The Netherlands is the best country in Europe to live for health care, a new report has found.The 2014 Euro Health Consumer Index (ECHI) ranked 37 countries according to several factors. These were patient rights and information disclosure; accessibility and waiting times for treatment; outcomes; the range of services offered; illness prevention and access to pharmaceuticals.
The top score possible was 1,000 points, and the Netherlands achieved 898. Switzerland came second, followed by Norway, Finland and Denmark. The UK, excluding Scotland, landed in 14th place (718 points) with Spain 19th and Italy 22nd.
Scotland, which has a separate health service and a higher per-capita spend, was ranked two places below England.
The data for the report was gathered last year. A recent NHS survey of more than 1 million patients, published last month, found that almost 11 per cent of them were unable to get an appointment to see a GP the last time they tried – placing extra strain on accident and emergency departments.
Other statistics released last month showed a small improvement in NHS accident and emergency performance after three of the worst weeks on record over Christmas.
The EHCI report said the UK "is still definitely a part of European waiting list territory" adding that "unfortunately, in 2014, the English waiting time scores are worsening slightly, which is confirmed by English press reports on health care accessibility".
However, it said that efforts within the NHS to reduce hospital infections have paid off.
The Netherlands has been in the top three countries in each report published since 2005. The latest one said the Netherlands has addressed a weak spot – accessibility – by setting up 160 primary care centres which have open surgeries 24 hours a day, seven days a week. In addition, “politicians and bureaucrats seem farther removed from operative health care decisions in the Netherlands than in almost any other European country. This could in itself be a major reason behind the Netherlands' landslide victory".
The authors praised the “very respectable” amount of money ploughed into the Swiss health care system, coupled with a good score for accessibility. Norway has benefited from a “very high per capita spend on health care services” which is “finally paying off” according to the report. Meanwhile Finland “has made a remarkable advance, and seems to have rectified its traditional waiting time problems".
The report was supported by two unrestricted grants. The first came from Medicover S.A in Belgium, a private health care organisation dealing in health insurance, prepaid health and medical services, occupational medicine and laboratory services. The other came from the New Direction Foundation in Belgium, which describes itself as a free market, European-realist think-tank affiliated to the Alliance of European Conservatives and Reformists.
According to the report authors, the results show the flaws in health care systems like the NHS model, known as the Beveridge system, where the financing and provision of health care are handled within one organisation.
The other type of system, the Bismarck system, is based on insurers who are organisationally independent of care givers and health care providers. This is the case in the Netherlands, Germany (ranked ninth) and Switzerland.
“The Netherlands example seems to be driving home the big, final nail in the coffin of Beveridge health care systems, and the lesson is clear: remove politicians and other amateurs from operative decision making in what might well be the most complex industry on the face of the Earth: health care,” wrote the report authors.
“Beveridge systems seem to be operational with good results only in small population countries such as Iceland, Denmark and Norway.”
They added: "Large Beveridge systems seem to have difficulties at attaining really excellent levels of customer value. The largest Beveridge countries, the UK, Spain and Italy, keep clinging together in the middle of the index.”
The authors said there could be at least two explanations for the poor performance of the larger Beveridge countries. The first, they suggested, could be that public organisations do not offer the compensation and other incentives required to recruit the type of “world-class” managers needed to handle such a large organisation effectively. The other could be political interference getting in the way of decisions that should be focused on the patient.