The plans of the Obama administration for healthcare reform have been compared to many other countries, including Britains NHS and the Swiss healthcare system. Given the fairly negative connotation the Dutch have in some circles in the US, it is perhaps politically wise not to compare a major transformation initiative to the Dutch healthcare system. Swiss sounds so much better. However, given the celebration of 400 years of Dutch-American relations and the progress that we have made since the introduction of the key Healthcare Insurance Act in 2006, sharing Dutch experiences could be helpful.

Universal coverage is not the same as "everything will be paid for". The Dutch system attains universal coverage for all citizens through a mandatory health insurance policy covering a fixed set of healthcare products and services that are considered basic to the health and wellbeing of people. Additional coverage can be acquired on a voluntary basis. Health insurance companies have developed a wide variety of policies that cater to the needs of different groups. Through employers and social services, compensation schemes are put in place to enable everyone to take basic healthcare insurance and pay for it. The compositiion of the mandatory package is established through a yearly political discussion with the national parliament. Insurance companies compete on the basis of price and service conditions of their policies for both mandatory and additional coverage.

Products and services in the Dutch system are defined by means of Diagnosis Treatment Combinations, which are (in theory) medically recognizable and homogeneous in terms of cost. They bear quite a resemblance to Diagnosis Related Groups (DRGs), the difference being mainly the fact that they should make sense to patients and physicians. These products and services are the basis for contracts between (private) health insurance companies and (private and/or not-for-profit) healthcare provider organizations. Contracts state specifics in terms of volume, quality and price of the products and services to be provided. Insurance companies are not obliged to contract all relevant healthcare providers, hence patient choice can be limited depending on the policy. However, often a default price is utilized when care is provided for which no specific contract is in place.

The market mechanisms, i.e. competition for policies among health insurance companies and contracts among healthcare providers, provide the key means for attaining high quality and efficient healthcare. However, the incentives are not truly aimed at limiting healthcare consumption and transformation of healthcare across provider communities. One of the experiments that are currently taking place is to define healthcare products and services from a patient perspective rather than from a provider perspective. For instance, long term care for chronic conditions is being defined and being contracted in such a way that it includes all services from home care, family physicians and medical specialists in hospitals. This new way of contracting calls for regional cooperation of otherwise independent healthcare provider organizations. This cooperation rewards any increases in quality and efficiency that stem from this cooperation, such as the redistribution of tasks among the providers.

Universal coverage, product and service definitions, and market incentives together create a dynamic environment for healthcare procurement and delivery. It also stresses the need for proper information governance and information exchange in order to inform decision making and coordinate care. The influence of these trends on management information, datawarehouse design, institutional and personal health records, and the development health information exchanges is formidable. Given the fact that the Obama administration has set aside a substantial budget for Health IT, the challenge before us is to shape these investments into solutions that contribute to healthcare reform. Any views on how to embed and support the strategic agenda on a national scale are welcome!