The EU has a long experience with nationalized, single-payer¹ health systems. Do they really provide the best patent care and experience? A new pan-European study supports the idea that competition and patient involvement in medical decisions is most effective. The study shows that, once again, the drones who speak of the marvels of single-payer European health care systems don’t have a clue as to what they are talking about.

The latest report from the Brussels-based Health Consumer Powerhouse, titled Euro health Consumer Index 2009 (please note the link is to the full report in a pdf format), contains some interesting data relevant to the healthcare debate in the US. The study measured and ranked the quality of the user/patient experience within 33 European countries by looking at six factors: Patient rights and information, e-Health, Waiting times, Outcomes, Range/reach of services provided, and Pharmaceuticals. ²

What system scores the highest? The Netherlands. Why?

The NL is characterized by a multitude of health insurance providers acting in competition, and being separate from caregivers/hospitals. Also, the NL probably has the best and most structured arrangement for patient organisation participation in healthcare decision and policy making in Europe.

Here comes the speculation: one important net effect of the NL healthcare system structure would be that healthcare operative decisions are taken, to an unusually high degree, by medical professionals with patient co-participation. Financing agencies and healthcare amateurs such as politicians and bureaucrats seem farther removed from operative healthcare decisions in the NL than in almost any other European country. This could in itself be a major reason behind the NL landslide victory in the EHCI 2009.

The study compares, from a patient-centric perspective, the two primary health care funding models: Bismarck healthcare systems based on social insurance, with a multitude of insurance organizations that are independent of healthcare providers, and Beveridge systems, “where financing and provision are handled within one organisational system…such as the NHS of the UK, counties of Nordic states etc.”³ The report contains an interesting observation:

Looking at the results of the EHCI 2006 – 2009, it is very hard to avoid noticing that the top consists of dedicated Bismarck countries, with the small-population and therefore more easily managed Beveridge systems of the Nordic countries squeezing in. Large Beveridge systems seem to have difficulties at attaining really excellent levels of customer value.

Countries with Bismarck systems also performed better in “bang for the buck”, a metric computed by the authors in an attempt to measure health care spending efficiency.

Additionally, the study points out, to no surprise, that patient experience improves as national legislative attention is turned to providing information that enables patients to make smarter choices in consultation with their providers, regardless of GDP and funding resources:

…the way to the top of the Euro Health Consumer Index is not too difficult; the key measures are: choice, patients’ rights, accessibility, information/transparency, quality measurement – and some of these cost little to introduce.

The key factor seems to be the overall responsiveness of the national system, and the capability to implement strategic changes. Under external pressure, visible in the past few years, individual countries take very different measures to keep healthcare sustainable, ranging from deep systematic reforms to defensive restrictive measures on the level of provision and access. Apparently, some national healthcare systems experience a sort of inertia to any change.

Looking at the American health care debate, the conclusions seem clear: a single payer system with limited choice and a high degree of government control doesn’t provide the best patient experience. Ironically, health care reform in Europe is focused on increasing competition and reducing sclerotic bureaucracy – exactly the opposite of the longer-term outcome to be expected under the current round of US healthcare reform proposals.