Dutch MEP warns against introducing universal health insurance

A Dutch MEP has warned against the introduction in Ireland of a system of universal health insurance (UHI) similar to the model in place in her country.

Kartika Liotard says UHI in the Netherlands has led to rising costs and made many people "afraid to go to the doctor".

"Universal Health Insurance as it is available in Holland sounds good on paper but in practice things are not as rosy as they should be," according to Ms Liotard, a member of the United Left group in the European Parliament who is in Dublin this week at the invitation of Irish Socialist Party MEP Paul Murphy.

The Netherlands always had a good system of healthcare, but under the new model, quality and access have suffered, she says. “The simple fact is that ordinary healthcare is not accessible for many people anymore. It’s too expensive.”

Minister for Health James Reilly has promised equal access to care for all under his model of UHI, scheduled to begin in 2019. His officials have visited the Netherlands and Germany to study the systems in place there, though the Minister claims his system will follow a "distinctly Irish" model.

Basic package
In the Netherlands, the basic package of services costs about €1,200 a year, Ms Liotard points out. While children are covered free, once they are over 18 they have to start paying. In addition, people have to pay the first €360 of their spending on items such as medicines and physiotherapy each year.

The annual premium is collected through the tax system and although there is assistance for people on low incomes, everyone has to pay something, she says.

Under the Dutch system, the minister for health makes decisions each year on what items should be included in the basic basket of services to be provided under UHI. This decision is made in consultation with stakeholders such as patients, healthcare professionals and health insurers. Ms Liotard claims the involvement of “profit-driven” health insurers in the process has resulted in the basket of services becoming “emptier and emptier”.

Complementary insurance
People wanting cover for services not included in the basic basket – such as dental treatment, physiotherapy or reproductive services – can take out their own complementary insurance but often at exorbitant prices, she says. Older people, in particular, can face high loadings on their premiums while others with pre-existing conditions may be unable to obtain cover.

Privatisation
"The privatisation of insurance has led to the privatisation of healthcare," Ms Liotard argues, with too much power in the hands of health insurers.

“So if you have a problem with your knee and you live in the south of the Netherlands, you might have to travel up to the north of the country for the operation because of restrictions imposed by your insurer. There may be a place nearer home where you can get the operation but you’ll have to pay extra to have it done there.”