STEVE INSKEEP, host:
It's MORNING EDITION from NPR News. I'm Steve Inskeep.
DEBORAH AMOS, host:
And I'm Deborah Amos. In Your Health today, ever wish you could get a house call from a doctor? In the Netherlands you can any evening or weekend. NPR's Patti Neighmond went to the Netherlands as part of our series on health care in Europe.
Patti, why did you focus on after-hours care?
PATTI NEIGHMOND: Well, Deb, we're looking at countries that insure everybody and still spend less on health care than we do here in the U.S. One might expect that having doctors do house calls nights and evenings and weekends for everyone would be something no country could afford, but not so.
AMOS: OK. So how do they do it?
NEIGHMOND: Well, it turns out that getting sick and being treated by a primary care doctor, even after-hours, is a cost saver. The important word here is primary care doctor. In the U.S., some of these doctors do house calls, but the main place where people go to get care after-hours and on the weekends is often the hospital emergency room. Now, that's partly because many people are uninsured and they don't even have a family doctor.
But the emergency room is an expensive place to get medical care. So in the Netherlands, every neighborhood has what they call an after-hours clinic or a post. And I spent one evening with doctors who work in one low-income neighborhood in Amsterdam.
AMOS: All right. So let's hear what it's like.
(Soundbite of phone call)
Ms. LITA VAN DEN BURG (Physician's assistant): (Dutch spoken)
NEIGHMOND: It's early evening, 6:00, and things are beginning to bustle. A couple of doctors gulp down dinner, a paramedic checks his medical bag for supplies, and Lita Van den Burg begins to field phone calls.
Ms. VAN DEN BURG: (Dutch spoken)
NEIGHMOND: Van den Burg is a physician's assistant trained to figure out when patients can stay home and when they need to come in to the clinic. She offers a variety of advice for things like ointments for rashes, what to expect with an ankle strain, whether a fever is serious or not.
And sometimes she'll tell patients to come on into the clinic. On this night, they'll see Dr. Nora Bartelsman, the family doctor on duty.
Dr. NORA BARTELSMAN (Primary Care Physician): And what do I have? Children with fevers, back aches, skin rashes, infected eyes, bladder infections, anything. The more serious situations, we'll visit patients in their homes. And what would be serious? Just a moment, please.
Oh, she - my colleague has two house calls at the moment.
NEIGHMOND: Bartelsman's colleague, Dr. Pascale Paques, has just received word that a patient who needs care is bedridden and can't come to the clinic. The patient's son is on the phone.
Dr. PASCALE PAQUES (Primary Care Physician): They can't really judge the situation. He just says that his father can't get out of his bed anymore, and he doesn't - he can't tell anymore details. So we just have to go and have a look at what's going on.
So Paques and her partner, Gerard Kuil, a paramedic who also drives the car, head out.
Even their transportation is geared to primary care. They drive around in what looks like a half ambulance, half taxi. It's a small Audi, painted bright yellow and blue, with a siren stashed inside that can be put on top of the car if need be. They have some medical gear but not a lot. As they drive to the patient's home, another call comes in.
Dr. PAQUES: Hello?
Unidentified Man #1: (Dutch spoken)
NEIGHMOND: About five minutes later, Paques and Kuil arrive at the first patient's home.
Dr. PAQUES: Hello.
Unidentified Man #2: (Dutch spoken)
NEIGHMOND: Ushered in, Paques heads up a steep narrow staircase. At the top, there are two tiny bedrooms with twin beds. In one room, a frail man lies in a sort of fetal position. His son wrings his hands. He explains to the doctor that his father is 91 years old and unusually listless. He won't get out of bed, not even to help his elderly wife, who he usually cares for. She's quite sick too, and in bed in the next room.
Dr. Paques begins her exam.
Dr. PAQUES: Hello. (Dutch spoken)
Unidentified Man #3: (Dutch spoken)
Dr. PAQUES: (Dutch spoken)
NEIGHMOND: Paques coaxes the man to sit up, takes his blood pressure, taps gently on his belly.
Dr. PAQUES: (Dutch spoken)
Unidentified Man #3: (Dutch spoken)
NEIGHMOND: Paques decides this is not heart failure, even though the patient's calves and face are really swollen. She gives him an injection to relieve the fluid build-up and then gives the son a prescription for more diuretics and tells him to check in with the doctors in the morning. The son agrees, thanks the doctor, and then it's off...
(Soundbite of car)
NEIGHMOND: ...to the second house call.
This is an assisted living facility. It's bright and clean, particularly in contrast to the first house. This patient is also elderly, but he's up and about.
His wife answers the door. They speak with Dr. Paques and the patient describes abdominal pain that has now subsided. Paques decides to do an exam anyway.
Dr. PAQUES: (Dutch spoken)
Unidentified Man #4: (Dutch spoken)
NEIGHMOND: The patient's a little embarrassed that the doctor came here and the pain is gone, but the doctor says better safe than sorry. She suggests the patient had a hernia that retreated.
After cordial goodbyes, it's on to the next patient, a terminally ill man with prostate cancer who is vomiting from chemotherapy. Paques gives his wife a prescription for anti-nausea medication. There's not much more she can do.
Back at the clinic, Paques enters her notes about her treatment of each patient into their electronic medical records. Just like their family physicians, she has access to all the information about these patients and can pass along what happened this evening. A seamless communication system.
Paques is about to settle in, but she gets a call about another patient...
(Soundbite of phone ringing)
NEIGHMOND: ...an elderly diabetic woman who's disoriented and dizzy. This could be serious. Paques nearly runs to the car and gets to the patient's home within 10 minutes. The patient's son, Rudolph Heemeijer, is amazed at how quickly she got there.
Mr. RUDOLPH HEEMEIJER: I was still hanging on the phone; there was a miscommunication with the operator. I was waiting for an answer if will - if the doctor will come, and then the doctor was here and I was still hanging on the phone.
NEIGHMOND: This is longest visit of the evening so far. Paques talks with the patient, her two sons, her husband, examines her and decides the patient must go to the hospital. Paques calls an ambulance and leaves the son in charge.
Of the six patients she's seen tonight, this is the only one she admits to the hospital.
Dr. PAQUES: Well, I do think house calls are very good to have, because, as you can see, several people who were quite ill weren't really able to come with their own transport to the GP or hospital, whatever, I could still manage to keep it home.
NEIGHMOND: A more comfortable situation for the patient, says Paques, and a lot less costly for the health care system.
Dr. PAQUES: The cost of an ambulance is already very high and as soon as you're in a hospital you have to do a certain amount of tests which we don't do. And very often you can keep people at home, especially if they're very ill or terminally ill. I think it's much more patient friendly and also better for your budget.
NEIGHMOND: And for those patients who were able to travel to the clinic and see Dr. Nora Bartelsman, it's still a cheaper option than a hospital ER. While Dr. Paques was out on house calls, Bartelsman saw about 30 patients in the clinic.
Dr. BARTELSMAN: Anxiousness is always a good reason to see someone. If parents are worried about a sick child, we let them come. If they have symptoms that haven't been going away, we let them come. If they have things that we think need to be seen - and especially on Friday evening - you know, it's a long wait until their doctor's are back again on Monday, so we'd rather see them now than wait till Monday to see their own doctor when they could have been treated much earlier.
NEIGHMOND: Across the Netherlands, there are about 120 after-hours clinics like this one. And over 90 percent of the Dutch population have access to them.
Patti Neighmond, NPR News.
AMOS: You can get a big picture view of how the Netherlands health care system stacks up against other European countries and America at npr.org/yourhealth.
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