Quality and cost of healthcare: A cross-national comparison of American and Dutch attitudes

Lindenthal, J. J., Lako, C. J., van der Waal, M. A. E., Tijmstra, T., Andela, M. & Schneider, M., Feb-1999, In : American journal of managed care. 52, 2, p. 173-181 9 p.

Research output: Contribution to journalArticleAcademicpeer-review

  • J.J. Lindenthal
  • C.J. Lako
  • M.A.E. van der Waal
  • T. Tijmstra
  • M. Andela
  • Mareleyn Schneider

Objective: To compare attitudes of consumers in America and Holland toward the quality and cost of healthcare.

Study Design: Data were derived from one American (n = 466) and two Dutch (n = 260, n = 1629) surveys.

Patients and Methods: Questionnaires were completed by respondents. Pairwise comparisons requiring respondents to compare statements with one another were used to assess preferences for quality of care. Respondents were asked to "indicate the extent to which each of the factors listed plays a role in placing demands on the American (Dutch) healthcare system." Factors included the public's tendency to consume, high technology, defensive medicine, decrease in informal care, increase in standard diagnostic procedures, and medicalization.

Results: Americans reported comparatively greater concern with empathy, whereas the Dutch were more interested in the continuity of care. Effectiveness, knowledge, information, and patient-physician relationships were ranked higher in both nations than waiting time, autonomy, and efficiency. Respondents in both countries attributed the increase in healthcare cost primarily to the high cost of technology. Compared with their Dutch peers, Americans were less likely to attribute increases in the cost of healthcare to the public tendency to consume and to the decrease in informal care and were move likely to implicate defensive medicine and an increase in diagnostic procedures.

Conclusion: As both nations experience pressures to reduce costs while maintaining and augmenting the quality of healthcare, planners and government officials should tailor their approaches to each nation's problems within the context of their public perspectives. Replication of such studies should help assess the impact of changing societal values on healthcare delivery.

Original languageEnglish
Pages (from-to)173-181
Number of pages9
JournalAmerican journal of managed care
Issue number2
Publication statusPublished - Feb-1999



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