The Netherlands: Where have we been?

Abstract

Since 2006 the health care system has changed significantly in the Netherlands. It is based on the conviction that solidarity is a very important driving force in our society. Health care costs are financed by a dual system. All regular medical treatments (whether provided by a general practitioner or the hospital) are covered by a compulsory basic health insurance with one of the private health insurance companies. Medication costs are also covered by these insurance policies [1]. The insurance companies are obliged to provide a package with a defined set of insured treatments. The government decides every year which treatments are covered by the insurance. For instance in 2011 some treatments will no longer be covered (dental care for people older than 18 years; oral contraceptive agents for women over the age of 21) while others will be added (medication for smoking cessation). Some other costs, for instance the costs of a geriatric walker, are the subject of intensive political debate. On the one hand, the politicians try to cut costs, but on the other hand, they do not want to upset the public too much. So, for 2011, the walker can be reimbursed [2]. The insurance companies have to accept everybody for the same price for this basic package and they cannot refuse patients. The same premium is paid whether young or old, healthy or sick [3]. Affordability is guaranteed through a system of income-related allowances and individual and employer-paid premiums. In addition to this basic insurance package, it is possible to buy additional coverage for expenses that are not covered by this package. These additional packages differ markedly between the insurance companies and this is an area of intense competition. Furthermore, there is no obligatory acceptance policy with these packages and the insurance companies can refuse patients to buy these packages or demand a higher price.