The Netherlands: Health System Review 2010

xxiv
Health systems in transition The Netherlands
have become part of the acute hospital sector. These centres provide selective
non-emergency treatments for admissions up to 24 hours. The number of acute
beds per population in the Netherlands is below the EU15 and EU27 averages.
The average length of stay is slightly above the EU15 average, but this is also
caused by a high degree of substitution to day care, leaving the more severe cases
to hospital care. Both indicators show a decreasing trend. Among long-term
care institutions a steady reduction of bed supply and an increasing overlap of
functions between nursing homes and residential homes can be observed. The
quality of long-term care facilities is a point of concern. Information technology
plays an important role in the Dutch health system. Most Dutch people would
welcome the opportunity to contact providers through the Internet, but this
option is scarcely offered.
About 7% of the population works in the health care sector and, since the early
2000s, the total number has grown by about one-fifth. Compared to other
countries the relative number of nurses is particularly high. Most numerous
are nurses working in home care and in care for the elderly and disabled. At
present (late 2009), substitution and transfer of tasks from medical to nursing
professionals is an important trend. Furthermore, the introduction of managed
competition and new governance structures has seriously affected the role of
professionals, especially in relation to health insurers, with whom they now
have to negotiate about quality and price of care. Medical education is provided
at each of the eight Dutch universities, while nurses can either be educated at an
intermediate, higher or academic level, depending on their professional profile.
The quality of health care professionals is safeguarded by obligatory registration
and by various licensing schemes maintained by professional associations.
Workforce forecasting and careful planning of educational capacity seek to
prevent shortages or oversupply of health professionals. In a small and densely
populated country like the Netherlands unequal distribution of providers is not
a major issue, although in some parts of large cities additional efforts need to
be made to match demand and supply.
Provision of services
In the Dutch health care system, private health care providers are primarily
responsible for the provision of services. Health care can be divided into
preventive care, primary care, secondary care and long-term care. Preventive
care is mainly provided by public health services. Disease prevention, health
promotion and health protection fall under the responsibility of municipalities.