Observatory Data Repository. European Region: Netherlands statistics summary (2002present). http://apps.who.int/gho/data/view.country.14600. World Health Organization. Global Health Observatory Data Repository. Region of the Americas: United States of America statistics summary (2002-present). http://apps.who.int/gho/data/node.country.country-USA?lang=en. Slides 11-12: HHS.gov/HealthCare. U.S. Department of Health & Human Services. Facts & Features. Fact Sheets. Preventative Services Covered Under the Affordable Care Act. http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html. Slide 14: Government of the Netherlands. Health Issues. Health Insurance. http://www.government.nl/issues/health-issues/healthinsurance. References