The Dutch healthcare system does not accomplish the fundamental goals of the WHO

Published in MEDISCH CONTACT 42 > “Dutch Healthcare Mediocre Performer in Modern Europe”

How does the Dutch healthcare system perform according to the framework from the WHO?

Framework WHO (2000) and Dashboard by @gijsvanloef

source: Framework

The WHO suggests three fundamental goals to be achieved by the Health System:  a. Improving Health, including improving the average health status and reducing health inequalities; b. Enhancing responsiveness to the expectations of the population, including respect for persons and client orientation; c. Fairness of financial contribution, i.e. every household pays a fair share of the total health bill and everyone is protected from financial risks. The measurement of performance relates goal attainment to the resources available.


figures @gijsvanloef, derived from: WHO (2000)

Performance of the Dutch healthcare system

Life expectancy improves, but medical performance is somewhat lagging compared to modern European countries – due to unrestrained commercial powers, albeit complex regulation – and social inequalities remain very large. Respect for persons is strained in different ways, although client orientation is good. Choice of provider is under attack and transparancy of medical markets is poor. Low income groups suffer increasingly from health costs, solidarity is under pressure. System costs are relatively high (partly due to elderly care), while overall quality is moderate. Overall, the Dutch healthcare system does not accomplish the fundamental goals of the WHO.

figures @gijsvanloef, derived from: OECD Health at a Glance 2007 – 2017

Published in Business Insider: Zo scoort het Nederlands zorgstelsel op 7 indicatoren

May 10th, 2018

This is a concluding blog based on 3 years of non-sponsored research done by the author of this website Gijs van Loef. Preceding blogs and publications on this website. In december 2017 a free webbinar was released “How Well Does The Dutch Healthcare System Perform?” including textual feedback from scientists and medical practitioners > How Well Does The Dutch Healthcare System Perform

Coming up: essay in a Medical Journal 

Beoordeling van het zorgstelsel door de bevolking in 7 moderne Europese landen

In mijn blog van eergisteren melde ik dat de Zweden het minst tevreden zijn over hun eigen zorgstelsel. Het staat allemaal in het in mei 2017 gepubliceerde rapport van het CommonWealthFund:

In een representatieve steekproef werd de vraag gesteld: “Which of the following statements comes closest to expressing your overall view of the health care system in your country?”

Het resultaat, met accentuering: de meerderheid is tevreden (groen), of de meerderheid is ontevreden en wil verandering (van fundamenteel tot een complete stelselwijziging, in rood):

Naar mijn weten is er in de media geen aandacht besteed aan het rapport.


Eleven Countries Survey: “Nederlandse gezondheidszorg aan de top” (RTL Nieuws) ?!

RTL Nieuws bericht:

Nederlandse gezondheidszorg aan de top (?!)


Het bericht staat op Health Affairs en is gebaseerd op een bericht op, een gerespecteerde bron. Ze zijn kennelijk een sponsor van dit onderzoek. Maar dit is niet de conclusie van het Commonwealthfund, het is een bericht op hun website: The views expressed are those of the authors and should not be attributed to the Commonwealth Fund.

Kortom: het Commonwealthfund heeft bijgedragen aan de totstandkoming van dit onderzoek, maar het is niet gedaan in naam van. Dit onderzoek zegt niets over de mening van het Commonwealthfund.

Opzet en inhoud van het geciteerde onderzoek:

Het gaat om een telefonische enquete met een lage respons. Uit de Appendix blijkt dat de respons van de kwetsbare inkomensgroepen laag is (waar ook nog onvoldoende voor gecorrigeerd lijkt te zijn), het zijn vooral de relatief hogere inkomensgroepen die gereageerd hebben.

De survey is een lofzang op de poortwachtersfunctie van de huisarts en de vernieuwingen in de 1e en anderhalve lijnszorg in Nederland. Terecht. Maar de poortwachterfunctie is een historische verworvenheid. En hoe moeilijk is het om een goede fysieke toegankelijkheid te organiseren in een land zo klein en vlak als Nederland dat over zulke goede, geasfalteerde wegen beschikt? Daar komt bij dat wij een in internationaal opzicht ver ontwikkelde digitale infrastructuur hebben. De andere 10 landen hebben grote geofysische beperkingen. Het enige nieuwswaardige zou mogelijk kunnen zijn dan er rondom de 1e lijn in Nederland interessante vernieuwingen plaatsvinden. Maar dat is niet de teneur van de berichtgeving. Het gaat hier om de 1e lijnszorg, een bedrag van 8,5 miljard jaarlijks, ca. 10% van de kosten van de gehele Nederlandse gezondheidszorg.  Om nu op basis van 10% van de sector te concluderen dat de Nederlandse gezondheidszorg aan de top staat … is volstrekt misplaatst!

Wat te denken van het ministerie VWS dat dit bericht publiceert op: ?


<klik> op link >

Site met Abstract en kader met opties: Full Text , kies Full Text. NB: Om de Appendix te kunnen openen moet je subscriber zijn, dat kost geld.

In New Survey Of Eleven Countries, US Adults Still Struggle With Access To And Affordability Of Health Care


In all countries, shortfalls in patient engagement and chronic care management were reported, and at least one in five adults experienced a care coordination problem. Problems were often particularly acute for low-income adults. Overall, the Netherlands performed at the top of the eleven-country range on most measures of access, engagement, and coordination.


First, populations that were hard to reach— (…)

Second, the survey had reasonable but still low response rates, which might introduce bias in an unknown direction.


The Dutch system—which includes the best access to same- or next-day appointments and after-hours health care, low use of the ED, relatively few problems with coordination of care, and the lowest rate of reported gaps in the doctor-patient relationship—provides an example of what works.One of the system’s features that underpin its performance is that almost all Dutch citizens are registered with a general practitioner of their choice, so that doctors know their patients’ medical history.14 Dutch general practitioners also have a statutory responsibility to provide after-hours care, which is usually met through cooperatives that provide walk-in care and also have electronic access to the patient’s primary care record—thus ensuring an alternative to the ED and reducing fragmentation of care.16 In addition, 88 percent of Dutch general practitioners make home visits.15 Dutch primary care doctors were early adopters of electronic medical records and report one of the highest rates (70 percent) of being able to exchange information electronically of doctors in the eleven countries, facilitating care coordination between providers. Multidisciplinary teams are the norm in Dutch primary care, with over 90 percent of health care practices employing nurses or case managers to help manage care for patients with chronic conditions, and an increasing number of practices are participating in care groups that receive payments to assume overall clinical responsibility for managing and coordinating care for such patients.17 All of these system features help make Dutch primary care particularly effective.

Among the most striking findings of the survey whose results are reported here are the missed opportunities across countries for health promotion. The vast majority of adults in all countries, except the United States, are not being engaged in conversations about how to lead a healthy lifestyle through good nutrition and exercise.

Disclaimer onderaan:

This study was supported by the Commonwealth Fund. The views expressed are those of the authors and should not be attributed to the Commonwealth Fund.



Deliberate Choice: Public Good or Marketplace


Which public tasks, (partly) funded by government taxes, should be executed by governmental agencies and which should be executed by business organizations? is the central theme of this book. A conceptual model, constructed of three perspectives, is presented.
1st – Public execution and the Free market are treated as counterparts, mixed combinations of Public assignment and Business execution exist in between. Six different types are described.
2nd – Human conduct, both in public and private activity, consists of five elements: Will, Capability (Resources, Knowledge), Thought, Activity, Legality.
3d – Public tasks are defined at four aggregate levels: individual rights, collective systems, national security and cultural heritage and international obligations, specially fostering sustainable development.
These are the three perspectives that are combined in the conceptual model.

Conceptual model copyright Uber Local care 092014