Exploring different healthcare systems

In the Netherlands patients are not allowed to leave hospital without health insurance, in Denmark, you can only attend hospital by referral from a GP or the out-of-hours service, while in Finland an average of 88% of people claim to be satisfied with their health service, compared with the EU average of 41.3%. Maureen Browne reports.

However, it emerged that health services in the Netherlands, Denmark, and Finland share common problems with Ireland, when healthcare professionals from the three countries, visited Ireland recently as part of the HOPE Exchange Programme.

There is concern in each of the countries over the escalating cost of healthcare, the increasing number of older people, the increasing burden of chronic illness and the cost of effective new medications.

The health services in the Netherlands, which has a population of over 16.4 million, are financed by compulsory health insurance schemes, with the state subsidising premia for low income people. Multiple private health insurers compete for insured persons and health insurance is part of employee packages. Health insurers can negotiate to a certain extent with health care providers on price, volume and quality of care; and are allowed to make a profit and pay dividends to shareholders. They are obliged to accept new applicants and they are not allowed to differentiate their premium to take account of the risk profile of the applicants.

When GPs refer a patient to hospital they have to fill in a form detailing why they couldn’t provide the care themselves

Gatekeeping GPs are at the core of the Dutch system and it is considered they prevent unnecessary use of more expensive secondary care. GPs are encouraged to carry out as much care as possible and when GPs refer a patient to hospital they have to fill in a form detailing why they couldn’t provide the care themselves

Ilon Metaal, senior HR business partner at Spaarne Gasthuis, one of the largest hospitals in The Netherlands, who visited Ireland as part of the HOPE Exchange said that hospitals had no waiting lists for treatment. In ED they could wait up to six hours.

Insurance could cover care in public or private hospitals and was becoming more expensive because of very expensive medicine costs. She said hospitals were very expensive and she is concerned that the Netherlands spends a lot of time on care and too little on prevention. Patients can choose their own hospital.

Basic health premia for primary and acute care costs about €110 a month. People over the age of 18 must pay the fist €400 of their medical expenses. All the insurance companies put money into a fund for those who are not insured

Ilon said she envied the Irish nursing education system. In Holland nurses are educated to diploma level but this is now changing and by 2020 all nurses must have a bachelor degree which will be a challenge.

She came to Ireland because she was very interested in the organisation of the HSE because it is so large.

Finland has focused on health promotion including disease prevention, which has resulted in the eradication of certain communicable diseases and improvement in the health of population.

“We have had a great time and really appreciate the hospitality We have spoken to so many people and seen so many aspects of the health system. We have been in public hospitals private hospitals, community services and attended leadership & Masterclass courses.”

Denmark with a population of 5.7 million finances its health system through general taxation and healthcare is organised in such a way that responsibility for services provided lies within the lowest possible administrative level, usually the county councils. Denmark is divided into five regions and regions are funded by local and national taxation   Since 1970, most decisions regarding the form and content of health care activity have been made at county and municipal level.

Except in an emergency, patients need to be referred by their GP in order to receive specialist treatment in the hospital sector.

As well as treating patients, the hospital and primary care sectors also offer preventive treatment as well as conducting medical training and research

The Ministry of Health has a coordinating and supervisory role, but no operational responsibilities for health services. Denmark has just a few private hospitals, mainly for orthopaedic work and cosmetic enhancement.

Bodil Clemensen, Head Nurse at a hospital Emergency Department in Denmark, wanted to see Ireland and the Irish health service because she believed she could learn something from the way it is organised and run. She said that Denmark is having similar problems to Ireland – an increasing number of elderly people, more people with chronic illness and the increasingly expensive medication.

The goal is that all patients should have an examination or treatment within four weeks of referral by a GP, but this is not always possible. She said the country had very good cancer packages. If a GP thinks a patient may have cancer they should be seeing a consultant within one week.

If a patient needs a hip replacement and there is a long delay, the patient can go to a private hospital which will be paid for by the state.

In Denmark, you can only attend hospital by referral from a GP or the out of hours service. Ambulances take patients to the nearest hospital. If a patient suffers, say from a bad stroke or heart attack, a doctor will decide the hospital to which the patient will be taken.

Finland spends about €15.7 bn providing healthcare for its 5.4 million people. About 80% of funding is provided through general taxation and everybody is entitled to state healthcare regardless of their income.

Although the Ministry of Social Affairs and Health has the highest decision-making authority, the local governments are responsible for providing healthcare to their residents.

For years, Finland has focused on health promotion including disease prevention, which has resulted in the eradication of certain communicable diseases and improvement in the health of population.

The quality of service in Finnish healthcare is considered to be good; according to a survey published by the European Commission in 2000, Finland belongs to the top five countries who are most satisfied with their healthcare with an average of 88% of Finnish respondents satisfied compared with the EU average of 41.3%.

Merja Sankelo, Nursing Director of Education, Hospital District of South Ostrobothnia said it was up to patients to choose any hospital they wish and there are no waiting lists. If patients cannot get a public service they can go privately and the State will pay about 40% of the cost.

Finland has had electronic patient records for many years. It also uses and electronic prescriptions and new technologies in home care.

She said she had observed more overweight people in Ireland than in Finland.

Merja said she thinks it very important that the Irish Department of Health has a Chief Nursing Officer and she would like if Finland had a similar appointment.

In Finland postgraduate education is very well organised with education centres around the country providing free postgraduate professional education for health professionals.