- The Washington Times - Tuesday, February 7, 2006

AMSTERDAM — State-sponsored universal health care has long been among Europe’s most cherished ideals, and the Netherlands has prided itself in having one of the Continent’s most generous systems.

Now, the Dutch government is implementing what might be considered a social heresy: a major health care overhaul that allows competition and slow price increases.

As Europe grapples with the high cost of caring for aging populations, the Dutch plan introduced Jan. 1 will be watched closely in London, Paris and especially Berlin, which is considering similar reforms under its new chancellor, Angela Merkel.

Although the initial changes are modest, they set the stage for further liberalization. Dutch doctors worry that in the long run insurers will have too much say over what treatments are covered for which patients.

Under the new system, a core package of basic medical treatments such as vaccinations, major surgeries and emergency treatments will remain covered by a state-funded universal insurance policy at a cost of about $105 per month, with extra subsidies for low-income households.

Additional treatments seen as non-vital, such as physical therapy, postnatal nursing at home and alternative medicine, will be available from insurers in supplementary, non-subsidized packages. So will dental care.

The fiercest debate and lobbying was over which treatments would be included in the basic package, with sometimes surprising results. For instance, birth-control pills are not covered, but sterilizations are.

Health insurers are obliged to sell everyone the basic package at a standard price, even high-risk patients who used to pay extra. Insurers must provide free coverage to children.

“Most people in the world would cry with joy to have this health insurance plan,” said Health Minister Hans Hoogervorst, the policy’s main architect.

He said the long-term goal is to expose each of the three pillars of the system — health care providers, patients and insurers — to some market forces.

The Netherlands will never follow the U.S. model of full liberalization, he said.

“A truly market-driven health care sector is not politically viable, nor is it desirable because it is such a unique market,” he said.

“Americans spend nearly as much taxpayers’ money as we do, in addition to large sums of private money. There is also the problem of the uninsured, and that is not an example one wants to follow,” he said.

The Netherlands spends about 10 percent of its budget on health care, trailing only Germany and France among major European countries. Costs for the average person have nearly quadrupled since 1998, and many people fear the new system will cost more and cover less.

To make the reforms politically palatable, the government has included most treatments in the basic package. Mr. Hoogervorst said his government won’t save any money in the short run, but the result will be the leanest health care package in Europe.


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