Netherlands Tops European Health Consumer Poll for Second Successive Year

The fifth annual edition of the EHCI has been published by the Health Consumer Powerhouse (HCP), which prepared the report in association with the European Commission's Directorate General (DG) Information Society and Media. In the 2009 EHCI report, the healthcare systems of 33 countries in Europe were assessed and ranked, including all 27 EU member states, Norway, Switzerland, Iceland, and Albania (the latter two for the first time), and EU candidate countries Croatia and Former Yugoslav Republic (FYR) Macedonia.

In the report, points were allocated to countries for six sub-disciplines in healthcare: outcomes; range and reach of services provided; waiting time for treatment; pharmaceuticals; patient rights and information; and finally e-health. This last category features as a sub-discipline for the first time in the EHCI reports, and measures the extent to which healthcare systems use the internet to provide patients with access to medical records, and healthcare professionals and the wider public with information concerning medical services and treatments.

The HCP states that the EHCI does not measure which healthcare system is the best, rather that it measures the consumer friendliness of healthcare systems. Although it emphasises this difference, it declares that in the case of the EHCI's winner in 2009—the Netherlands—it is possible to state with near certainty that this country does have the best healthcare system in Europe.

Netherlands Tops Poll of Healthcare Systems Again

For the second year in succession, the Netherlands is in the first place in the EHCI. The Dutch healthcare system has no weak spots in the HCP's view. Among the reasons it puts forward for its effectiveness is the multitude of health insurance providers, operating separately from care providers, who act in competition with each other; the highly structured arrangement for the participation of patient organisations in healthcare decisions is another reason suggested.

The HCP also speculates that an important reason for the success of the Dutch system is the fact that decisions on healthcare are taken to a very high degree by medical professionals, with the co-participation of patients; more so than in almost all other European countries, non-healthcare professionals (bureaucrats and politicians) are distanced from the process of healthcare decision-making.

The maximum possible points one country could be allocated was 1,000; the Netherlands gained 875 points, some 56 points more than Denmark, which was in second place for the second year in a row. Notable changes in the rankings include Sweden's fall from fifth to eighth, which was mainly the result of its poor record on accessibility. Even Albania was able to outperform Sweden in this sub-category, although Sweden retained its top position in the rankings in the outcomes sub-category. Estonia, which had reached 11th place in the 2008 EHCI, fell by 7 places to 18th in 2009, which the HCP suggests may be the result of the economic crisis having an adverse effect on healthcare systems. Croatia's leap of seven places to 22nd is explained by the HCP as partly the result of an improvement in patient access to medical data.

Netherlands and Denmark Top Pharmaceuticals Sub-Category

The pharmaceuticals sub-category is broken down to four indicators of quality: Rx subsidy; layman adapted pharmacopeia; novel cancer drugs deployment rate; and access to new drugs (time to subsidy). A weighted score was allocated to each country for the total, and the two highest-ranked countries overall—the Netherlands and Denmark (which both had a score of 138 for the sub-category)—also finished at the top of the pharmaceuticals category. However, more surprising perhaps was the presence of Slovakia in the top half of this sub-category, with a weighted score of 113, and Spain sharing the second-highest score (of 125) with the United Kingdom, Germany, and Austria, despite finishing in only 21st place in the overall rankings.

Following on from the example of Sweden and Denmark, many countries in Europe have now put into place internet-based instruments for finding information about pharmaceuticals, designed for use by non-pharmaceutical professionals. As an important aspect of patient empowerment, the HCP emphasises the significance of the presence of such instruments in 13 European countries, including countries in the CEE region such as the Czech Republic, Slovakia, Romania, and Hungary.

Outlook and Implications

The HCP emphasises that its report is part of the vision to introduce cross-border healthcare in Europe, giving patients choices through imparting knowledge on the healthcare policies of countries in Europe, and thus enabling comparisons. Moves towards cross-border healthcare in the EU are already in progress, and can be expected to gain momentum as mobility across the bloc increases (see Europe: 3 April 2009: European Parliament Expected to Back Cross-Border Healthcare Provision Vote).

The EHCI is principally focused on assessing the extent to which healthcare systems in European countries are user friendly for health consumers. To this extent, it does not claim to give any country the accolade of being "the best" or indeed "the worst" healthcare system in Europe, but only judges the friendliness of the systems for users against its own criteria. Nevertheless, such surveys can be useful to see the progress of countries in their adoption of new systems and technologies; the HCP's inclusion of e-health as a sub-category goes to the heart of the "user-friendliness" of healthcare systems, and developments in this area across Europe will certainly have an effect on the pharmaceutical industry. The example of Slovakia's recent introduction of an internet-based search facility to find generic versions of originator medicines—as a means to save money—is a case in point (see Slovakia: 24 September 2009: Slovak Health Ministry Launches Awareness Campaign for Cheaper Medicines).