The report is available in English with a French summary - KCE

KCE reports 57 Musculoskeletal & Neurological Rehabilitation 153
8.3 THE NETHERLANDS
8.3.1 Health care organisation in general
The Dutch health care system is characterized by some fundamental policy changes
since the end of the 1980’s 141 . In general terms, and due to problems both of serving the
population and of financing (cost containment), the system is trying to make the shift
towards a more flexible, demand oriented and market driven model. Policy makers are
less imposing the particular organization regimes, but are creating the frameworks of a
welfare state in which providers and the public is offered more flexibility in using and
providing health care. The system reform is often identified as a movement from a
“public regulated system” towards a “regulated market model”. The recent shift
towards “market oriented models” implies a shift of the steering power from the public
to the private sector.
The health care system changes are built on the assumption that more market forces
will enable a more efficient and effective health care system, and especially a more
flexible system that is able to handle the fast changing heath care needs and demands of
the public. The health care system changes aim at improving the quality whilst also
controlling public expenditure.
8.3.2 Health insurance
Since the mid 1990’ two major insurance regimes affected the use and right to medical
and social care: de ziekenfondswet (ZFW) en de Algemene Wet Bijzondere
Ziektekosten (AWBZ) The ZFW and AWBZ provided for benefits in kinds, while the
AWBZ also provides for cash benefits.
• Treatment and services available under ZFW are (in general terms):
medical and surgical treatment (including limited number of sessions
for physiotherapy and speech therapy); obstretic care, dental care,
pharmaceuticals, non psychiatric hospital admissions; aids and
appliances; transport, maternity care and care in an audiology centre;
costs for genetic testing, haemodialysis, services for patients with
chronic recurring respiratory problems, rehabilitation, and services of
a thrombosis prevention unit.
• The underlying principle of AWBZ is that people should continue to
live in their homes as long as possible, whether they receive care at
home or in an institution: For the AWBZ seven distinct functions are
defined: domestic help, personal care, nursing care, supportive
guidance (helping in the organization of daily life), activating guidance,
treatment, and accommodation
Since January 2006 a new, mandatory national health system, imposes individuals to
purchase private health insurance. A standardized basic coverage (Basisverzekering) is
guaranteed for all citizens by means of the Ziekte-Verzekerings-Wet (health care
insurance law) (ZVW):
• Medical care, including hospitalization (up to 365 days) and specialists;
• Dental care for children (under age 18);
• Specialist dental care and dentures for adults;
• Pharmaceuticals;
• Maternity and postnatal care for up to ten days after childbirth;
• Ambulance and transportation costs; and
• Some medical and paramedical rehabilitation services.