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Workers enjoy bountiful medical benefits in Europe Health care in U.S. offers less, costs more


BRUSSELS, Belgium -- Most European countries are far more generous than the United States with workers who become sick or disabled. The Netherlands is beginning to realize that it has been generous to a fault.

So bountiful are Dutch sickness benefits that DSM, a chemical company in Heerlen, found that 13 percent of its 12,000 workers called in sick on an average day in 1979. So it began giving bonus vacation days to workers who had not been ill in the previous year -- which knocked the absentee rate to below 4 percent but also meant fabulous amounts of vacation for some workers.

Arthur Spierts, a DSM press officer, is entitled to 27 regular vacation days plus a 25-day bonus. "I can't take all 52 days off; it's impossible," he said. "I have so many days off that the problem is not the holidays; it's doing your job." This year Mr. Spierts plans only 42 days off. For the 10 vacation days that he won't take, DSM will pay him double.

The Dutch disability benefits law, dating to 1967, was deliberately designed to reduce the unemployment rate by purging the elderly from the labor force -- a sort of early retirement. Workers could qualify for full benefits if they could show that they had lost as little as 15 percent of their earning capacity.

Economist Leo Aarts of the University of Leiden says authorities expected the disability rolls to reach 200,000. Instead, they soared to 900,000. There is one Dutch citizen on disability for every seven in the labor force -- triple the U.S. rate, Mr. Aarts says.

Parliament tightened the law in 1987 by reducing benefits for the partially disabled and requiring them to look for work. With the Dutch economy in the doldrums, further cuts are under debate this year.

Bart Hoelscher, 28, hopes they do not touch him. He lost his job as chief of a grocery store's produce section in the southeastern Dutch town of Maasbree three years ago because pinched nerves in his back made it difficult for him to walk or even to stand. He received his full salary of about $900 a month (70 percent from the government, 30 percent from his employer) for a year and is still receiving about $650 while studying for a sit-down job as a personnel officer. Meanwhile, his wife works weekends in a nursing home.

If the disability program must be cut, Mr. Hoelscher said, the cuts should land on those who have abused the program, not on him. "I can't help it that I'm disabled," he said. "I can't help it that the economy is not running well."

Many European countries, unwilling to let their disabled subsist indefinitely on welfare, assume responsibility for rehabilitating them. Austria runs seven hospitals and four rehabilitation centers, some situated picturesquely in the Alps; it subsidizes care in a variety of homes and spas.

Klaus Foget, crippled at 19 in an automobile accident, does not know what would have become of him without Austria's rehabilitation program, under which he learned how to negotiate through life in a wheelchair; he studied hard enough to make himself a Vienna judge. Government-provided insurance paid for his wheelchair, adapted his house to his disability and covers his continuing orthopedic help. "If you show that you're willing to work," he said, "they'll help you."

For Europe's general population, national governments either provide or pay for most health care. Of the 24 industrial countries in the Organization for Economic Cooperation and Development, a club of 24 of the world's richest countries, in only two -- Turkey and the United States -- does the public sector's share of health care costs fall below half.

The U.S. medical profession insists that it delivers the best health care in the world.

This much is sure: The U.S. system is by far the most expensive. Health care consumes about 12 percent of U.S. economic output, half again as much as in most European countries. At the same time, Europeans seem far happier than Americans with their health care system. A 1990 study found satisfaction rates in Europe in the 40 percent to 50 percent range, compared with 10 percent in the United States.

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