Aside from
Those with higher incomes had the option of
ment in the public health sector must be
enrolling in the funds if they wished, or opting
approved at the ministry level. All hospital
Switzerland, the
out of the government system and purchasing
administrators and other health officials are
Netherlands has
private insurance. Sickness funds were
appointed on the basis of political affiliation
perhaps the most
financed through a payroll tax and a flat-rate,
with the governing party, often with little regard
for relevant training or other qualifications.204
per-capita premium.208
market-oriented
Not surprisingly, Greece has far less mod-
The funds provided a uniform package of
national health
ern health care technology than the United
benefits including physician and hospital
States. The United States has more than twice
care, specialist care, diagnostic tests, prescrip-
care system in
tion drugs, and dental care for children.209
as many MRI units per million people and 20
Europe.
percent more CT scanners.205 Much of the
While consumers could switch funds annual-
state-of-the-art equipment that does exist is
ly, there was little competition between funds
clustered in the country's small number of pri-
and few consumers actually switched.
vate clinics and hospitals. Indeed, the vast
The new Dutch system operates on the the-
majority of high technology biomedical tests
ory of managed competition like Switzerland
are performed by the private sector.206
(see below). Both the social health insurance
program and the alternative private health
One study summed up the problems with
insurance option were replaced by a require-
the Greek health care system this way:
ment that all Dutch citizens purchase a basic
health insurance plan from one of 41 private
The Greek health system does not yet
insurance companies. Although a fine may be
offer universal coverage and has frag-
imposed for failure to comply, there is no
mented funding and delivery. Funding is
comprehensive system for identifying citizens
regressive, with a reliance on informal
who do not meet the mandate. An estimated
payments, and there are inequities in
1.5 to 2 percent of the population is currently
access, supply and quality of services.
uninsured.210
Inefficiencies arise from an over reliance
on relatively expensive inputs, as evi-
The required plan, which covers mini-
denced by the oversupply of specialists
mum benefits set by the government,
and undersupply of nurses. Resource
includes general practitioner and specialist
allocation mechanisms are historical and
care, hospital stays, some dental care, prena-
political with no relation to performance
tal care, some medicines, and travel expenses.
or output; therefore providers have little
In one interesting innovation, most of the
incentive to improve productivity.207
required benefits are specified in terms of
"functions of care" rather than by provider
category. Thus, "rehabilitation care" is
That would appear to be a fairly accurate
required, but no particular type of rehabilita-
summary.
tion provider is mandated.211 This may mean
that the benefits package will be less suscep-
Netherlands
tible to manipulation by provider interest
groups, but it is much too early to tell.
The Health Ministry sets premiums, which
Aside from Switzerland, the Netherlands
average around €100 per month for an indi-
has perhaps the most market-oriented nation-
€
vidual. Insurance companies can offer varying
al health care system in Europe. That was the
deductibles, ranging from €150 to €€1,000 per
case even before 2006, when a series of reforms
€
year, allowing for a small level of price compe-
introduced even more market mechanisms.
tition. Policies can also offer rebates of up to
The old pre-2006 Dutch system resembled
€€225 if a policyholder uses no health services
Germany's. Dutch workers with incomes
below €32,600 were required to enroll in one of
in a given year beyond seeing a primary care
€
physician.212 About 90 percent of the popula-
30 government-controlled "sickness funds."
22