The Netherlands: Health System Review 2010

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Health systems in transition The Netherlands
Principal health care reforms
In 2006, a structural health care reform was implemented in the Netherlands.
The reform can be seen as the realization of a long-standing political wish to
unite the old sickness fund scheme and the voluntary private health insurance
scheme. Early attempts to unite all health insurance schemes into a single
mandatory scheme failed at the beginning of the 1990s, mainly because of
strong opposition from health insurers, employers and physicians. During the
1990s, however, smaller reforms originating from early plans were gradually
implemented. This helped pave the way for basic health insurance for the whole
population before the final and successful attempt at reform in 2006. The reform
introduced managed competition supervised by independent bodies. The health
insurers, the health care providers and the insured became the market players.
These players interact with each other on three different sub-markets: the
health insurance market, the health care provision market and the health care
purchasing market. Reforms therefore, aim at the proper functioning of these
markets. Examples of reforms include giving patients the tools to make active
decisions when taking out health insurance, the establishment of a transparent
and uniform pricing system (e.g. for GPs, hospitals), selective contracting and
increasing the extent of free negotiations between health insurer and provider.
No structural changes in the health care system are foreseen in the future policy
agenda for health. The Dutch government aims to introduce small reforms that
further enable managed competition in the system. Other government aims are
to strengthen the position of the patients, to further strengthen primary care,
to introduce electronic patient records, and to implement further changes to
mental and long-term care.
Assessment of the health system
The Dutch health system is characterized by relatively low total health care
expenditure in terms of share of GDP compared to the EU15 but in terms of
per capita expenditure (in PPP, purchasing power parity), health expenditure
in the Netherlands was above the EU15 average in 2006. From an international
perspective, financial and human resources allocated to health care seem
sufficient to meet the needs of the population. In terms of physical resources,
the picture is more mixed. Although the number of acute beds is below the
European averages, the bed occupancy rate and average length of stay may