The Netherlands: Health System Review 2010

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Health systems in transition The Netherlands
Organization and regulation
A major health care reform in 2006, introduced after almost two decades of
preparation, has brought completely new regulatory mechanisms and structures
to the Dutch health care system. The reform introduced a single compulsory
insurance scheme, in which multiple private health insurers compete for insured
persons. Health insurers can negotiate to a certain extent with health care
providers on price, volume and quality of care; and are allowed to make a profit
and pay dividends to shareholders. They are obliged to accept new applicants
and they are not allowed to differentiate their premiums according to the risk
profile of the applicants. The government changed its role from direct steering
of the system to safeguarding the process from a distance. Responsibilities have
been transferred to insurers, providers and patients. The government controls
the quality, accessibility and affordability of health care. The establishment
of new “watchdog” agencies in the health sector aims to avoid undesired
market effects in the new system. Furthermore, in long-term care as well,
increased competition among providers of outpatient services is changing the
system considerably. The delegation of responsibility for domestic home care
services to the municipalities has resulted in more diverse care arrangements.
Traditionally, self-regulation has been an important characteristic of the Dutch
health care system. Professional associations are responsible for re-registration
schemes and are involved in quality improvement, for instance by developing
professional guidelines. In addition to a well-developed advisory structure the
Dutch health care sector can rely on an extensive infrastructure for research
and development, covering medical research, health technology assessment and
health services research.
Financing
In the Netherlands, 8.9% of GDP was spent on health care in 2007. Between 1998
and 2007 the expenditure (in constant prices) increased in real terms by 38%.
The Dutch health insurance system is divided into three so-called compartments.
The first compartment consists of a compulsory social health insurance (SHI)
scheme for long-term care. This scheme provides for those with chronic
conditions continuous care that involves considerable financial consequences
and is regulated in the Exceptional Medical Expenses Act (Algemene Wet
Bijzondere Ziektekosten, AWBZ). The AWBZ is mainly financed through
income-dependent contributions. A complicated cost-sharing system applies to
individuals using AWBZ care. The care is provided after a needs assessment and