Dutch Public Health Service as Successful as U.S Private Services, but With Less Screening
Prevention is better than cure; however, when it comes to screening for
cancer new research shows that U.S. health services are not as
cost-effective as international, and publically run, counterparts. The
research, published in The
Milbank Quarterly, compares U.S. screening services to screening
in the Netherlands and found that while three to four times more
screening took place in the United States, the rates of mortality were
similar.
The research was conducted by Dr. Martin L. Brown from the National
Cancer Institute in the United States, alongside colleagues from the
Erasmus MC University Medical Center in Rotterdam.
“Since 2010 new laws in the U.S. require private health insurance plans
and Medicare to cover preventive services with no deductibles or
copayments,” said Brown. “Preventive medicine is seen as being
cost-effective compared to the costs sustained through illness. However,
practical cost saving depends on how the preventive services are
implemented.”
The team focused on cervical cancer screening, which accounts for a
small fraction of overall health care spending, but represents broader
preventive health services. For comparison the authors carried out a
cross-national study of cervical cancer screening intensity and
mortality trends in the United States and the Netherlands.
The team used national cancer incidence and mortality data from both the
United States and the Netherlands to estimate the number of Pap smears
and the cervical cancer mortality rate since 1950. Their results
revealed that even though three to four times more Pap smears per woman
were conducted in the United States than in the Netherlands over a
period of three decades, the two countries’ mortality trends were
similar.
Five-year coverage rates for women aged thirty to sixty-four were
comparable between the countries at 80 to 90 percent. However, because
screening in the Netherlands was limited to ages thirty to sixty,
screening rates for women under thirty and over sixty were much higher
in the United States.
“The components of the screening service, such as evidence review,
monitoring of screening practices and reimbursement policies, were more
systematically linked and implemented nationwide in the Netherlands than
in the United States, making the service more cost-effective,” said
Brown. “To a large extent this was due to the Dutch model of having a
public health service, rather than the U.S. medical services model.”
