Americans down on the U.S. health-care system
Dutch rate theirs most favorably of 10 industrialized nations
By Kristen Gerencher
MarketWatch
July 13, 2008
SAN FRANCISCO (MarketWatch) — International comparisons of health-care systems can be tricky to tease out, but the Dutch appear most satisfied with their system and Americans the least satisfied, according to a new survey of 10 industrialized countries.
The Dutch system was most popular with its citizens while adults in the U.S. were itching for national reform the most, according to Harris Interactive, which cited three separate data sets.
A third of Americans said they believe the U.S. system “has so much wrong with it that we need to completely rebuild it,” while only 9% in the Netherlands hold such a sentiment about their health-care system. Twelve percent of Spaniards favored a complete overhaul, compared with 15% in France, 17% in New Zealand, 18% in Australia and 20% in Italy.
People in the Netherlands also were most likely to say their health-care system works well and needs only minor changes, with 42% holding that view vs. 29% who said so in France. About a quarter of participants in Canada, New Zealand and Australia were fairly satisfied with their health care. The U.S. and Italy were least likely to want minimal changes, with only 12% and 11% supporting just minor tweaks, respectively.
Americans are fed up with the headaches in their system, but that’s generally not due to the quality of care they receive, said Uwe Reinhardt, professor of economic and public affairs at Princeton University. Had the survey asked participants about their most recent hospital stay, for example, the U.S. likely would’ve scored higher, he said.
“What Americans are upset about is the unbelievable hassle of having to select health insurance, maybe not getting it … losing insurance when they lose their job,” Reinhardt said. “The American citizen is massively insecure.”
Doctors and nurses routinely hear demoralizing news that U.S. medicine is inferior “when the real problem is the way we finance health care and the hassle of claiming insurance,” he said.
Americans’ feelings about the U.S. health-care system have remained stable over the last decade, with roughly twice as many saying they want a complete overhaul compared with other nations, said Karen Davis, president of the Commonwealth Fund, a private foundation in New York that has tracked the issue.
What’s more, Americans’ personal share of medical expenses is the highest in the industrialized world, Davis said. In 2007, 30% of Americans reported having out-of-pocket medical expenses of more than $1,000 in the last year compared with 19% of Australians, 12% of Canadians, 10% of Germans and New Zealanders, 5% of Dutch and 4% of Britons.
Accounting for success
The Dutch financing system has been transitioning to a new model in the last year, where residents contribute payroll taxes into a central fund, Reinhardt said. Then they receive a voucher to buy coverage from nonprofit or for-profit private insurers.
Those polled as the change went into effect may have been reluctant to add any more reforms — even though the system functions pretty much the same way as before, he said.
“The system is so tightly regulated and so many transfers are made among people to make sure everyone can afford the insurance and everyone has access to the same care that it’s really just a social insurance system in disguise,” Reinhardt said. “It’s not even vaguely close to the U.S. system.”
Dutch health care also addresses patients’ need for medical attention during nonbusiness hours, Davis said. “The Netherlands has this amazing off-hours system of care so you can always get a nurse or doctor at night or in the evening.”
It’s not just Dutch patients who seem satisfied. In 2006, only 3% of physicians in the Netherlands said they thought their system needed a complete overhaul compared with 9% of U.K. doctors and 16% of doctors in the U.S, according to the Commonwealth Fund.
In some countries that have universal coverage, a sense of pride pervaded the participants’ answers, along with a smaller dose of concern about the systems’ sustainability. In Great Britain, nearly 70% agreed that the National Health Service must be maintained because it’s “crucial” to British society, according to the Harris Interactive survey. But 24% called it a “great enterprise” that probably can’t be maintained in its current form.
Contemplating trade-offs
Majorities in France (70%) and Britain (59%) said their health systems are the envy of the world. Still, nearly as many in France as in the U.S. said fundamental changes are needed to make the system work better. Half of American adults said so compared with 47% of French adults.
Victor Rodwin, professor of health policy and management at New York University’s Wagner School of Public Service, said the French and Danish have among the highest satisfaction rates in European polls of health-system perceptions.
“The French tend to defend their system because they look across the channel and see the British system of rationing and they say that’s not for them,” he said. “They look across the Atlantic and see the U.S. number of uninsured and high prices and say that’s not for them.”
At the same time, some French physicians complain that they’re underpaid and that the system is weighed down by wasteful spending and a lack of responsiveness to consumer preferences, Rodwin said.
In France, people automatically receive a standard, generous insurance benefit that includes prescription drug coverage, he said. They have no deductibles but small copayments. The system is financed largely through taxes.
“What makes France unique is there’s such good access not only to primary care, which you also get in Britain, but also to specialty care,” Rodwin said. “And there’s a high premium on patient choice.”
To be sure, France has one of the most expensive health-care systems in Europe, with expenditures totaling about 11% of its gross domestic product. The U.S. spends 16% of its GDP on health care. Cost containment has been an issue in France for the last 20 years, but unlike the U.S., lawmakers there aren’t talking about national health reform, Godwin said.
Still, cost concerns are growing, he said. “There is an increasing realization that this cannot last forever. There’s constantly new technology and pressure to cover all this and deliver it to the entire population.”
Harris Interactive tapped three sources for its findings. The data for France, Italy, Spain and Germany come from an FT/Harris Poll conducted in June 2008 for the Financial Times. The data for the U.S. and Great Britain come from a Harris Interactive survey conducted for the International Herald Tribune and France 24 in May 2008. The data for the Netherlands, Canada, New Zealand and Australia come from a Harris Interactive survey conducted for the Commonwealth Fund between March and May 2007.
Kristen Gerencher is a reporter for MarketWatch in San Francisco.