The document compares the health care systems of the United States and Netherlands. It finds that while government health care expenditures as a percentage of total spending are similar between the two countries, total per capita health care expenditures are much higher in the US. The standard coverage provided in the Netherlands includes broader benefits like access to general practitioners and dental for those under 18, while out-of-pocket costs for individuals are higher as a percentage of private spending. Both countries require residents to have health insurance and penalize those who do not comply.

1. Health System Comparison
{
United States ~ Netherlands
Kristin S. Martin ~ November 2013

2. To make a general comparison on key factors of
health care expenditure by country and a detailed
comparison of the further statutory U.S. health
care program (Affordable Care Act) to the
Netherlands universal health care system;
specifically what is covered in each system.
Objective

3. Due to the current transition the United States is
experiencing to further move under to the
regulations and mandates within the Affordable
Care Act I wanted to compare current U.S. data
and details of the Affordable Care Act to another
country that currently has a health care program
with significant governmental oversight,
seemingly positive outcomes and similar
socioeconomic comparisons to the United States.
The country I selected to compare to: the
Netherlands.
Introduction

4. {
Medicare, Medicaid, Employer and Private Insurance
United States of America

5. The United States health care program has been
mainly private insurance through an employer or
self-purchased and also segregated coverage for
those age 65 and over (Medicare) and those with
qualifying low income (Medicaid). These
programs left approximately 16% of the U.S.
population uninsured.
In 2010 the Affordable Care Act was signed into
law with phased implementation over a series of
years. Currently we are experiencing the
implementation of the law that expands coverage
to a greater percentage of the U.S. population and
increases mandated preventative coverage.
Introduction ~ United States

6. {
Statutory health insurance
Video: Dutch Health Care System
Netherlands

7. Within the last decade the Netherlands transitioned to
a statutory health insurance system based on
government mandates and regulations that requires
coverage for all residents, documented workers and
foreign students. Leaving approximately 2,000
undocumented workers and visitors without coverage.
Although, voluntary and private funds are available to
cover that small population.
The government intentionally left the acquisition and
administration of insurance to the private sector with
the expectation that competition among the insurers
would result in a better outcome for the individual.
Introduction ~ Netherlands

8. {
United States
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Prior to the implementation of the Affordable
Care Act health care insurance availability
through employers, private insurers and
Medicare and Medicaid programs for
qualified individuals. Gaps in coverage exist
where individuals are either not covered due
to lack of qualification or by choice.
Under the Affordable Care Act everyone is
legally obligated to obtain health insurance.
Medicare and Medicaid programs continue.
Medicaid broadens qualifications to cover
additional individuals.
Basic medical care is offered through private
insurers per federal mandates and
regulations.
Penalties for non-participation will be
phased with a yearly penalty increase over
the next three years for non-participants.
 2014 ~ $95/adult or 1% of family income
 2016~$325/adult or 2% of family income
 2016~$695/adult or 2.5% of family income
{
Netherlands
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Under the Dutch Health Insurance Act
everyone is legally obligated to obtain health
care insurance.
Basic medical care, as defined by the law, is
covered by national health insurance.
Penalties for non-participation are incurred
monthly at 130% of the nominal premium.
Insurance is acquired by the consumer
directly with private insurers.
Supplemental private insurance is available
to cover additional health care costs not
covered under national health insurance.
Penalty fee is whichever is greater

Supplemental private insurance is available
to cover additional health care costs not
covered under under the law.
High-Level Comparison

9. Netherlands
Gross national income per capita
(2012 US $)
50,120
48,250
Total expenditure on health per
capita (2011 US $)
8,608
5,122
Per capita gov’t expenditure on
health (2011 US $)
3,954
4,388
General government expenditure
on health as a % of total
government expenditure
19.8
20.6
20.9
35.5
Life expectancy – male
76
79
Life expectancy – female
81
83
Out-of-pocket expenditure as a %
of private expenditure on health
Statistics
United States

10. United States
{
What Is Covered
Under the Affordable Care Act

11. {
15 Covered Preventative
Services for Adults
Under the Affordable Care Act
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Abdominal Aortic Aneurysm ~ one-time
screening for men of specified ages who have
ever smoked
Alcohol Misuse ~ screening and counseling
Aspirin ~ for men and women of certain ages
Blood Pressure ~ screening for all adults
Cholesterol ~ screening for adults of certain ages
or at higher risk
Depression ~ screening for adults
Type 2 Diabetes ~ screening for adults with high
blood pressure
Diet ~ counseling for adults at higher risk for
chronic disease
HIV ~ screening for all adults at higher risk
Immunization ~ vaccines for adults
Obesity ~ screening and counseling for all adults
Sexually Transmitted Infection ~ prevention
counseling for adults at higher risk
Tobacco Use ~ screening for all adults and
cessation interventions for tobacco users
Syphilis ~ screening for all adults at higher risk
{
22 Covered Preventative
Services for Women
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BRCA ~ counseling about genetic testing for
women at higher risk
Breast Cancer Mammography ~ screenings
every 1 to 2 years for women over 40
Breast Cancer Chemoprevention ~ counseling
for women at higher risk
Cervical Cancer ~ screening for sexually active
women
Chlamydia Infection ~ screening for younger
women and other women at higher risk
Contraception ~ Food and Drug Administration
approved contraception methods, sterilization
procedures, and patient education and
counseling, not including abortifacient drugs
Domestic and interpersonal violence ~ screening
and counseling
Gonorrhea ~ screening for all women at higher
risk
HIV ~ screening and counseling for sexually
active women
HPV DNA Test ~ every three years for women
who are 30 years old and have normal cytology
results
Osteoporosis
Rh Incompatibility
Sexually Transmitted Infections ~ counseling for
sexually active women
Syphilis ~ screening for women at increased risk
Well-women visits ~ to obtain preventative
services

12. {
{
Women ~ Pregnancy
Pregnancy ~ Women
 Anemia ~ screening on a routine basis
 Bacteriuria ~ urinary tract or other infection
screening
 Breastfeeding ~ comprehensive support and
counseling from trained providers, as well as
access to breastfeeding supplies, for pregnant and
nursing women
 Folic Acid ~ supplements for women who may
become pregnant
 Gestational Diabetes ~ screening for women 24 to
28 weeks pregnant and those at high risk of
developing gestational diabetes
 Hepatitis B ~ screening at first prenatal visit
 Tobacco Use ~ expanded counseling for pregnant
tobacco users
{
26 Covered Preventative
Services for Children
26 Covered Preventative Services for
Children cont’d
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26 Covered Preventative
Services for Children
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Alcohol and Drug Use ~ assessments
Autism ~ screening at 18 & 24 months
Behavioral ~ assessments
Blood Pressure Screening
Cervical Dysplasia ~ screening for sexually active
females
Congenital Hypothyroidism ~ newborn screening
Depression Screening
Developmental ~ screening under 3 years of age,
and surveillance throughout childhood
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Dyslipidemia ~ screening for children at higher
risk of lipid disorders
Fluoride Chemoprevention ~ supplements for
children without fluoride in their water source
Gonorrhea ~ preventative medication for all
newborns
Hearing ~ newborn screening
Height, Weight and Body Mass Index
measurements
Hemotocrit or Hemoglobin screening
Hemoglobinopathies ~ newborn screening
HIV ~ screening for adolescents at higher risk
Immunizations
Iron ~ supplements for children 6-12 months at
risk for anemia
Lead ~ screening for children at risk of exposure
Medical History ~ throughout development
Obesity ~ screening and counseling
Oral Health ~ risk assessment ages 0-10
PKU ~ newborn screening
Sexually Transmitted Infections ~ prevention
counseling and screening for adolescents at
higher risk
Tuberbulin ~ testing for children at higher risk
Vision screening

13. Netherlands
{ What Is Covered

14. {
Standard Package ~ All
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Medical care ~ general practitioners, specialists,
obstetricians and midwives
Hospital admissions and treatments
Approved medications
Maternity care
Postnatal care
Limited physiotherapy, exercise therapy, speech
therapy, occupational therapy, and dietary
advice
Smoking cessation
Assistive medical devices
Patient transport ~ ambulances and transport of
seated patients
Medical care outside of Netherlands ~
emergency services
Dental ~ up to 18 years old
{
Supplemental Insurance
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Additional insurance can be purchased to cover
such items as:
Additional physiotherapy treatments
Sport-medical care
Extended coverage if traveling outside of the
country
Extended coverage for glasses or contacts
Dental ~ over 18 years old
Orthodontic care

15. Conclusion
{
What are the major differences?

16. 
The governments of U.S. and the Netherlands spend on health is
very similar as a percentage of total government expenditure,
19.8% and 20.6% respectively. There is significant disparity in the
amount of total expenditure on health per capita; the United States
is spending nearly 65% more per capita and falls behind on life
expectancy for both males and females to the Netherlands.

Standard health care in the Netherlands is broader-based coverage
that goes beyond the preventative coverage under the U.S.
Affordable Care Act. The Netherlands health care includes items
such as all visits beyond preventative to general practitioners,
specialists, obstetricians and midwives, dental for individuals 18
and younger, and more. Individual out-of-pocket expenditures as
a percentage of private health expenditures is higher in the
Netherlands at 35.5% where the U.S. is at 20.9% (2011 data).
Conclusion

17. Slide 5:
International Profiles of Health Care Systems, 2013. Table 1-Health Care System Financing and Coverage in Fourteen Countries.
Page 6. The Commonwealth Fund.
http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2013/Nov/1717_Thomson_intl_profiles_hlt_care_
sys_2013_v2.pdf.
Slide 6:
Video. The costs and benefits of Dutch health care. Dutch Government. November 17, 2010.
Slide 7:
International Profiles of Health Care Systems, 2013. The Danish Health Care System, 2013. Vrangbaek, Karsten. University of
Copenhagen. Page 28-36. The Commonwealth Fund.
http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2013/Nov/1717_Thomson_intl_profiles_hlt_care_
sys_2013_v2.pdf.
Slide 8:
The Requirement to Buy Coverage Under the Affordable Care Act.
http://kaiserfamilyfoundation.files.wordpress.com/2013/04/requirement_flowchart_3.pdf.
ZilverenKruis. National Health Insurance 2013. Financial Penalty. Page 6. December 24, 2012.
http://www.zilverenkruis.nl/english/downloadlijst/forms%20and%20brochures/Brochures/Information-for-Impats.pdf.
Slide 9:
The World Bank. Data. United States. GNI per capita, Atlas method (current US$). 2012. http://data.worldbank.org/country/unitedstates.
The World Bank. Data. Netherlands. GNI per capita, Atlas method (current US$). 2012.
http://data.worldbank.org/country/netherlands.
World Health Organization. Global Health Observatory Data Repository. European Region: Netherlands statistics summary (2002present). http://apps.who.int/gho/data/view.country.14600.
World Health Organization. Global Health Observatory Data Repository. Region of the Americas: United States of America
statistics summary (2002-present). http://apps.who.int/gho/data/node.country.country-USA?lang=en.
Slides 11-12:
HHS.gov/HealthCare. U.S. Department of Health & Human Services. Facts & Features. Fact Sheets. Preventative Services Covered
Under the Affordable Care Act. http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html.
Slide 14:
Government of the Netherlands. Health Issues. Health Insurance. http://www.government.nl/issues/health-issues/healthinsurance.
References