In The U.S. And Holland, Diabetes Looks Different
The reason? ‘Two years ago, the Netherlands redesigned its health care system. The reform was developed by Alain Enthoven, the U.S. economist who created HMOs. It resulted in a Dutch health care system that closely resembles a giant American HMO. Unlike in the U.S., however, Dutch citizens are universally insured, and the system is organized around encouraging — rather than discouraging — comprehensive care for patients with chronic illness.’
Dr. Steve Edelman, 52, a diabetes specialist at the University of California and founder of a Web site called Taking Control of Your Diabetes, knows all too well that this isn’t the case in the U.S.
Diagnosed with Type 1 diabetes at 15, he chose to become an endocrinologist in order to counteract a system that continually let him down. No one educated him about the importance of preventive care.
“I didn’t realize a lot of things were needed — yearly eye exams, cholesterol tests. It took me 10 to 15 years to finally realize what I needed to do to avoid terrible complications of diabetes,” he says…
On average, the U.S. system spends about $6,000 per person on health care, including whatever the government, employers and individuals pay out of pocket. For less than half that — about $2,700 — the Dutch get better care, research indicates.
Take the case of Rene Thain, 62, a retired salesman from Maastricht. A few years ago, while on vacation with his wife, Thain developed a painful condition that caused his toe to get increasingly bigger and redder.
Thain’s doctor immediately sent him to endocrinologist Nicolaas Schaper, who heads the Diabetes Center at University Hospital in Maastricht. Schaper diagnosed Thain with a rare complication that occurs in diabetic patients who no longer have feeling in their feet. A minor injury can cause so much blood flow that ligaments disintegrate and bones weaken and crumble. If not properly addressed, the condition can cause ulcers and result in amputation.
Unlike Edelman back in the U.S., Thain did not have to pressure, cajole or argue with an insurance company to get immediate effective care. Instead, he was promptly referred to a clinic for diabetes patients with foot problems. There, a multidisciplinary team, which included an orthopedic surgeon, internist, rehab doctor, shoemaker and plaster technician, helped him address the problem.
Thain wore a plaster cast for about four months. Today, his foot is pretty much back to normal, a success Schaper credits to a system that is geared to kick into action as soon as problems occur.
That certainly does not mean that the Dutch health care system is flawless, it certainly is not, but it does indicate that US politicians could benefit (and the American people as well) by taking a closer look at our system, and copying what’s good for the US as well.
Please don’t use a single case as the demonstration of the difference in health care systems. EVERYONE has a story. Stats are far more important. In this case I’d want to see that when comparing apples to apples (i.e. same demographic mix) the Netherlands have fewer Type 2 diabetics who have not had an eye exam in the past two years, or a lower average HbA1c .
I’m not suggesting they don’t have better outcomes but using one anecdote of a rare condition does not demonstrate a SYSTEM’S superiority. Frankly, that’s the "game" that folks in the US usually do.
As the sufferer of a couple chronic illnesses I couldn’t agree more with this article. The U.S. is not just flawed it is horribly broken.
Health care, and the insurance industry (disability care, etc) need to be overhauled. Insurance is the 2nd biggest lobby in the U.S. and has virtually hamstrung our country and its fine doctors.
The Netherlands system has its upside and downside. In the U.S. I have only seen the downside become worse and no upside for the middle and upper middle class at all. (Not even going to TALK about the lower class!)
Good post!
As a US expat who’s lived in the Netherlands for over two years now, I’ve had a chance to observe both of these systems in action for myself. Although I’m the first to argue that the US healthcare system is in desperate need of a complete overhaul, the Dutch system isn’t the model we should use.
Yes, it’s universal and extremely cheap. And it still holds true that you get what you pay for. When I first looked into Dutch health care, I came across a lot of stories about Americans driving to private Belgian hospitals with critical ailments like acute appendicitis, or South Africans flying home to Johannesburg for treatment because they found Dutch health care to be so poor. I thought it was the rantings of some whiny, homesick expats. Now, I understand.
In my two years here (after the much lauded reform), I’ve seen Dutch ER doctors and nurses treating extremely bloody traumas without gloves, acute meningitis patients unsequestered and left to languish two days without proper diagnosis (bacterial vs. viral), routine exams such as the cervical smear test performed only every five years (not 1-2 as is the standard of care in the US), and on and on. I’ve also been refused antibiotics for a urinary tract infection, which, if left untreated, can be disastrous. I’ve met probably half a dozen women here (all with different doctors) who’ve complained of this same problem.
Any one of these examples would be malpractice in the US. Yes, errors and bad medicine happen everywhere, but Americans don’t realize how good we have it. I’d rather be healthy and fight with an insurance company any day than get easy, crappy treatment.