The Netherlands: Health System Review 2010

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14 Health systems in transition The Netherlands Fig. 2.1 Organizational overview of the Dutch health care system Zvw Wmo Parliament AWBZ Curative care Providers General practitioners Hospitals and specialists Pharmacies Other providers Health Care Inspectorate (IGZ) Wpg Health purchasing market Referral system Dutch Healthcare Authority (NZa) Ministry of Health, Welfare and Sport (and other ministries) Care offices (zorgkantoren) Long-term care Nursing homes Centre of Needs Assessment (CIZ) Health provision market Insurers Home care organizations Municipalities Health Care Insurance Board (CVZ) Advisory bodies: Health Council, SCP, RVZ, RIVM Health insurance market Dutch Competition Authority (NMa) Public health Citizens Services for occupational medicine (ARBO -diensten) Municipal health services (GGD) and youth care institutions Research and prevention: National Institute for Public Health and the Environment (RIVM) Quality control Contractual relationship Patient flow (referral system) Advice Acts
Health systems in transition The Netherlands 15 2.2 Historical background 2.2.1 Government involvement in public health As in other European countries in the first half of the 19th century, disease prevention in the Netherlands strongly focused on the alleged noxious mist and fumes so frequently occurring in the lowlands. The real causes for disease, namely polluted drinking water and mosquitoes, remained as they were. After clean drinking water and systematic sewage disposal were recognized as beneficial for improving public health, it took decades until public and private law created the necessary conditions for governmental action. In 1866, the Netherlands Society for the Promotion of Medicine (Nederlandse Maatschappij ter Bevordering van de Geneeskunst, NMG) published a mortality atlas in the first attempt to empirically understand the social conditions of health and mortality. Moreover, engineers became interested in issues of hygiene and sanitation, public housing and drinking water systems. The implementation of new insights and plans, however, was postponed as a result of conservatism and weak governance. Although in 1856 the central government advised municipalities to establish local health committees with medical experts to tackle poor hygiene and other public health threats, it took more than 10 years before these committees effectively cooperated in improving the urban population’s health. The growing awareness of public hygiene as a matter of collective interest – the prevention of mass epidemics – eventually laid the basis for community-based sanitary activities. Such activities started in the wealthy areas of cities and were later extended to slums and rural areas (De Swaan 1989; Van der Woud 2004). From the beginning of the 20th century, the organization of public health at local level was stimulated with the development of municipal health services (Gemeentelijk Gezondheidsdienten, GGDs). The first such services were established in Amsterdam, The Hague and Utrecht. Initially these departments were involved in control of infectious diseases and care for the poor. Until the Second World War, their number gradually increased, despite the absence of a legal obligation for municipalities to have a public health department. Later, new tasks were adopted, such as infant and youth welfare (including school health), TB care and district nursing. From the 1950s, smaller municipalities started to establish joint municipal health services. The 1982 Health Care Facilities Act (Wet Voorzieningen Gezondheidszorg) and later, in 1989, the Collective Prevention in Public Health Act (Wet collectieve preventie volksgezondheid,
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Page 3 and 4: Health Systems in Transition Willem
Page 5 and 6: Contents Preface � � � �
Page 7 and 8: Preface The Health Systems in Trans
Page 9 and 10: Acknowledgements The Health System
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Page 21 and 22: Abstract The Health Systems in Tran
Page 23 and 24: Executive summary Introduction The
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4. Regulation and planning The 2006
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116 Beds per 1 000 inhabitants 14 1
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190 30-day mortality 1.0 0.8 0.6 0.
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9. Conclusions The health care syst
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10. Appendices 10.1 References Acti
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The Health Systems in Transition pr
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The European Observatory on Health
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The Netherlands: Health System Review 2010

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