Health care in the Netherlands
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The philosophy underpinning the Dutch healthcare system is based on accessible, affordable, good quality care. The Dutch system has been shaped by a number of historical trends and developments and social conditions.
Foundation of the healthcare system
The Dutch healthcare system is governed by five basic healthcare-related acts: the Health Insurance Act (Zorgverzekeringswet), the Long-Term Care Act (Wet langdurige zorg), the Social Support Act (Wet maatschappelijke ondersteuning), the Public Health Act (Wet publieke gezondheid) and the Youth Act (Jeugdwet). In addition, there are several general laws in place (including the Competition Act (Mededingingswet)) and a number of specific healthcare acts (such as the Healthcare Quality, Complaints and Disputes Act (Wet kwaliteit, klachten en geschillen zorg)).
The five healthcare-related acts form the foundation of the healthcare system. The Health Insurance Act (which provides for hospital care) and the Long-Term Care Act (which focuses on other types of care) account for the bulk of the healthcare budget available in the Netherlands. The Long-Term Care Act is a national act governing healthcare throughout the Netherlands. In implementing the Health Insurance Act, private health insurance companies play a key role in a system based on ‘regulated competition’ and a number of specific public requirements. The central government and municipalities are jointly responsible for implementing the Public Health Act which focuses primarily on keeping people healthy. The Social Support Act and the Youth Act provide for other forms of care and support. The roughly 380 local authorities and the central government of the Netherlands are primarily responsible for enforcing these two acts.
Principles of the Dutch Healthcare System
he current Dutch healthcare system can best be explained by looking at a number of recent changes. In 2006 the new 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. It should be noted that virtually all health insurance companies in the Netherlands are not-for-profit cooperatives that allocate any profits they make to the reserves they are required to maintain or return them in the form of lower premiums. There are a total of 23 insurers in the Netherlands which bear a risk for their operations.
The Health Insurance Act has transformed the Dutch healthcare system from a supply-driven to a demand-driven system. Private health insurance companies are improving the healthcare system in a number of ways: shorter waiting lists and less red tape in conjunction with a greater focus on effectiveness and quality, in the interest of patients and policyholders. A process of selective contracting enables health insurance companies to control the effectiveness and quality of the care provided by healthcare providers. Members of the public, in turn, also have some degree of control over this process, since they are given the opportunity every year to switch healthcare providers and can influence the policies of health insurers and health institutions. While the healthcare system is essentially a private system, the government plays a controlling role in order to protect the public interest.
The Public Health Act dates from 2007 and replaced the Public Health (Preventive Measures) Act (Wet Collectieve Preventie Volksgezondheid). It also includes regulations on infectious diseases. The Public Health Act focuses on prevention and health promotion and makes it possible to respond quickly in the event of threats and in terms of dealing with an infectious disease crisis.
Long-term care, youth health services and social support
The Long-Term Care Act, the Social Support Act and the Youth Act were introduced more recently, having entered into force in their present form in 2015. The Long-Term Care Act is administered by special long-term care administrators commissioned by the central government. A number of activities the Long-Term Care Act administrators deal with are the responsibility of the healthcare administration offices. Among other things they purchase the care and are responsible for implementing the personal healthcare budget.
Additionally, several other organisations are involved in its implementation, such as the Care Assessment Agency (Centrum Indicatiestelling Zorg) and the Central Administration Office (Centraal Administratie Kantoor). The local authorities are responsible for implementing the Social Support Act and the Youth Act – they provide the support, assistance or care services or are supported in this process by a healthcare provider.
The motivations behind the creation of these laws are opportunities to improve the quality of the care provided, promote an integrated approach, and keep healthcare available and affordable in times of an ageing population and in which many people suffer from chronic illnesses. The foundation of these domains are people’s opportunities rather than their shortcomings. Initially, people are encouraged to draw on their own network and resources for support, but support is always available for those unable to secure it themselves. Those requiring permanent supervision or 24-hour home care are entitled to care services under the Long-Term Care Act.
The healthcare system was drastically overhauled in order to facilitate the enactment of the three new acts. As a first step in this process, the General Exceptional Medical Expenses Act was repealed. This act had come to cover a wide variety of care and support services over the years, as a result of which the system of long-term care was at risk of becoming unmanageable. Some of the people making use of the provisions under this act are currently covered under the Health Insurance Act, the Social Support Act or the Youth Act. Since 2015, all long-term care has been provided under the Long-Term Care Act, which is strictly intended for the most vulnerable categories of people.
econdly, the local authorities are responsible for administering and implementing the Social Support Act and the Youth Act. Many people who previously received care on the basis of the General Exceptional Medical Expenses Act can turn to the local government for lighter forms of care and support. The idea behind this change is that local authorities are closer to the people and are therefore able to provide effective, high-quality care. Local authorities also have plenty of options when it comes to pursuing a preventive health policy, including within other policy domains.
The five acts in practice
Private individuals may be affected by the five healthcare-related acts in the ways described below. For example, when someone needs to see their GP, is hospitalised, or needs nursing and care at home, this is paid out of the compulsory basic health insurance package under the Health Insurance Act. The central government and local authorities offer preventive care, for example youth healthcare for children aged between 0 and 18. Those who require permanent supervision or 24-hour home care can make use of provisions under the Long-Term Care Act after the Care Assessment Agency has carried out an assessment.
The Social Support Act and the Youth Act provide for other forms of support, assistance and care. For example, those who require home assistance or a wheelchair due to a disorder can apply for this care to the local authority. The latter can then arrange for support under the Social Support Act. If there are families that require parenting support, for example, if an autistic child requires support in everyday living, or if treatment has to be provided to a young person with a psychological disorder, the local authority can provide this under the Youth Act.
These are just a few examples of the care, assistance and support services provided under the five healthcare-related acts. A general description of the five acts can be found in the next four chapters of this publication. In these sections, we review the various parties involved, the types of support, assistance and care provided under the law, the quality of the care services provided, funding, and supervision.