I saw that the Socialist Health Association were looking for blog posts on international health inequality, so I wrote this small piece on my experiences as a British expat living in The Netherlands.
“In the Netherlands’ system, decision-making power is taken from amateurs and given to professionals who work with patients” Arne Bjornberg, research director at Health Consumer Powerhouse
From a British perspective, it’s easy to equate the notion of ‘pay to play’ healthcare with the infamous American standards in the sector. Probably not a surprise, considering just a quick google search brings up a seemingly infinite abundance of American articles and media on the subject; most notably, Michael Moore’s disturbing 2007 documentary; Sicko.
But despite a prominent public health care lobby in the U.S, recent Government shut downs have proven how controversial any move to secure an egalitarian health care system still is in many parts of the world.
However, even more distressing is how much closer free market healthcare is to us in Britain than we might think.
In 2004, The Netherlands passed a landmark healthcare reform which was marked with a disquieting new feature; “individuele verantwoordelijkheid” (Individual responsibility). As economic liberalism is a staple facet of Dutch heritage, the reform was largely welcomed as a pragmatic response to national concern about the adverse affects that an ageing population might have on the Dutch economy in coming years. However, while resounding as little more than this (a distastefully laissez faire policy shift) examining the details of ‘Individual responsibility’ begins to expose the stark issues that the shift to free market healthcare realises.
Most considerably, the complication caused by profit-orientated insurance companies. Due to the towering demand for private healthcare packages (Anyone over 18 is legally obliged to have one) there is a large, convoluted market which thrives with numerous entities competing for the market share. Of course the obvious issue with such a system is that in order to undercut competitors, most insurance companies employ controversial tactics such as short term low rates (which rise exponentially over longer periods) and false or dishonest advertising such as ‘complete’ healthcare packages that don’t include basic requirements such as physiotherapy and dental care. Here, the concept of healthcare is transformed from the nobility of a civil right to the sordid manner of a mobile phone contract.
But perhaps even more serious is the public perception which is left in the aftermath of Government U-turns on healthcare. In the case of The Netherlands, collective perception toward healthcare tends to be confused between conflicting ideas about what healthcare is there for. On one side it represents the functioning, objective hand of unbiased medical aid, but on the other it is the Dutch epitome of cold, risk orientated, egotistical capitalism. The result is a kind of dialectical dilemma in which the public loathe their hospitals for representing a capital obsessed system which impoverishes them, but equally rely on them as a vital part of their society.
In practice, the sufferers of this system aren’t just the disconcerted public, but the hardworking individuals who work in the hospitals or clinics and, in the absence of anyone else to blame, take the brunt of the free market system from the disconcerted consumers of healthcare. Unlike the democratic accountability inherent in a state controlled facility, insurance companies are accountable to very little beyond their prerogative to increase profit making; A practice which undeniably involves giving less to the public and and taking more.
Looking at this example, the fear for the stability of the NHS is that the superficial signs of progress that often accompany the horsemen of the ‘free market apocalypse’ (Mostly promulgated by the knee-jerk EU reaction to economics: ‘see a market; liberalise it’) will capture the spirits of a Conservative Government which has already treated its moral backbone like an elastic band to make cuts in similar departments (Such as Education, Welfare and Pensions)
Leaving Cameron to administer the lethal injection to health equality in the U.K, first lulling us to sleep with sloganistic falsities promising the end of a ‘Soviet healthcare nightmare’ and then beginning the operation to strip away the country’s last great institution.
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3 Comments

  1. Excellent article, I can also give anecdotal experience of health care whilst living in Germany in 1968, A friend of mine was a nurse in a Bavarian private clinic, one evening she came home in a distressed state, I asked what the matter was and she said that the clinic had run out of money and she had to give seriously sick patients chalk tablets instead of what they needed. She also did not know at that time whether she would be paid at the end of the month.

    This is perfectly true and people had better wake up because it just might happen here.

  2. Brian Fisher says:

    Thank you, Oz. Very helpful. Can you give some examples of how this approach affects healthcare? Perhaps both from the point of view of the patient and from that of the professional?

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