The Dutch Healthcare System: Public-Private healthcare, Challenges, Trends, Secondary care Drivers, and Priorities

GDP growth in the Netherlands over the last 5 years has been relatively stable.  Exports remain the Dutch economy’s main growth driver, alongside private consumption and private investment. With domestic demand on the rise again, virtually all industries are set to benefit from a growing demand for their goods and services for the third consecutive year in 2016. The Netherlands ranks 25th in the world in terms of Purchasing Power Parity (PPP).

In 2015, health expenditure in the Netherlands accounted for 10.75% of the GDP. It is expected to decrease very slightly in 2016 (to 10.61%), though the absolute expenditure value will rise by 1.8%.

Introduction to the Netherlands: its economy and how public healthcare is provided privately

Under the Dutch healthcare system, the public sector has a supervisory and regulatory role over the provision of care which is dominated by the private sector. Around 81% of hospitals in the Netherlands are owned and managed on a private not-for-profit basis, with specialists working on a self-employed basis.

Hospitals are private organizations but they are not allowed to pay out profits to third parties or shareholders (e.g. health insurers).

Providers of the basic and supplementary health insurance in the Netherlands are also private, governed by private law and permitted to have for-profit status although they are regulated by the Dutch Health Insurance Fund (CVZ).

Organization of healthcare provision in the Netherlands

In 2006 the Health Insurance Act entered into force, under which all residents of the Netherlands are entitled to a comprehensive basic health insurance package. This act is implemented by private, competitive health insurers and healthcare providers.

The healthcare system in the Netherlands is divided into 3 sectors or compartments, which are:

  • Long-term care for chronic conditions
  • Basic and essential medical care from GP visits to short-term hospital stays and specialist appointments or procedures
  • Supplementary care, for example dental work, physiotherapy, cosmetic procedures

Care provision under the first and third compartments does not vary significantly, however the second compartment can vary as described below.

Compartment 1:  Long-term Care for Chronic Conditions
  • Under this compartment, care is provided regardless of the patient’s financial situation and it is regulated through the Exceptional Medical Expenses Act (AWBZ) fund.
  • The AWBZ is currently funded through the Long Term Care Act (WLZ) and contributions to this fund are taken from income-related salary deductions, supplemented by a general government revenue grant.
Compartment 2: Basic Essential Medical Care
  • In this compartment, the private health insurance market is responsible for providing a basic package of health insurance to all Dutch citizens (Zvw).
  • Government finance schemes help to ensure that the accessibility of care is maintained, regardless of income. It also provides a safety net for illegal immigrants.
Compartment 3: Supplementary Care
  • The third compartment consists of a voluntary (supplementary) insurance aside from the Zvw.
  • In this compartment, there is a wide range of coverage that differs depending on the insurer. Premiums vary widely, as well.

Trends in the secondary care sector

  • The number of acute beds per person in the Netherlands has been below the European average for several years (currently 332 per 100,000 people with the EU average at 356).
  • The number of acute beds is rising and bed occupancy rates have been falling.
  • The availability of diagnostic imaging is unusual in international terms, with relatively few MRI and CT scanners by EU standards but proportionately many PET scanners.
  • The high population density means that most Dutch citizens are within a 25-minute drive to a hospital.

Priorities and drivers of hospital development

Current hospital priorities include:

  • Streamlining communication with municipalities and the primary care sector
  • Improving care pathways
  • Shortening waiting times for elective surgeries
  • Improving the overall quality of care
  • Strengthening the usage of information technology systems
  • Shifting the focus from inpatient care to outpatient settings and to day-care surgery

Challenges facing the Dutch healthcare system

Although the Dutch healthcare system is highly developed and considered one of the best in the world, there are still several challenges to overcome.

Challenges (described in further detail below) include:

  • Changing demographics and increases in chronic diseases
  • The need for further innovation
  • Large socioeconomic variations in health status
  • Quality of care
  • Achieving higher levels of quality
  • Long-term care under pressure
  • Financial sustainability
  • Stuck between the old and the new system
  • Policy changes and sustainability

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