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What the US could learn from the health care systems in EU

European health care is steadily improving according to a recent report. Infant mortality and survival rates of heart disease, stroke and cancer are all moving in the right direction. Patient choice and involvement are also developing. But still too many countries stick to inefficient ways to fund and deliver care services.

This is a main conclusion from the 2016 Euro Health Consumer Index (EHCI), published last Monday (30 January) by Health Consumer Powerhouse (HCP) Ltd. The company  aims at open comparisons of national healthcare systems performance as a tool to improve outcomes and to support patient empowerment.

According to the report, copying the most successful European healthcare systems would save money that could be invested in saving lives and improving performance.

The 2016 comparison includes 35 countries, among them all EU member states, and is based on a weighed score of 48 indicators measuring patient rights, access to health care, treatment results, range of health services, prevention and use of pharmaceuticals.  The information has been collected from a variety of sources, including surveys and feedback from national agencies.

The report admits that the results should be treated with some caution because of information quality problems. Intentionally some known indicators measuring public health status, such as life expectancy, lung cancer mortality, total heart disease mortality, and diabetes incidence, have been excluded.

According to the report such indicators tend to be primarily dependent on lifestyle or environmental factors rather than healthcare system performance.

However, the report is apparently the only available comparison in the health care area and draws the attention to important issues from a consumer/patient perspective, such as waiting times for operations, access to specialists and under-the-table payment (bribes to doctors).

The European Commission has also been trying with the cooperation of the member states to produce something similar but so far with no success because it requires the agreement of all countries. Health care is not regulated in the EU but is indirectly affected by a number of EU interventions in public health.

Contrary to popular belief, the report concludes that direct access to specialist care does not generate access problems by the increased demand; repeatedly, waiting times for specialist care are found predominately in systems requiring referral from primary care.

The report also ranks the countries by cost efficiency. Some countries provide very good healthcare in relation to the cost. However, the report states that there is no correlation between accessibility to health care and money spent for the simple reason that it is cheaper to run a healthcare system without waiting lists.

For the first time two countries – the Netherlands and Switzerland – receive more than 900 points out of a maximum of 1000 points. This means that they are coming close to meeting all the criteria for good and consumer friendly healthcare. A notch behind are Norway (865), Belgium (860), Iceland (854), Luxembourg (851), Germany (849) and Finland (842).

Health care in The Netherlands

The Netherlands is the only country which has consistently been among the top three in the total ranking of the European Index the Health Consumer published since 2005. According to the report, the Dutch healthcare system does not seem to have any really weak spots.

The Dutch system is characterized by a multitude of health insurance providers acting in competition, and being separate from caregivers/hospitals. Also, The Netherlands has probably the best and most structured arrangement for patient organisation participation in healthcare decision and policymaking in Europe.

The Dutch healthcare system has addressed one of its few traditional weak spots, accessibility, by setting up 160 primary care centers which have open surgeries 24 hours a day, 7 days a week. Given the small size of the country, this should put an open clinic within easy reach for anybody, according to the report.

Swedish Professor Arne Björnberg, the author of the report, is not satisfied with the situation in his home country. The Swedish score for technically excellent healthcare services is dragged down by access/waiting time problems. In 2016, Sweden dropped back to 12th place with 786 points, which were enough for 10th place a year ago.

“Sweden, together with Romania, are the only two countries without any upwards trend during the last 10 years in the score of the total index,” says Björnberg to The Brussels Times. “They haven’t become worse – other countries have simply passed them.”

In spite of a general improvement among all national health systems, the gap remains between the top performers (in Northwestern Europe plus Switzerland) and the least developed ones (in former Central and Eastern Europe and Southeastern Europe).  The only exception from this pattern is Macedonia, which more or less has eliminated waiting times by electronic booking of appointments.

The Brussels Times asked Professor Arne Björnberg if the US where the new administration intends to “repeal and replace Obamacare”, could learn from the European health care systems as measured in the report.

“The problem in the US is that the only other health care systems they know about are the British and Canadian ones, which aren’t the best examples,” he replies. “They could learn a lot from e.g. the German and Dutch systems.”

Obamacare extended health care coverage to millions of Americans which now may lose their health insurance. The report does not include a measure on coverage in Europe. Instead the “equity of health care” was measured by the public share (%) of total health care costs – a figure that is above 45 % in all countries and reaches almost 80 % in some countries.

The Brussels Times (Source: Euro Health Consumer Index 2016)