Dutch realities: Evaluating health care reform in the Netherlands from a human rights perspective

Abstract

In light of the rising costs of health care, the Netherlands has introduced regulated competition into its health care system from 2006 onwards. In addition, it is trying to contain the costs with the gradual introduction of a number of austerity measures. This chapter looks at these developments from the perspective of the internationally guaranteed human right to health, thereby paying particular attention to the dimension of 'access to health care' under the right to health. An assessment is made of the legal entitlements to health care, and the recognition of the right to health care in the Netherlands. Subsequently, the Dutch health care system is analysed in light of an important component of the human right to health, i.e. the 'AAAQ' requirements, which stipulate that health care services have to be available, accessible, acceptable and of good quality. This will be followed by an analysis of the governmental 'obligation to protect', in the light of which attention will be paid to accountability mechanisms for addressing possible failures to realise the right to health (care) in the Netherlands. The overall aim of this chapter is to illustrate how from the perspective of the right to health a developed country like the Netherlands tries to cope with a number of serious challenges in the health sector. Our main findings are that while the international right to health is not given much recognition in the Netherlands, the notions underpinning this right are embedded in Dutch law, policies and practice. In terms of health outcomes, issues of concern are the rising socio-economic health inequalities, which raise the question of how such inequalities can best be tackled, for example by improving the living conditions of disadvantaged groups within the population and by placing more emphasis on prevention. Furthermore, health care privatisation and the recent cuts in health care expenditure raise some issues with regard to the 'AAAQ', for example in terms of geographic accessibility and affordability of care. When it comes to accountability and participation in the Dutch health care system, the problems are not so much a lack of mechanisms, but rather a lack of coordination and efficiency.