The Netherlands: Health System Review 2010

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Health systems in transition The Netherlands
growing health care expenditures. Furthermore, as already mentioned, the
Exceptional Medical Expenses Act (AWBZ) was introduced in 1967 to cover
catastrophic illness. The scheme was expanded over the years that followed
and eventually included psychiatric care, certain pharmaceutical services,
rehabilitation and home care services. The idea behind these successive
expansions of the AWBZ was gradually to develop a basic insurance scheme for
all Dutch citizens. In the 1990s, however, this aim was abandoned and the dual
system of health insurance for short-term and long-term care remained in place.
The 1973 oil crisis put pressure on the government to reverse its “laissezfaire”
health policy and to develop plans for far-reaching reforms of the
system with the aim, among others, of curbing rising expenditure on health
care. The basis for these plans was the 1974 White Paper on the Structure of
Health Care (Structuurnota Gezondheidszorg) (Hendriks 1974) in which the
government expressed its concern about the sharply increasing cost of health
care and, for the first time, formulated a coherent vision for the health care
sector. The most important characteristics of the intended reforms were: more
government influence on health care; decentralized planning of health care
facilities combined with more community influence and involvement; and the
substitution of care in hospitals by primary care, facilitated by a strengthened
primary care sector (Sixma 1997). A single national health insurance scheme
for all citizens, as proposed in the document, was rejected. However, despite
the measures taken, the costs continued to rise.
The strengthening of primary care became a priority again in 1983 with
the publication of the White Paper on Primary Care (Nota Eerstelijnszorg).
This proposed to promote efficiency in the health care system through a more
coherent provision of primary care services. In the meantime, patients started
to organize themselves and became an increasingly important driver for
change. The request for patient participation, in addition to the need to control
expenditure, contributed to the political insight that structural reforms were
unavoidable (Kappelhof 2005).
The 1987 Dekker Plan, called “Willingness to change” (Bereidheid tot
Verandering) was another attempt to realize the desired single health insurance
scheme for all Dutch residents. In contrast to previous plans, however, this one
was based on market principles. In a regulated market environment (managed
competition) health insurers would compete for insured persons, and, to
a limited extent, would negotiate contracts with health care providers. This
should result in lower and better controlled health care expenses. Ideas from the
Dekker Plan formed the basis of the Simons Plan in 1992, which was introduced