In Dutch Healthcare, Uw Mening Telt: Underestimate WOM and Customer Satisfaction at Your Peril

I had the privilege to spend New Year's in Rotterdam with a young Dutch/American family and their guests (us=American expats, family members=Dutch).

First, let me say that if you have the opportunity to visit Rotterdam, please consider planning your trip to coincide with New Year's celebrations...I've never seen (nor heard) anything like the panoply of combustion that commenced. The air was so thick with firework smoke you couldn't see bridges over the Maas River.

Our generous hosts were an American expat in the military reserves who works at the same site as my husband. Her spouse is Dutch (employed in the banking industry), and they welcomed an 8 month old son into the household this year.

For foodies out there, dinner began with a cheese course that rivals any I've enjoyed in the US (Camembert, Brie, Gouda, etc.), some chocolates and marzipan that again blew US sweets away (we dispensed with formalities quickly), excellent wines from all over Europe, beer, and for my husband, whiskey and "Cola Light."

We moved on to salad, green beans, a hearty root vegetable mix, and grilled lamb. In case you're not drooling yet, for dessert we had some sort of cakey chocolate decadence with vanilla ice cream.

Needless to say, if you're ever in Holland and invited into someone's home for dinner, by all means, accept!

Due to our interesting mix of people and backgrounds, dinner conversation ranged from travel to family to politics, to - yes - healthcare.

Around the table, guests included:
  • Hostess: Military reservist American expat, lived in Holland for several years
  • Ruby the Panamanian cat, who liked holiday lamb very much indeed
  • Host: Dutch banker with parents of South African heritage
  • Host's sister: Dutch physiotherapist (similar to our Physical Therapy profession) - self-employed
  • Myself: slightly jet-lagged and constantly stuffing face with food
  • My Spouse: IT guy trying to keep me from eating too much cheese
  • Our Friend: IT guy, American expat, lived in Holland for almost 2 years - our "in country" godfather
  • Hostess's Sister in Law: Well traveled Dutch mother of 2 - taking trip to Hawaii and New Zealand (8 week holiday!) in the near future
  • Hostess's Brother in Law: Dutch father of 2, employed in sales, wearing North Face jacket

In speaking about healthcare, I was anxious to learn more about the Dutch system.

After quickly explaining my background, I asked a few pointed questions about how Dutch citizens choose hospitals. Patient satisfaction in individual pay systems is a topic of great interest. I was careful not to ask about specific illnesses or name conditions, however, pregnancy and childbirth seem to be very acceptable topics of discussion.

I'll learn much more about the system in the coming weeks, but from our basic conversations, apparently you can select where to go from hospitals in an area corresponding to where you live/work. More on this later.

The Dutch system now has at least two tiers of payment/referrals, and this system is developing to be "more like the US" according to one of our fellow guests (his tone was critical rather than celebratory).

In January of 2005, the Dutch government put into place a Board for Healthcare Rates (College Tarieven Gezondheidszorg/Zorgautoriteit i.o., or CTG/ZAio) that sets healthcare tariffs.

The system now uses DBCs (diagnosis treat combinations), which I believe are similar to our DRG system.

From the patient perspective, two other important things I learned:

1. Transparency is not just a buzzword here.

In Dutch homes, many people either keep curtains open 24-7 or don't have window
coverings. Home life is an extension of your social self, and much that happens behind closed
doors in the States is not hidden here. One day soon I'll have to go meet a neighbor on the
haven behind ours, who I see regularly when we are both in our kitchen areas washing up.

In Dutch hospitals, I believe costs are more transparent than they are in the States (after one conversation it's a hypothesis; I need multiple conversations before it becomes a theory).

My hosts could tell us exactly how much they were billed for the birth of their son. They were
not surprised nor embarrassed to share this information. It was similar to conversations I've had since my arrival related to rental/housing costs. They also knew which insurances had
been billed (his not hers) and had corresponded directly with those collecting payment at the
hospital where their child was born (our hostess though surely she needed to pay more than
she was billed, so she contacted the hospital direct).

2. When Selecting Hospitals, Customers Discuss Service Line Reputations and Staff Competencies - And They Share Opinions

My hosts selected Erasmus MC for two reasons. First, it is known for being the only Dutch hospital in Rotterdam where NMN epidurals are given. "Natural" birth seems to be the norm. Second, our host had some family connections to a well-respected OB/GYN, who accepted our
hostess as a patient.

I asked the Dutch citizens around the table how they learned what services each hospital
provides. Each named "word of mouth" and "reputation" as the reason they selected various facilities. Apparently hospitals do occasionally run small print advertisements, but
communications seem to originate from person-person (C2C) rather than the B2C orientation
we're more familiar with in the states. They also seemed more actively engaged in sharing opinions.

Do hospitals have systems in place to gather WOM feedback? It seems some do...At MCRZ for instance, another Rotterdam hospital with two locations, patients can deliver feedback via a quick and easy online survey.

Does your hospital make it easy for patients to share word of mouth recommendations and provide feedback on their care?

Next Issue: Review of relevant findings - 2006 RiVM Dutch Health Care Performance Report (published by The National Institute for Public Health and the Environment).

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