The Dutch like their health care system and feel comfortable with it, polls show, even when things don't go exactly as they want. This is in no small part because they have built a system that reflects national values such as pragmatism and stoicism.
Paul Schnabel, a sociologist at Utrecht University in The Netherlands, says this correlation is especially apparent when it comes to matters of birth and death.
In the Netherlands, most women try to have their babies at home. They view giving birth as something that should be natural, not medical, Schnabel says, and services across the country reinforce this idea. For example, in Amsterdam there's a center for pregnant women that combines a spa, shopping center and school — not something one would likely see in the United States.
Only 8 percent of all Dutch women use epidurals for pain relief during childbirth.
Pain helps guide the birthing process, says midwife Beatrijs Smulders, one of The Netherlands' most vociferous proponents of natural childbirth.
"If you feel pain while pushing, you stop for a while, stretch and then push again," Smulders says.
Women who use epidurals might not know when to rest, causing greater damage to their system because they aren't in touch with their pelvic floor, she says.
Dutch doctors don't necessarily agree with that line of thought, but whatever the case regarding pain, one thing is clear: The Netherlands has an infant mortality rate that's about 25 percent lower than in the United States.
The Dutch also feel strongly that death is something highly personal and that patients should be in control. The Netherlands passed a law to legalize euthanasia, permitting doctors to help patients die by giving them a lethal dose of medication.
"You could say it's very much accepted by the general population that people can decide at the moment you would like to take steps to die and that you could help them," Schnabel says.
It's acceptable for people with painful conditions, such as cancer, to decide when they want to step out of it rather than prolong their medical treatment, he says. Ultimately, the health care system ends up saving money.
An Anti-Medication Attitude
Dutch culture emphasizes that dealing with life's problems helps usher young people into adulthood. In keeping with this view, it is considered preferable to endure aches and pains without resorting to medication.
General practitioners are encouraged to keep patients away from unnecessary drugs.
"Most pains will go away by themselves" is the philosophy, Schnabel says. If patients are given medication, doctors are careful to prescribe the minimum amount for the minimum time.
As a result, the Netherlands spends less than half what the United States does on medications per person.
But some things are changing. In the town of Maastricht, in the southern part of the Netherlands, obstetrician Jan Nijhuis says more women are requesting epidurals — underscoring that a health care system built around culture may not be a good fit for all.
"Many women get frustrated because they have so much pain, and they can't get an epidural — they think they are being told they are losers and can't perform well. That's very sad," he says.