The Netherlands: Health System Review 2010

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Health systems in transition The Netherlands
Wcpv) made a municipal health service (GGD) obligatory and made the
municipalities responsible for management and funding (GGD Zuidhollandse
Eilanden 2009).
An organized system of state medical inspection was first established in
1865 following the Health Act (Gezondheidswet). In the 20th century, four
areas of state inspection were distinguished: health care, pharmaceutical care,
mental health care and veterinary care. In 1995 the former three areas merged
to become the Health Care Inspectorate (Inspectie Gezondheidszorg, IGZ). The
Inspectorate, an independent advisory body to the Ministry of Health, Welfare
and Sport, supervises the quality and accessibility of care. At present (2009), in
addition to IGZ two more inspectorates are relevant to public health: the Food
and Consumer Product Safety Authority (Voedsel en Waren Autoriteit, VWA)
and the VROM Inspectorate (VROM-Inspectie) (Health Care Inspectorate
2009). The latter enforces legislation in order to guarantee a safe, healthy and
sustainable living environment in the Netherlands.
2.2.2 Towards sickness funds: development of health insurance
Early predecessors of the sickness funds were mutual funds founded in the first
half of the 19th century by charities, physicians, pharmacists and other private
individuals. With the rise of industrial capitalism in the late 19th century, new
funds were established, for example by labour unions, to support the industrial
proletariat in case of illness, the need for medical care and unemployment.
Despite the gradual increase of central powers, the liberal non-interventionist
traditions of those days prevented the government from taking initiatives
related to health care and health insurance. However, from the beginning of
the 20th century this tendency changed and the government gradually became
more involved in solving social problems, including those related to illness. A
reflection of this change was the 1901 Accident Act (Ongevallenwet), which can
be seen as a first step towards a system of social insurance in the Netherlands
(De Swaan 1989; Veraghtert and Widdershoven 2002).
Fragmented voluntary arrangements were gradually replaced by obligatory
state health schemes (De Swaan 1989; Veraghtert and Widdershoven 2002).
The adoption in 1913 of the Sickness Act (Ziektewet) marked the end of fully
autonomous funds and the start of government interference in the health
insurance sector. However, it took decades before a system of health insurance
became operational. Implementation of the 1913 Sickness Act was not achieved
until 1930, after many political conflicts. Eventually, the Act only covered
sickness benefits, excluding medical expenses. Until the Second World War all