A health survey ranking healthcare systems in Europe ranked the Netherlands, according to consumer value, at number one despite having one of the lowest spending levels on medicines in the continent.

The annual 2008 Euro Health Consumer Index compiled by private Swedish company Health Consumer Powerhouse (HCP) ranked 31 countries on the basis of a range of criteria including clinical outcomes, access to treatment, waiting times and patient rights.

The Dutch topped the list being hailed as a "truly stable top performer", with Denmark coming in second. Austria, in 2007 had the honor of topping the list while in 2006 it was France. In the current ranking France has dropped to 10th place as it "could not keep up with the improvement rate" according to the report.

The study said, "The Netherlands have started early on the work on patient empowerment, which now clearly pays off in all areas."

HCP President Johan Hjertqvist said, "It is justified to say that the Dutch have the best healthcare system in Europe. When the Obama healthcare policy team looks in Europe for inspiration it seems to be the right system to study."

In the ranking at third place was Austria followed by Luxembourg, Sweden and Germany. France was ranked at 10th place while Britain came in 13th and Italy took 16th rank and Spain 18th.          

According to HCP spokeswoman Kajsa Wilhelmsson, countries like Sweden and Netherlands spend more wisely as compared to the French. "The Swedes get the medicines they really need but they don't swallow the amount that the French do," she said. "It doesn't prove they are mean about new medicines just because they don't have a high spend. They might be using the money more efficiently on more modern rather than old drugs, or on generics."

Estonia beat Britain in performance and was said to "demonstrate how to deliver quality performance with relatively low levels of expenditure," according to the report summary.

The ‘Bismarck’ health care system followed in countries like Germany, the Netherlands, France and non-EU member Switzerland, have all found place in the list's top ten. Named after Prussian Chancellor Otto von Bismarck, the Bismarck system is based on social insurance, where there is a multitude of insurance organizations which are organizationally independent of healthcare providers.

The Beveridge system, named after William Beveridge, the social reformer who designed Britain's National Health Service, produces healthcare systems where financing and provision are handled within one organizational system, such as the National Health Services of Britain and Nordic states. "These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge," the report said.

Latvia came at the bottom of the list which was first published in 2005.