In the u.s., rich kids see the doctor more. in the netherlands, poor kids do. – the washington post trichomoniasis in the mouth

But what’s most interesting is how the countries deal with inequality differently. In the United States, access to primary care seems to be a matter of who can afford it. Poor children are much less likely than rich children to see a doctor or a dentist for outpatient treatment or checkups.

Getting to the doctor early in life is important, says lead author Dougal Hargreaves, a pediatrician and associate professor at University College London. “We know health care in childhood and adolescence can have an especially big impact, both at the time, and on health outcomes later in life,” he says.

Consistent childhood checkups head off serious problems and set up good habits for adulthood. Yet, as the researchers note, the Centers for Disease Control and Prevention have warned that millions of U.S.


children are not getting important preventive care, such as blood pressure checks and screenings for vision or developmental problems.

Hargreaves and his colleagues, Jeroen Struijs, a researcher with the Dutch Ministry of Health, and Mark Schuster, chief of general pediatrics at Boston Children’s Hospital, could not infer from the data why the children were contacting the doctor or the dentist. But from the broad patterns they could see that the United States and the Netherlands are mirror opposites.

In fairness, the gap might better be described as the American disadvantage. From birth to old age, Americans are sicker and die earlier than people from most other wealthy countries. “The health disadvantage is pervasive,” warned a 2013 report from the National Research Council. “It affects all age groups up to age 75 and is observed for multiple diseases, biological and behavioral risk factors, and injuries.”

The report names two major causes for the health disparities. First, Americans just seem to lead riskier lives overall. They are at higher risk for obesity, heart disease and STDs, and are more likely to die by gun violence or in car crashes.

Then, inequality exacerbates these problems. Despite the rollout of the Affordable Care Act, the United States still has higher levels of poverty and uninsurance than many of its peers. About 10 percent of Americans are uninsured, compared to less than one percent in the Netherlands. So even though the U.S. health-care system spends a lot more money on people, a lot of people are out of the system.

The comparison between the United States and the Netherlands is interesting, Hargreaves adds, because there are many similarities between their health-care systems. The Netherlands requires citizens to buy private health insurance on competitive but highly regulated exchanges, and provides subsidies to those with lower incomes. This setup resembles what the ACA looks like for people in the United States who don’t have health insurance through their employers.

Expanding access to routine care was also one way the ACA was supposed to bring down health-care costs. It’s easier to fix a problem if you catch it early, or so the logic goes. So far, it’s not clear whether this argument proves true for adults. But it may make more sense for children, who have much longer lives ahead of them. There are many conditions in youth that benefit from timely medical attention. The ACA lists 26 preventive measures, from autism screening to obesity counseling, that insurance companies must make free to encourage people to come in.

This may be a cultural thing. But the Dutch also have a more robust and family-friendly primary care system, the researchers note. Doctors are more available outside work hours, in part because they get paid a bonus. Physicians also get paid more for taking on patients from low-income neighborhoods. This means it’s easier for parents to bring their children in for routine care, without having to wait too long or take a day off.