Why can’t we be like those guys?
Why are our health and education systems inferior to those of other European countries? Because theirs are the products of decades-long planning
Dutch healthcare: a doctor and patient at the Dutch Royal Philips Electronics Hospital, in Eindhoven. Photograph: Lex Van Lieshout/AFP/Getty
Finnish prisons: inmates in the yard at Helsinki jail. Finland has slashed its prison population. Photograph: Yoray Liberman/Getty
Danish jobseekers: people search for work at a job centre in Copenhagen. Photograph: Esben Salling/AFP/Getty
Finnish education: primary pupils in Finland, which has the best school results in Europe. Photograph: Olivier Morin/AFP/Getty
How they do it in the Netherlands
The Netherlands has overhauled its healthcare system in recent years and achieved many of the goals health campaigners cherish: reasonably affordable healthcare, quality services and equitable access.
It’s not without its flaws, though. Under the Dutch system insurance firms buy care on behalf of their customers from hospitals and other care providers. Premiums, which are mandatory, are typically about €1,200 a year for adults; people on low incomes receive subsidies to help them pay their insurance.
To ensure compliance with both the spirit and the letter of the law, the system is tightly regulated by NZa, the powerful Dutch state health regulator. Cherrypicking the healthiest applicants – or, conversely, charging applicants more on the basis of age or medical condition – is prohibited.
In Ireland marketers have found ways around cherrypicking rules, such as by marketing to younger people, but the government in the Netherlands has put in place a number of safeguards.
For example, it audits each company’s enrolment plans and activities every year, and a central fund subsidises insurance companies that end up insuring higher-risk groups. This fund is financed through a mix of member and government contributions.
Why can’t we do it here?
Fine Gael cited the Dutch healthcare model as the inspiration for its policy of moving towards universal health insurance. If it were implemented, it would help narrow the two-tier nature of the health services here.
But there are some big obstacles. If the system were rolled out here, anyone who didn’t have health insurance and wasn’t eligible for a medical card would face paying hefty premiums. Against a backdrop of shrinking personal incomes, it would likely meet major opposition from voters. Implementation of a Dutch system would, according to the Irish Congress of Trade Unions, lead to more smaller hospitals closing. It would also require a big emphasis on patient information and top-class IT systems, which are sorely lacking here.
In addition, moving towards this kind of model would mean the political system would not have a role in the day-to-day running of the health system. A strong regulator would be required to ensure the interests of the public were protected.
It’s also not clear yet how expensive it would be. Latest figures indicate the Dutch system costs about 10 per cent of GDP, compared with about 7.6 per cent in Ireland. (When figures are adjusted, based on Ireland’s younger population, our system is slightly more expensive than the Dutch one.)
How they do it in Finland
Forty years ago Finland had a rigid prison model, inherited from neighbouring Russia, and one of the highest rates of imprisonment in Europe. But academics provoked a rethink of penal policy, with their argument that it ought to reflect the region’s liberal values.
Today Finland jails fewer of its citizens than any other European Union state; tens of thousands of Finns have been spared prison; the taxpayer has saved tens, if not hundreds, of millions of euro; and its crime rate is also among the lowest in the EU.
The country’s jails include a mix of “open” and “closed” prisons – although sometimes it can be difficult to tell the difference. In many closed prisons, high walls have been removed in favour of CCTV and electronic alerts. Neither are there heavy metal gates and gloomy cells. Instead, living spaces for inmates resemble college dormitory rooms.
So why does it work? Academics say the basis of its penal system is rehabilitation rather than retribution. In addition, experts point out that the kinds of economic and social disparities that can produce violence in other countries are far less prevalent in Finland’s welfare-state society. Street crime is low, and law-enforcement officials can count on support from an uncynical public.