title: Quality and cost of healthcare: a cross-national comparison of American and Dutch attitudes.
abstract: OBJECTIVE
  To compare attitudes of consumers in America and Holland toward the quality and cost of healthcare.
  
  
  METHODS
  Data were derived from one American (n = 466) and two Dutch (n = 260, n = 1629) surveys.
  
  
  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 more likely to implicate defensive medicine and an increase in diagnostic procedures.
  
  
  CONCLUSIONS
  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.
authors.affiliation: New Jersey Medical School, Newark, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Lindenthal
authors.forename: C J
authors.initials: CJ
authors.lastname: Lako
authors.forename: M A
authors.initials: MA
authors.lastname: van der Waal
authors.forename: T
authors.initials: T
authors.lastname: Tymstra
authors.forename: M
authors.initials: M
authors.lastname: Andela
authors.forename: M
authors.initials: M
authors.lastname: Schneider
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D003431:Cross-Cultural Comparison; D003675:Defensive Medicine; D004358:Drug Therapy; D017048:Health Care Costs; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D011787:Quality of Health Care / Q000145:classification*; D011795:Surveys and Questionnaires; D013675:Technology, High-Cost; D014481:United States