Health System in the Netherlands

Abstract

A lengthy process of policy efforts to reform the health-care system and to introduce managed competition into the system resulted in the new Health Insurance Act (Zorgverzekeringswet) in 2006. A single compulsory health insurance scheme was introduced, and managed competition for providers and insurers became a major driver in the health-care system. This has meant fundamental changes in the roles of patients, insurers, providers, and the government. Insurers negotiate with providers on price and quality, and patients choose the provider they prefer and join a health insurance policy of their choice. The system of managed competition is currently in place for the curative health-care sector and part of the mental health-care sector (ambulatory mental care and institutional mental health care up to 1 year). Since 2006, the role of the national government has changed from directly steering the system to safeguarding the proper functioning of the health-care markets. Long-term care (nursing care and long-term mental care) is regulated by the Long-term Care Act (Wet landurige zorg) and the Social Support Act (Wet maatschappelijke ondersteuning). During the past decade, social support for disabled and chronically ill and several forms of home care were already transferred to municipalities.

General practice plays a central role in the Dutch health-care system. All citizens are listed with a general practitioner (GP) or GP practice. GPs serve as gatekeepers: patients have to visit their GPs first for their health complaints and only upon referral they can go to a medical specialist. Furthermore, compared to other countries, the relative number of nurses is high.

Dutch citizens are on average very satisfied with their health-care providers, and the accessibility of the health-care system is excellent. However, so far, the Netherlands has not been successful in curbing the growth on health-care expenditure. The government tries to control costs in several ways, for instance, by increasing the compulsory deductible.