It’s time for Canada to go ‘Dutch’ on health care

Authored June 24, 2022

Related Services:

Canada’s current model for providing health care is unsustainable. Despite having one of the highest per-capita spending levels of developed countries, long wait times, overcrowded emergency departments and a shortage of family doctors are issues plaguing most communities across the nation.

And things will only get worse. Just ask Dr. Katharine Smart, president of the Canadian Medical Association (CMA). She recently told CTV News that “what's clearly coming is the collapse of the current health-care system," adding “we’re not seeing is the political will to take that seriously.”

Instead of taking the difficult steps to address the structural problems at the core of our health-care woes, federal and provincial governments seem content to keep medicare lingering on life support, despite the suffering that it causes citizens.

Canada should instead look abroad for a solution, specifically to the Netherlands. The land that gave us the telescope, Bluetooth and the first modern market-oriented economy has a health-care system widely regarded as one of the best on the planet.

Holland has a multi-payer system

As with Canadian medicare, Dutch health care is based on the idea that every citizen is entitled to health services. But instead of the government funding that solely through taxes, their multi-payer system requires all citizens to purchase health coverage from private insurers.

These firms, most not-for-profit cooperatives, are required to accept all applicants. Profits are allocated to reserves or else they return them in the form of lower premiums. Standard benefits include hospital stays, access to a physician, home nursing accommodation and prescription drugs. While adults pay premiums, annual deductibles and copayments for certain services and drugs, the government pays for children up to the age of 18.

Private insurers negotiate with health-care providers about funding methods and other matters, which leads to more cost-effective treatment for their clients. Dutch residents can also shop around between insurers, looking for the service and premium level they want and can afford.

Uninsured adults in Holland are fined and their insurance premiums may be levied directly from their paycheques. And the small percentage of the Dutch people who conscientiously object to health insurance can opt-out if they agree to make mandatory contributions into a health savings account.

‘Every patient is on the same level’

This blend of private and public health care funding has won praise from many corners. Dr. Robert Ouellet, past-president of the CMA, has said that since insurance companies cannot refuse to take on a new client, “the result is every patient is on the same level and has the same importance, because the money follows the patient. What they are doing is what they call ‘managed’ competition.”

I believe most Canadians would agree that our bloated medicare system needs an injection of competition to become vibrant and healthy. I regularly hear from my clients – doctors, surgeons and other health professionals on the frontlines – about the increasing workloads they face as Canada tries to preserve an antiquated health-care system that is failing at almost every level.

The Dutch model, on the other hand, is winning near-universal praise. For example, Dr. Paul Woods, a former president and CEO of London Health Sciences Centre, notes in a health-care trade journal that the Netherlands has “has an incredible primary care model, where if you have a need, you can pick up the phone and have that need satisfied immediately, whether it’s a telehealth visit or after hours … the standard Canadian answer to a need at 2 a.m. is to go to Emergency, which is a terrible answer.”

Most Dutch people can get doctor visits quickly

The article adds that Dutch general practitioners are required to provide at least 50 hours of service between 5 p.m. and 8 a.m. annually in order to maintain their professional licences. That is why 61.5 percent of people in the Netherlands can get an appointment with a doctor or nurse either the same day or the next, as compared to 34.7 percent of Canadians.

When asked if Canada needs to spend more than the 10.8 percent of GDP on health care, Dr. Woods replied, “Maybe we do need to spend more, but we definitely need to spend it differently.”

For the sake of all Canadians, especially the one in seven who don't even have a family doctor, a new approach is needed. The Dutch may have the model Canada should emulate.

• Tracey Tremayne-Lloyd is a Certified Specialist in Health Law and founder of TTL Health Law.


Ms. Tremayne-Lloyd was the keynote speaker at the Medical Staff Association 2011 meeting on June 20, 2011. Her presentation was titled: “Hospital Governance: An Indispensable Joint Venture of Medicine and Management and Rights and Responsibilities of the Medical Staff”. The presentation was well received by the Medical Staff and the topic was certainly relevant. We would recommend her and have her back for any further topics.

Hien Ta, M.D., FRCPC Past Medical Staff President, York Central Hospital

Tracey Tremayne-Lloyd Health Law