The Dutch have the best health care system in Europe, according to a new 31-nation league table which puts the UK in 13th place, noting that waiting times and access to cancer drugs are “still a problem” in Britain.

The annual Euro Health Consumer Index (EHCI), which ranks national health care systems based on performance in six categories, judged Denmark (placed second overall) to be this year’s category leader in terms of patient rights/information and e-health, while the best for waiting times were Luxembourg (fourth overall), Germany (sixth) and Switzerland (seventh). The other category leaders were: for outcomes – Sweden (sixth overall); range and reach of services – Netherlands; and pharmaceuticals – Austria (third overall).

Denmark, Hungary and Luxembourg have made strong improvements in their health services since last year, but those of Belgium, France, Sweden, Cyprus and Portugal have deteriorated, says the Index, which is published by consumer advocacy group Health Consumer Powerhouse (HCP). While the table’s lower rankings are generally occupied by central and eastern European countries – with Latvia at the bottom – Estonia is in eleventh place, and receives praise for providing a value-for-money service, reducing waiting times and improving access to new medicines.

The UK has made some notable advances since last year’s rankings, but the Index points not only to continuing problems with waiting times and availability of cancer drugs but also that its outcomes remain “surprisingly poor.” In its recommendations, HCP calls on the National Health Service (NHS) to allow patients to have direct access to specialists, and says the government should inform patients that they have the right to seek treatment abroad, for example when they are faced with long waiting times. “This might put the appropriate pressure on the NHS to shape up,” it says.

Among the poor-performing richer nations, the index notes that Belgium, which has dropped to 12th place, is still “remarkably slow” at offering access to new medicines, and asks why such access is also so poor in Luxembourg’s well-funded system. The introduction of new cancer drugs in Norway is also too slow, given the country’s levels of expenditure, it adds.

Many European countries are building a problem with waiting times, and to alleviate the access issue the HCP calls for the abolition of primary care gatekeepers, “particularly as there is no evidence supporting the theory that gate-keeping saves money,” it says.

Overall, the study stresses the link between medical outcomes and ease of access to services and quality information for patients, and reports that, throughout Europe, education of patients and the general public “would provide a marked improvement in care and outcomes.” There is also a general need for earlier diagnosis, more active follow-up, and greater transparency, said HCP president Johan Hjertqvist, who asked: “how can a healthcare system be guided and directed without records of what it actually delivers?”

When US President-elect Barack Obama’s healthcare policy team looks to Europe “for inspiration,” they should find it in the Netherlands, he concluded.

- The NHS Confederation, which represents over 95% of NHS organisations, has dismissed the ECHI, saying that it "should carry its own health warning pointing out that anything but the broadest comparison using their figures is meaningless."

The figures take different data collected in different ways from health services that do not even offer the same range of services, and not account is taken of whether people have to pay for some services or not, said the Confederation's policy director, Nigel Edwards.

"Everyone involved in the NHS knows that it needs to improve, but these figures have little to add in helping that process," he added.