A Peek into the Dutch Healthcare System

Dutch citizens enjoy a significant amount of freedom in terms of where they purchase their health insurance and the facilities from which to receive care. Under this system, the government is responsible for the accessibility and general quality of healthcare, but not its management. Patients are automatically ensured under the AWBZ plan, and they are responsible for getting enrolled under their own basic insurance or Zvw plans. Total health expenditure in the Netherlands accounts for about 13 percent of the GDP. Of that amount, about 86 percent stems from public expenditures and 14 percent from private sources.

The Dutch Universal healthcare system has maintained a top position in the annual Euro Health Consumer Index (EHCI), which has been comparing healthcare systems across Europe during the past five years. Ranking is based on 48 indicators, including patient rights and information, accessibility, prevention and clinical outcomes.

Dutch citizens enjoy a significant amount of freedom in terms of where they purchase their health insurance and the facilities from which to receive care. Under this system, the government is responsible for the accessibility and general quality of healthcare, but not its management.

Affiliation to the national health insurance is mandatory (under risk of being fined) and there are currently two main parts or sections:

  • Zorgverzekeringswet (Zvw): This plan is referred to as the “basic insurance” and it covers common medical care.
  • Algemene Wet Bijzondere Ziektekosten (AWBZ): This plan offers coverage such as long-term nursing care.

Patients are automatically ensured under the AWBZ plan, and they are responsible for getting enrolled under their own basic insurance or Zvw plans.

Basic health insurances function as a combination of private providers offering plans with built-in social conditions established on the principles of solidarity, efficiency and value for the patient.

Since the 2006 reform of the healthcare system, the role of the government switched from having direct control over volumes, prices and productive capacity to playing an increased role in monitoring and making sure that the market is functioning properly.

This completely changed the market dynamics to a system in which there are three main players: Insurers, patients and healthcare providers. The healthcare market itself can be divided into three main areas, which are: Health insurance, healthcare provision and healthcare purchasing.

The health insurance market: Health insurers offer the basic insurance package to citizens, who are obliged to insure themselves.
The health care purchasing market: In this area health insurers can negotiate with providers on price, volume and quality of care.
The healthcare provision market: In this area, providers offer care to patients. In principle, patients are free to choose their provider. However, health insurers may impose restrictions to this free choice.

Like most of its Western European counterparts, The Netherlands scores quite well on most healthcare parameters such as health status, infrastructure, access to medical services etc.

Under the Dutch healthcare system, primary care practitioners serve as gatekeepers or first point of contact. Patients must first see a GP and receive a referral before they can go on to secondary care with a specialist.

Healthcare Expenditures

Total health expenditure in the Netherlands accounts for about 13 percent of the GDP. Of that amount, about 86 percent stems from public expenditures and 14 percent from private sources.

Public expenditures are as follows:

  • Government contributions: 15%
  • Income taxes: 39%
  • Nominal premiums and income dependent employer contributions: 32%

Private expenditures are as follows:

  • Out of pocket payments: 10%
  • Supplementary Health Insurance: 4%

In terms of expenditures, the largest sums are spent on treatments related to cardiovascular disease and mental illnesses. At the same time, rapid increases in expenditure have occurred for cancer, diseases of the nervous system and sensory organs as well as metabolic diseases.

These conditions have higher prevalence rates among the elderly, indicating a relatively strong effect of population aging on future health expenditures.

The treatment and management of these diseases is evolving and resulting in newer and more expensive medications; further adding to the increased costs.

In the Netherlands, all citizens contribute to the Social Health Insurance (SHI) scheme in two ways:

  • The first way is by paying a flat rate premium or nominal premium directly to an insurer of their choice.
  • The Second way is for an income dependent employer contribution to be deducted through each individual’s payroll and transferred to the “Health Insurance Fund”. These resources are then allocated among the health insurers according to a risk-adjustment system.

The government defines the standard nominal premium from which they can decide which income groups will receive financial help in order to pay insurance premiums.

Insurance Companies

As previously mentioned, patients under the Dutch healthcare system may choose from a wide array of private insurers, which are governed by private law and have a “for-profit” status despite the fact that they are tied into the Health Insurance Fund.

Such firms must be registered with the Supervisory Board for Health Insurance (CTZ).

This registration process facilitates the supervision of the services provided under the Health Insurance Act and makes the company eligible to receive payments from the risk equalization fund.

The Health Insurance Fund

Health insures under the Dutch healthcare system are not permitted to risk select. In order to diminish some of the risk, insurers are required to send the nominal premiums they collect directly to the Health Insurance Fund (CVZ).

In turn, the CVZ pools and redistributes the money collected through income-related payments. The amounts redistributed take into account the original choices made by consumers, after being adjusted for “solidarity criteria” related to age, gender, region and/or disability.

Additional calculations include:

  • Pharmacy-based cost groups (PCG’s): which assess the response of chronic disease to prescription drugs and
  • Diagnostic Cost Groups (DCG’s), which allocate risk according to about thirty major diseases that patients may have.

The aim of this system is to be fair to both individuals and insurers.

Additional Public Health Insurance

Many patient’s choose to purchase supplemental voluntary insurance to help cover the types of care that are not covered under the basic package (e.g. some types of dentistry and physiotherapy, procedures that are considered cosmetic).

Individuals can also purchase supplementary private insurance to help guarantee faster access to care.

 

For further quantitative information on the Netherlands healthcare system and the macroeconomic climate, please look into our Business intelligence platform or order the TforG Deep Dive report for The Netherlands containing volumes of 620 surgical procedures in 13 specialisms.