Dutch health system retains ‘Best in Europe’ crown


The Netherlands has the best healthcare system in Europe, according to the annual Euro Consumer Index. Dutch healthcare was top of the list for the second year running, this time with an even bigger margin of victory.

In second place was Denmark, which performed strongest in providing patients with access to information and enforcing patient rights, but lost marks for having longer waiting times. While Sweden fared best in the analysis of health outcomes, its e-health investment was weaker. The Netherlands’ performance was broadly strong in all categories. 

Arne Bjornberg, research director at Health Consumer Powerhouse, said the league table serves as “a reality check” for governments who can use the data to benchmark their healthcare against Europe’s best-performing health systems. 

He said the success of the Dutch system can be attributed partly to its funding model. “The top end of the scoreboard is dominated by countries where the financing of hospitals and the operation of hospitals are separated. In the Netherlands’ system, decision-making power is taken from amateurs and given to professionals who work with patients,” he said. 

Bjornberg was critical of countries which require patients to visit family doctors before accessing specialist health services. He said using family doctors as “gatekeepers” leads to longer waiting times and does nothing to reduce costs. “We don’t believe in forcing people to access care only through their family doctors,” said Bjornberg, who advocates greater patient choice based on easily accessible information on which hospitals perform best. 

Patient choice improves outcomes 

He said there are still only three countries – Germany, Denmark and the UK – where the public can go online and compare outcomes at hospitals. Patients may soon be able to travel across European borders for treatment, in line with a new directive on patient mobility. This option, said Bjornberg, will only be availed of by between 3% and 5% of patients. 

However, he said it was important to have access to data showing which hospitals were best for particular operations. “For example, once Croatia joins the EU it could become a destination for health tourism because it’s relatively inexpensive and has a record of good results,” according to the researcher, who added that there are “no reasons for restrictions on cross-border care”. 

“Patient mobility seems to scare healthcare administrators but that’s because they are control freaks,” he said. 

According to the research, healthcare in Europe is getting better every year. However, Bjornberg notes that in several countries, such as Ireland, Spain and Greece, public perceptions of the health services are poor, despite the systems scoring better year after year. 

“These three countries seem to have domestic ‘marketing problems’ for their healthcare services,” the report notes. 

E-health investment disappointing 

Bjornberg said Europe’s performance in e-health is “disappointing” with just seven out of 33 countries scoring well. He said the health industry is a long way behind other sectors in using technology to generate efficiencies. 

Highlighting his own experience as a hospital manager, Bjornberg was also critical of the general standard of management in the health sector, pointing to the success of IKEA and Ryanair in providing efficient services to a huge cohort of customers. 

“I wouldn’t mind if Ryanair ran health care. They have have the newest planes and get you there on time. You might want better food, perhaps.” 

Johan Hjertqvist, president of Health Consumer Powerhouse, said transparency will become a major issue as borders between national health systems dissolve. 

"With patient mobility growing around Europe, there is a strong need for transparency exposing the pros and cons of the national healthcare systems. The EU intends to introduce a cross-border care scheme which requires significantly better information to patients. This year's measurement indicates that forward-looking governments start using healthcare information and choice to engage patients in the decision-making, building a pressure from below for improvement," he said.

The annual Euro Health Consumer Index compares health services in 33 European countries based on patient rights, e-health, waiting times, outcomes, range of services offered, and access to medicines. 

Last year, the Netherlands edged out Denmark to take the title of Europe's best healthcare system (EURACTIV 14/11/08), while Austria came out on top in 2007 (EURACTIV 1/10/07). 

Greater information sharing and patient choice have been highlighted by proponents of cross-border healthcare in Europe. The European Parliament passed a directive in April which paves the way for greater patient mobility (EURACTIV 24/4/09

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