“The Netherlands healthcare is ‘a chaos system’, meaning patients have a great degree of freedom from where to buy their health insurance, to where they get their healthcare service. But the difference between the Netherlands and other countries is that the chaos is managed. Healthcare decisions are being made in a dialogue between the patients and healthcare professionals.”
If you’re interested in healthcare models relative to capitalism, this post is for you. Long personal account first. Analysis second.
For the past month, like our October two years ago in Arnhem, we’ve been dealing with health issues of the everyday (but nevertheless difficult) variety.
Round 1: Michael came down with a case of strep throat. He discovered in the process that there is no test for strep throat here – neither the instant nor the overnight-culture variety. When he went to the emergency clinic over the weekend, they refused him antibiotics (for all of the reasons that antibiotics are bad for you and for the population at large), with the lukewarm reassurance that he would turn a corner in 5-7 days. While the fever was gone by the one-week mark, the glass-in-throat feeling of strep stayed with him a solid 2.5 weeks.
Round 2: Midway through this, I was struck by strep. Having heard that I’d need to exaggerate my symptoms to in order to get antibiotics, I went to the doc prepared to play it big. No need: Between the high fever, pockmarked throat, and full-body rash, I was in and out of our huisartspraktijk (GP) with antibiotics in hand – no exaggeration necessary – within 10 minutes.
Round 3: But then, a week later, on the way to Puerto Rico for a conference, my strep came back again, strong. The doctor at the hotel prescribed a super dose of antibiotics, plus steroids for the swollen throat.
When later I showed our Dutch doctor what the American doc had prescribed, her eyebrows shot up to her hairline: “That’s the strongest possible antibiotic at the highest dose that we can legally prescribe in Holland.”
At the height of our glass-in-throat time, Michael found an over-the-counter strep test that you can buy in the US. While back in the States, I ordered a 25-pack delivered to the hotel and carried it across the ocean with me.
Round 4: Then the big boy woke up with his own glass-in-throat-o-rama. Knowing that the fever and vomiting were probably next, we gave him the strep test and got an almost instant positive. He rode to the doc’s office on the back of my bike, slumped against me.
At the doc, I pulled out the strep test almost triumphantly. Subtext: “Aha! Take that! You think we should wait for antibiotics because maybe it’s a virus! But I’m his mother and I am telling you, you must treat him! Give me the drugs!” Without a trace of condescension, the Dutch doctor laughed and clapped her hands in delight. “What?! How cute!” she proclaimed. “Americans have a home test for streptococcus!”
When I pressed her on why the Dutch don’t have this most ubiquitous, baseline test, she cocked her head thoughtfully. “Really, knowing that it’s strep throat doesn’t change anything for us in terms of protocol,” she said. “We want your body to fight the infection. Antibiotics are bad for everyone individually and for all of us. If you don’t do anything, we know that you’ll feel better within 5-7 days. So unless you have a high fever, we let your body fight the infection.”
The same is true for chicken pox. There’s no vaccine here. When a child contracts chicken pox, the daycare workers post a sign so that everyone can go over to that child’s house for playdates – hoping for an infection, to build natural immunity and to get chicken pox out of the way early.
If you or your kids are sick, unlimited or extremely generous sick-leave policies (with days for adults and additional days for staying home with your sick kids) mean that you can stay home for 5-7 days or more when you need to. This is part of the whole work to live, don’t live to work philosophy.
In addition, school sick policies are beautifully lenient. Is your kid too sick to go to school? Well then, keep them home. Subtext: Use your common sense, do you need a spelled-out policy for every single thing? If it’s just a regular old cold or low fever or earache or lice or something, send them to school anyway. Kids aren’t really going to avoid getting each other sick – that’s a fantasy. Let them build their immune systems.
And indeed, after the doc prescribed a minor antibiotic for Iver, much thanks to his fever + the positive strep test + my advocacy, she asked him cheerily, “So, headed back to school now?” She expected that he’d take a first dose and then get on with a normal day.
To recap, the Dutch healthcare philosophy is: Being allowed – or forced – to fight non-life-threatening infections without medication builds a tremendously strong immune system. In the meantime, while you ail, there is always the ever-present suggestion to “take a paracetamol” (acetaminophen).
In theory, this is awesome. In practice, it’s quite a difference for Americans. Most of us, including me, are used to being treated as healthcare consumers, who expect an answer or a fix or a program for everything that ails us (much thanks to Michael for pointing this out to me). We expect a diagnosis and results; then if we don’t like the answer, we seek second opinions.
Americans are used to coordinating complex webs of our own healthcare. In my demographic, that often means western allopathic care + complementary and alternative medicine + homeopathy and naturopathy. I’ve observed that Americans tend to either: 1) fully trust the medical system and give our care over to docs (as we did in both Michael’s and my first family), OR 2) we’re iconoclastic, mistrusting mainstream medicine and protocols, always after the DIY or alternative approach, in search of the proverbial holistic health. (As adults, Michael is more #1; I’m more #2. We got our healthcare there from amazing, holistic-inclined family and pediatric NPs. And we had two homebirths in the US, which probably puts us squarely in camp #2.)
By contrast, the Dutch do not treat people as healthcare consumers, but as citizens receiving healthcare: individual physiologies, yes, but members of a population. Dutch doctors are the frontline workers in a public-health-first system. They’re not unsympathetic to individuals, and they’re particularly great with kids. But they are not in the business of giving out medicine-on-demand; of making a profit for pharmaceutical companies; or taking orders from insurance companies. I don’t have the sense that they care if you switch providers because you don’t like the diagnosis. For many ailments, there’s not even a diagnosis or a fix or a program. There’s just good old-fashioned time, paracetamol, and come back again if this issue doesn’t resolve on its own.
In the Netherlands, health insurance is private (with a ton of choices), regulated, and mandatory. All of the basic elements, including mental healthcare, are always covered. All children are free; adults pay about $120 USD per month. Coverage is pretty much 100% with no deductibles. When Orri was admitted to the hospital two years ago, we walked out with $0 paid or owed. Same for every doc’s appointment, vaccination, and emergency care visit we’ve ever had.
And although insurance and practitioners operate privately (the capitalism part), the government and centralized regulatory bureaus ensure quality, mandate coverage, and keep costs and waiting times down. It’s not a perfect system, but it has been consistently rated the #1 or #2 healthcare system in Europe for the last 13 years, with the consistently lowest wait times, highest quality outcomes, greatest range and reach of services, and other metrics on the Euro Health Index.
So. Managed chaos. World-class medicine, but without the consumer choice. It can be maddening and painful if you’re used to meds-on-demand, and you definitely have to advocate for yourself and your kids. But the Dutch healthcare system is exactly the kind of institution that gives me hope that if we can’t stop capitalism, we can at least mitigate its profound cruelties (eg outrageous costs of pharmaceuticals and specialists; crushing medical debt that can follow a family for generations; etc.) via regulation and a strong social contract.
This chart on life expectancy against healthcare spend by year really says it all (gratis, Michael). The USA is the red line, and the Netherlands is in the upper middle. Let this sink in for a moment.
In other words: There IS a sane, sustainable, affordable, and humane approach to healthcare. The model exists and is proven. Healthcare consumers may have to give up some things: You don’t always get instant gratification or relief, and you have to agree to work within the system. You have to get the vaccinations – except in extreme cases, you don’t get to opt out of the public health protocols. But what you get in return for giving up some of your personal “rights” and access (which mostly only the wealthy can afford anyway) is something that serves everyone better, more evenly.
Though at times it’s personally hard to swallow (awful strep throat pun, anyone?), on the whole it feels like the way things should be.
Vacationland, Nederland 