Health access reforms in the Caribbean Netherlands from 2010-2023

Abstract

Background: In 2010, the islands of Bonaire, Sint Eustatius and Saba became part of the Netherlands, one of the four constituent countries within the Kingdom of the Netherlands. Public administration, including the health system, was reformed, with the Dutch Government aiming for a “level of facilities acceptable within the Netherlands, taking into account the specific circumstances on the islands”. Reform content: The Dutch Health Ministry became responsible for legislating, financing and policy in a health system with limited stakeholders. The health policy agenda focused on building a public, tax-financed insurance system and improving and expanding service provision by (1) general practitioners, (2) medical specialists (on- and off-island), (3) nursing homes, home and youth care, (4) pharmaceutical care and (5) mental health services. Several providers on the islands were established post-2010 to improve care availability and standards. Results: The health budget doubled in a decade, on-island facilities have been upgraded or newly established, availability and quality of care and certain specialist services have increased, and a mandatory, universal health insurance coverage for all legal residents with high financial protection (within the system) and broad benefits was introduced. Conclusions: Following developments to reach an “acceptable” level, the next ministerial goal is to move towards levels of care that are “equivalent” to those in the European Netherlands. However, persistent gaps in the data landscape hinder an evidence-based approach to policymaking and need to be addressed in order to obtain a more comprehensive picture on the performance of the health system, which is also relevant for other health systems in the Caribbean Region.