HEALTH
How they do it in the Netherlands
The Netherlands has overhauled its healthcare system in recent years and achieved many of the goals health campaigners cherish: reasonably affordable healthcare, quality services and equitable access.
It’s not without its flaws, though. Under the Dutch system insurance firms buy care on behalf of their customers from hospitals and other care providers. Premiums, which are mandatory, are typically about €1,200 a year for adults; people on low incomes receive subsidies to help them pay their insurance.
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To ensure compliance with both the spirit and the letter of the law, the system is tightly regulated by NZa, the powerful Dutch state health regulator. Cherrypicking the healthiest applicants – or, conversely, charging applicants more on the basis of age or medical condition – is prohibited.
In Ireland marketers have found ways around cherrypicking rules, such as by marketing to younger people, but the government in the Netherlands has put in place a number of safeguards.
For example, it audits each company’s enrolment plans and activities every year, and a central fund subsidises insurance companies that end up insuring higher-risk groups. This fund is financed through a mix of member and government contributions.
Why can't we do it here?
Fine Gael cited the Dutch healthcare model as the inspiration for its policy of moving towards universal health insurance. If it were implemented, it would help narrow the two-tier nature of the health services here.
But there are some big obstacles. If the system were rolled out here, anyone who didn’t have health insurance and wasn’t eligible for a medical card would face paying hefty premiums. Against a backdrop of shrinking personal incomes, it would likely meet major opposition from voters. Implementation of a Dutch system would, according to the Irish Congress of Trade Unions, lead to more smaller hospitals closing. It would also require a big emphasis on patient information and top-class IT systems, which are sorely lacking here.
In addition, moving towards this kind of model would mean the political system would not have a role in the day-to-day running of the health system. A strong regulator would be required to ensure the interests of the public were protected.
It’s also not clear yet how expensive it would be. Latest figures indicate the Dutch system costs about 10 per cent of GDP, compared with about 7.6 per cent in Ireland. (When figures are adjusted, based on Ireland’s younger population, our system is slightly more expensive than the Dutch one.)
PRISONS
How they do it in Finland
Forty years ago Finland had a rigid prison model, inherited from neighbouring Russia, and one of the highest rates of imprisonment in Europe. But academics provoked a rethink of penal policy, with their argument that it ought to reflect the region's liberal values.
Today Finland jails fewer of its citizens than any other European Union state; tens of thousands of Finns have been spared prison; the taxpayer has saved tens, if not hundreds, of millions of euro; and its crime rate is also among the lowest in the EU.
The country’s jails include a mix of “open” and “closed” prisons – although sometimes it can be difficult to tell the difference. In many closed prisons, high walls have been removed in favour of CCTV and electronic alerts. Neither are there heavy metal gates and gloomy cells. Instead, living spaces for inmates resemble college dormitory rooms.
So why does it work? Academics say the basis of its penal system is rehabilitation rather than retribution. In addition, experts point out that the kinds of economic and social disparities that can produce violence in other countries are far less prevalent in Finland’s welfare-state society. Street crime is low, and law-enforcement officials can count on support from an uncynical public.
Why can't we do it here?
While Finland's imprisonment rate has decreased by just over 60 per cent since 1960, during the same time frame Ireland's has increased by almost 500 per cent.
An Oireachtas committee recently visited Finland to see if it could learn from its system. It resulted in policy proposals aimed at creating a more effective penal system, with a greater emphasis on rehabilitation.
Among its main proposals were to reduce the prison population by a third over a period of about 10 years, with an emphasis on nonviolent prisoners. In order to safeguard society, it proposed that dangerous and violent offenders should remain incarcerated. This, it said, would be a starting point for a further range of measures aimed at tackling overcrowding in prisons and making the penal system more effective.
It would also require a major change in penal culture – but the experience in Finland shows that this can be done, the committee found, within a reasonable time frame and with impressive results. It also proposed additional measures, such as increasing the use of open prisons in Ireland, increasing remission rates and introducing legislation providing for more structured release, parole and community return.
SOCIAL WELFARE
How they do it in Denmark
Denmark has been held up as a model for many countries saddled with high unemployment and expensive welfare systems. They have pulled off the seemingly impossible: a lavish social-welfare system combined with very low unemployment. The foundation for much of this achievement, say experts, is its "flexicurity" system – a delicate balancing act between job-market flexibility and security for workers.
In Denmark, employers are free to hire and fire. In most cases, people who are laid off are guaranteed about 80 per cent of their wages in benefits. (The figure is capped for high earners). In turn, jobseekers are obliged to take part in retraining and job-placement programmes tailored to get them back into the workforce.
In fact, each year it’s estimated that almost a third of Danes change job. They are safe in the knowledge that the system will allow them to continue to pay their mortgage or rent and buy food as they go about securing a new position.
It’s also highly unionised. About 80 per cent of workers belong to trade unions, which often manage workplaces, assist in running unemployment-insurance programmes and help the unemployed into retraining.
It comes at a cost. Government spending accounts for about half of gross domestic product, but few Danes complain about a top income-tax rate of 50 per cent that helps to finance unemployment benefit, pensions, healthcare and social protection. The financial crisis has taken its toll in Denmark, too, and the government has been forced to trim its safety net.
Why can't we do it here?
Ireland's welfare system has long been criticised for being too passive. A person who loses their job, for example, can face a cliff-face drop in income and, if they have children, may end up receiving as much on welfare as they would in a low-paid job.
A recent Government review of whether welfare payments are effective at getting people back into work found that some schemes ran the risk of making people dependent on social assistance.
In moving towards a Danish-style system, Ireland’s social-protection system would need to become far more active. Some of this is happening. Welfare offices are being remodelled as “Intreo” offices, which provide support and guidance on education and training; the dole has also been cut for thousands of people who refuse to engage in training; more investment is being directed towards retraining.
But stubborn poverty traps, such as the rent supplement and the child dependant allowance – show how slowly the system can change. We’re a long way off the kind of Danish model where people can feel secure that they won’t fall through the gaps of our social safety net.
Worryingly, recent years show a steady erosion of vital programmes that assist the most vulnerable, such as those with disabilities. But most experts acknowledge that although we’re heading in broadly the right direction, meaningful change could take decades of investment and political leadership.
EDUCATION
How they do it in Finland
Finland's education system in the 1970s was nothing to shout about. It was a mediocre, inequitable system built on core subjects and top-down testing.
Since it introduced sweeping reforms over several decades, it has consistently scored towards the top end of international rankings for education systems. So what’s the secret?
Researchers say it has much to do with going against mainstream notions of a centralised, evaluation-driven system and more to do with high-quality tuition and allowing children the space to find their passions.
In Finland, the formal education system doesn’t begin until the age of seven. It also scorns homework and standardised testing until well into teenage years, preferring to focus on creative play and learning. All children receive a report card at the end of each term, but these reports are based on individualised grading by each teacher.
Teachers are also highly qualified. This follows a government decision in the 1970s to require all teachers to have master’s degrees. Teacher-training programmes are among the most selective professional schools in the country, so it can be just as hard to enter as medicine or law.
But the main driver of education policy in Finland has been the idea that every child should have exactly the same opportunity to learn, regardless of family background or income. Education has been seen mainly as a way of smoothing out social inequality, rather than producing stellar performers.
Why can't we do it here?
Although we have prided ourselves in the past for having one of the best education systems in the world, international measurement have shown otherwise.
The Organisation for Economic Co-operation and Development’s 2010 Pisa report on Irish education showed steep declines in performance in reading and maths. Finland, by contrast, scores towards the very top of these rankings.
So can we copy our Scandinavian neighbours? Education experts say there are a number of hurdles. For one, teachers are rewarded for time spent on the job rather than getting meaningful qualifications. So without a reward for going “above and beyond”, there’s little incentive to do so. This would need to change.
The Croke Park and Haddington Road pay deals have also simply reinforced the status quo, say many educationalists. In fact, additional payments for the most qualified teachers have been withdrawn.
Testing is still rigidly centralised at Junior Cert and Leaving Cert levels, and the system does little to encourage creative play for youngsters, although there are signs of a rethink of some of these policies.
Perhaps the biggest obstacle of all, though, consists of the social differences: Finland is an egalitarian society with socialist underpinnings that uses its education system to equalise opportunities. By contrast, Ireland is a more inequitable society where the system at second level often reinforces social advantage and disadvantage.
