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KCE reports vol.40 APPENDICES Physiotherapy 29
5. THE NETHERLANDS
5.1. BACKGROUND INFORMATION ON THE HEALTH CARE
SYSTEM
5.1.1. Health care delivery
Health providers, particularly in primary care (PHC), are (mostly) private. There is a strong emphasis
on primary health care, with general practitioners required to act as gate-keepers to secondary care.
5.1.2. Statutory Health Insurance
Entitlement to the statutory health insurance used to be based on income: 60% of the population was
then publicly insured, while 40 % of the population (those with higher income) had to opt for a private
insurance scheme.
The health insurance system has recently undergone a dramatic reform and is now (since 01-01-2006)
defined as a system under private law, with public features , (1). The private law means that health
insurance is provided by private insurance companies (and care offered is predominantly private). The
public features incorporate some market regulations for those medical insurers willing to participate
in this system, such as the definition of minimal requirements for a compulsory basic care package ;
the obligation for the insurer to accept anybody who applies for this basic package; and the
interdiction to charge different premiums to persons insured for the same range of services and
conditions within this basic care package (no risk selection).
All residents in the Netherlands must be insured for the basic health package, through the private
insurer of their choice. All residents must also pay an income-related contribution to a state-managed
centralised Health Insurance Fund (one of the purpose of this fund is to compensate insurers insuring
high-risk people).
The Health Insurance Act defines the modalities of this new compulsory insurance against the costs of
curative care, including its contents and extent of coverage, as well as several particular features
designed to take into accounts special groups (workers, children, low-income people ). In addition
the costs of prolonged nursing and care are covered by a statutory, compulsory insurance defined by
the Exceptional Medical Expenses Act. Protection against types of care not covered by these 2
compulsory health insurances can be purchased under the form of supplementary, voluntary health
insurance. Supplementary health insurances are not subject to regulation other than regulations
applied to insurances in general.
The care insurer might decide whether to provide the insured care through its own network of
services, or to reimburse the costs incurred with the care provider chosen by the patients.
5.1.3. Health insurance and ambulatory physiotherapy
Until 2004, publicly insured patients (60% of the population) were entitled to 9 sessions of
physiotherapy per year; those with chronic diseases were entitled to 18 sessions per year. Since
2004, entitlement within the public insurance has been limited to and to chronic diseases (for these,
there is a deductible of 9 sessions per year: first 9 sessions are paid by the patients) and to children