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The HCP was aware that tightening the criteria for Infant mortality, where the NL does not really excel, would lower the Dutch score, tightening the race for the 1 position.

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As Switzerland also got its Green score on this indicator reduced to Yellow, the suspense factor did not benefit from these changes. As stated above, the tightening of some indicator criteria seems to reward more affluent countries, with the NL still leading on points, down only 3 points since Switzerland is also holding out well on points, down 6 since The most obvious change from is the point gap now visible between the 12 countries of the Club, and those behind.

Rewarding real excellence in treatment results would help the more affluent countries in the ranking. The changes in rank should not at all be dismissed as an effect hpv vaccine nhs over 18 cost changing indicators, of which there are 46 in the EHCIas three indicators where almost all countries scores Green have been removed as non-discriminating. The Netherlands is the only country which has consistently been among the top three in the total ranking of any European Index the Health Consumer Powerhouse HCP has published since The Netherlands is sub-discipline winner, or joint winner, in three of the six sub-disciplines of hpv vaccine nhs over 18 cost EHCI The Dutch healthcare system does not seem to have any really weak spots, having made improvement regarding the waiting times situation, where some metastatic cancer neck European states excel.

There should be a lot to learn from looking deeply into the Dutch progress! Bronze medallists are Denmark at points.

Denmark was silver medallist some years ago, and has had a dip in the ranking, which was probably linked to the tightening of regulations for access to healthcare services. Inwith clinical excellence being more obviously rewarded, Danes seem to have learned to live with the access rules and are back on the podium. Norway 4th, pointsis losing out of the missing points from a perfect on their totally inexplicable waiting list situation!

Luxembourg sarcoma cancer flower sharing the 4th position at points. The very wise decision not to provide all forms of care at home, even though LUX could afford it, and allow their citizens to seek care in other EU countries, makes data availability slightly troublesome — it is likely that perfect data availability would give Luxembourg a higher score.

Finland 6th, points seems to have used traditional Finnish pragmatism to get out of the Waiting List swamp of a few years ago, and treatment results have also become first class.

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Out of the Swedish gap of to a perfectpoints are lost due to an abysmal waiting time situation. Thanks to clinical excellence, inSweden is still in 12th place but at points, 21 up since the previous year. The only countries scoring lower on Accessibility are Ireland alone in the bottom position of this sub-discipline and the U. Portugal, still 14th at points 28 down fromties this position with the U. In southern Europe, Spain and Italy provide healthcare services where medical excellence can be found in many places.

Real excellence in southern European healthcare seems to be a bit too much dependent on the consumers' ability to afford private healthcare as a supplement to public healthcare.

Also, both Spain and Italy show large regional variation which tends to result in a lot of Yellow scores for these countries.

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Some eastern European EU member hpv vaccine nhs over 18 cost are doing surprisingly well, particularly Slovakia due to improved Accessibility, Slovenia, the Czech Republic, and Estonia, considering their much smaller healthcare spend in Purchasing Power Parity PPP adjusted dollars per capita. Inthe FYR Macedonia made the most remarkable advance in the EHCI scoring of any country in the history of the Index, from 27th to 16th place, largely due to more or less eliminating waiting lists by implementing their real time e-Booking system!

Montenegro climbs from 34th to 25th! The fact that Montenegro is a small country with people does not diminish this achievement — large countries could do the same, regionalised if not nationwide. The Netherlands is the only country which has consistently been among the top three in the total ranking of any European Index the Health Consumer Powerhouse has published since The points in are even more impressive, particularly as the score criteria have been tightened for the EHCI in order to register differences.

The NL wins three of the six sub-disciplines of the Index, and the large victory margin to all competitors except Switzerland seems essentially be due to that the Dutch healthcare system does not seem to have any really weak spots, except possibly some hpv vaccine nhs over 18 cost for improvement regarding the waiting times situation, where some central European countries excel.

The Netherlands is unique as the only country consistently appearing among the top 3 — 4, regardless what aspects of healthcare which are studied.

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Also, the NL probably has the best and most structured arrangement for patient organisation participation in healthcare decision and policymaking in Hpv vaccine nhs over 18 cost. Also, the Dutch healthcare system has addressed one of its few traditional weak spots, Accessibility, by setting up primary care centres which have open surgeries 24 hours a day, 7 days a week.

Given the small size of the country, this should put an open clinic within easy reach for anybody. Here comes the speculation: one important net effect of the NL healthcare hpv vaccine nhs over 18 cost structure would be that healthcare operative decisions are taken, to an unusually hpv vaccine nhs over 18 cost degree, by medical professionals with patient co-participation.

Financing agencies and healthcare amateurs such as politicians and bureaucrats seem farther removed from operative healthcare decisions in the NL than in almost any other European country.

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The NL scores well or very well in all sub-disciplines, except possibly Accessibility and Prevention, where the score is more mediocre — on the other hand, so are those of most other countries. The historic Dutch problem of mediocre scores for Waiting times has to a great extent been rectified by — As can be seen from the references given in Section 7. Also, as can be seen in Section 4.

ByThe Netherlands are on par with Sweden and Germany for hpv vaccine nhs over 18 cost spend! This has been extensively treated in the EHCI report2. The Dutch healthcare system is characterised by over-use of in-patient care and institutionalised psychiatric care and elderly care.

It seems that actual modes of operating the healthcare system in The Netherlands could explain the high per capita healthcare spend, i. If the country can afford this, fine; but also for Outcomes and patient quality of life reasons, a programme to reduce the share of in-patient care would be beneficial for the Dutch healthcare budget! Silver medallists, points down from Switzerland has enjoyed a solid reputation for excellence in healthcare for a long time.

Therefore it is not surprising that when the n. Considering the very respectable money ploughed into the Swiss healthcare system, it should!

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Now along with Slovakia, the only country to score All Green on Accessibility. Swiss healthcare has probably been this good also before; the highly decentralised cantonal structure of the country has made data collection difficult. Denmark was catapulted into 2nd place by the introduction of the e- Health sub-discipline in the EHCI Denmark was in a continuous rise since first included in the EHCI Denmark has also made dramatic advancement in the reduction of heart disease mortality in recent years.

However, inthe introduction of the Prevention sub-discipline did hot help Denmark, which lost 20 points on this sub-discipline relative to aggressive competitors. Although the causality is hard to prove, that Danish score drop did coincide in time not only with the 2 www. It also coincided with the tightening of access to healthcare, with only two telephone numbers being available to Danish patients; the number of their GP, or the emergency number !

Inwith clinical excellence being rewarded higher, it seems that Danish patients have learned to cope with the hpv vaccine nhs over 18 cost restrictions! Norwegian wealth and very high per capita spend on healthcare seem to be paying off — Norway has been slowly but steadily rising in the EHCI ranking over the years. Traditionally, Norwegian patients complained about waiting times. This has subsided significantly, but is still where Norway loses most of the points missing: points compared with class leaders Switzerland and Slovakia!

The poor accessibility of Norwegian healthcare must be more or less entirely attributed to mismanagement, as lack of resources cannot possibly be the problem.

The fact that it is cheaper to operate a healthcare system without waiting lists i. Too much money can be a curse, hindering rationalization or the learning of efficient logistics.

Unlike Iceland, Luxembourg has been able to capitalize on its central location in Europe. With a level of common sense which is unusual in the in-sourcing-prone public sector, Luxembourg has not done this, and has for a long time allowed its citizens to seek care in neighbouring countries.

It seems that they do seek care in good hospitals.

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Probably for this reason, Luxembourg loses points on the Abortions indicator — for reasons of discretion, many LUX women probably has that done outside of the small and intimate Grand Duchy. LUX patients probably get even better treatment than the EHCI shows, as being treated abroad makes data collection complicated. The HCP has received some protest from LUX about the bad score on cigarette consumption, on the argument that most of those cigarettes are smoked by other nationalities.

From a European public health standpoint, peddling cheap fags to your neighbours is no better than smoking them all yourself. In fact, Finland is a leader in value-for-money healthcare. This situation helminthic therapy inflammation to have been put right in recent years, with Finland being among the top scorers hpv vaccine nhs over 18 cost Range and Reach of Healthcare Services.

Euro Health Consumer Index 1. Merkel ruling as Queen of Europe. The traditional weakness of the German healthcare system: a large number of rather small general hospitals, not specializing, resulting in mediocre scores on treatment quality, seems to be improving — a tendency even more prominent inwhen Germany is sharing 6th place on Outcomes.

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In a feedback round from national healthcare bodies, the response from the German Bundesministerium für Gesundheit BMG contained an interesting reference to a study of waiting times in German primary care.

It is irrelevant what the actual numbers were in that study; the unit of time used to measure and analyse primary care accessibility was not months, weeks or days, but minutes!

Iceland scores well on Outcomes Hpv vaccine nhs over 18 cost its own specialist qualification training for doctors, Iceland does probably benefit from a system, which resembles the medieval rules for carpenters and masons: for a number of years after qualification, these craftsmen were forbidden to settle hpv vaccine nhs over 18 cost, and forced to spend a number of years wandering around hpv vaccine nhs over 18 cost for different builders.

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Naturally, they did learn a lot of different skills along the way. Dropped out of the top 10 after reducing formerly hpv vaccine nhs over 18 cost access to specialist services aroundbut has slowly and steadily been climbing back. This pattern is not unusual after rule changes for Access see Denmark above! The management of the HCP have relocated to France; with a background from Sweden, our personal experience makes us believe that French patients must be a bit grumpy about Waiting Times in healthcare — from a Swedish perspective, Accessibility is fabulous!

A technically competent and efficient system, with a tendency to medicalize a lot of conditions4, and to give patients a lot of drugs! France has long had the lowest heart disease mortality in Europe, and was the first countrywhere CVD was no longer the biggest cause of death.

Also, France was 1 in the Euro Heart Index Austria 11th, points suffered a drop in rank in The introduction of the Abortion indicator did not help: Austria does not have the ban on abortion found in Poland and three more countries, but abortion is hpv vaccine nhs over 18 cost carried out in the public healthcare system.

Whether Austria should deserve a Red or an n.

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Surprisingly modest score on Outcomes, but still good — same score as Belgium. InSweden is still in 12th place, but back in the Club at points, thanks to clinical excellence being rewarded higher. This proves that Prevention is dependent on other forces of society than healthcare services! Sweden enjoys the companionship only of a number hpv vaccine nhs over 18 cost CEE countries having more than 30 abortions per live births, which in CEE probably is a remnant from before Sweden now has the highest healthcare spend per capita, after the three super-wealthy countries, see Section 4.

The HCP survey to patient organizations confirms hpv vaccine nhs over 18 cost picture obtained from the official source www. The target for maximum wait in Sweden to see your primary care doctor no more than 7 days is underachieved only by 4 Wadham, Lucy; The Secret Life of France, Faber Faber, In the HCP survey, Swedish and Irish patients paint the most negative pictures of accessibility of any nation in Europe. Particularly cancer care waits, not least in the hpv vaccine nhs over 18 cost Stockholm, seem inhumane!

Another way of expressing the vital hpv vaccine nhs over 18 cost Why can FYR Macedonia reduce its waiting times to practically zero, and Sweden cannot? Could this be an effect of the fairly recent Slovakian system of private additional healthcare insurance? Essentially the same performance as inbut a drop in points mainly due to the tightening of Outcomes score criteria.

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Does well in the Bang-for-the-Buck analysis! Nevertheless, the UK healthcare system has never made it into the top 10 of the EHCI, mainly due to poor Accessibility in only beating Ireland on this sub-discipline and an autocratic top-down management culture.


The country, which once created the Bletchley Park code-breaking institution would do well to study the style of management of professional specialists created there6! Mediocre Outcomes of the British healthcare system have been improving, but in the absence of real excellence, the tightened criteria puts the U. During the autumn of there were also worrying media reports about increasing Waiting Time problems, and reduced quality of cancer care.

Prea multe pentru a le duce pe picioare. Dar nu de oriunde.