JANUARY

THE NETHERLANDS
Decisions about the benefits package rest with the health minister. The Dutch Health Care Authority
(Nederlandse Zorgautoriteit) has primary responsibility for ensuring that the health insurance, health care
purchasing, and care delivery markets all function appropriately (e.g., by setting the prices for 30 percent of
diagnosis treatment combinations). Meanwhile, the Dutch Competition Authority (Autoriteit Consument en
Markt) enforces antitrust laws among both insurers and providers. The Health Care Inspectorate (IGZ) supervises
quality, safety, and accessibility of care. Self-regulation by medical doctors is also an important aspect of the
Dutch system (Smith et al., 2012). Private insurers are tasked with increasing health system efficiency and cost
control through prudent purchasing of health services.
The patient movement consists of a wide range of organizations, some for specific diseases and some
functioning as umbrella organizations. The patient umbrella organization Nederlandse Patiënten Consumenten
Federatie conducts a range of activities to promote transparency. Health Information Technology is not
centralized in one body. The Union of Providers for Health Care Communication (De Vereniging van
Zorgaanbieders voor Zorgcommunicatie) is responsible for exchange of data via an IT infrastructure.
What are the major strategies to ensure quality of care?
At the system level, quality is ensured through legislation governing professional performance, quality in health
care institutions, patient rights, and health technologies. In 2014, the National Health Care Institute was
established to further accelerate the process of quality improvement and evidence-based practice. The Dutch
Health Care Inspectorate is responsible for monitoring quality and safety. Most quality assurance is carried out
by providers, sometimes in close cooperation with patient and consumer organizations and insurers. There are
ongoing experiments with disease management and integrated care programs for the chronically ill.
In the past few years, many parties have been working on quality registries. Most prominent among these are
several cancer registries and surgical and orthopedic (implant) registries. Mechanisms to ensure the quality
of care provided by individual professionals include reregistration of specialists contingent upon compulsory
continuous medical education; regular on-site peer assessments by professional bodies; and professional clinical
guidelines, indicators, and peer review. The main methods used to ensure quality in institutions include
accreditation and certification; compulsory and voluntary performance assessment based on indicators; and
national quality improvement programs. Furthermore, quality of care is supposed to be enhanced by selective
contracting (e.g., volume standards for breast cancer treatment).
In 2014, a few pay-for-performance pilot programs featuring quality targets were initiated but, as yet, specifics
about the programs and effects are unknown. Moreover, in the new GP funding model, part of the old budget
is preserved for pay-for-performance projects. Patient experiences are also systematically assessed and, since
2007, a national center has been working with validated measurement instruments in an approach comparable
to that of the Consumer Assessment of Healthcare Providers and Systems, in the United States. Although
progress has been made, public reporting on quality of care and provider performance is still in its infancy
in the Netherlands. To stimulate the transparency movement, the Ministry of Health called 2015 the “year
of transparency.”
What is being done to reduce disparities?
Health disparities are considerable in the Netherlands, with up to seven years of difference in life expectancy
between the highest and lowest socioeconomic groups. Smoking is still a leading cause of untimely death.
The current government does not have a specific policy to overcome health disparities. In 2013, government
decided to include diet advice and smoking cessation programs in the statutory benefits package. Every four
years, health access variations are measured and published in the Dutch Health Care Performance Reports.
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