Total Health Spending, USD PPP Per Capita (2019): $5,765

(Note: “Health spending measures the final consumption of health care goods and services (i.e. current health expenditure) including personal health care (curative care, rehabilitative care, long-term care, ancillary services and medical goods) and collective services (prevention and public health services as well as health administration), but excluding spending on investments. Health care is financed through a mix of financing arrangements including government spending and compulsory health insurance (“Government/compulsory”) as well as voluntary health insurance and private funds such as households’ out-of-pocket payments, NGOs and private corporations (“Voluntary”). This indicator is presented as a total and by type of financing (“Government/compulsory”, “Voluntary”, “Out-of-pocket”) and is measured as a share of GDP, as a share of total health spending and in USD per capita (using economy-wide PPPs).”

Source: OECD (2021), Health spending (indicator). doi: 10.1787/8643de7e-en (Accessed on 20 January 2021).
https://data.oecd.org/healthres/health-spending.htm

Current Health Expenditure Per Capita (USD) (2016): $4,742
Current Health Expenditure as Percentage of Gross Domestic Product (%) (2016): 10.4%

Source: World health statistics 2019: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.
https://apps.who.int/iris/bitstream/handle/10665/324835/9789241565707-eng.pdf
https://www.who.int/gho/publications/world_health_statistics/2019/en/

Domestic General Government Health Expenditure as Percentage of General Government Expenditure (%) (2017): 15.3%
Population with household expenditures on health greater than 10% of total household expenditure or income (2010-2018) (%): NA
Population with household expenditures on health greater than 25% of total household expenditure or income (2010-2018) (%): NA

Source: World health statistics 2020: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2020.
Licence: CC BY-NC-SA 3.0 IGO.
https://www.who.int/gho/publications/world_health_statistics/2020/en/
https://apps.who.int/iris/bitstream/handle/10665/332070/9789240005105-eng.pdf?ua=1

Annual out-of-pocket payment, constant (2017) PPP per capita (USD) (2017): $545

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed Nov. 14, 2020.
http://apps.who.int/nha/database/

Out-of-Pocket Spending as Share of Final Household Consumption (%) (2017): 2.6%

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

Remuneration of Doctors, Ratio to Average Wage (2017)
General Practitioners: 2.3 (Salaried); 2.4 (Self-Employed)
Specialists: 3.3 (Salaried); 3.6 (Self-Employed)

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

Remuneration of Hospital Nurses, Ratio to Average Wage (2017): 1.2
Remuneration of Hospital Nurses, USD PPP (2017): $69,400

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

“The Netherlands is no longer one of the frontrunners in health spending in Europe, with Norway, Germany, Austria, and Sweden spending more per capita (Figure 9). In 2017, 10.1 % of GDP was devoted to health, slightly above the EU average of 9.8 %. This translates to EUR 3,791 per person (adjusted for differences in purchasing power), well above the EU
average of EUR 2,884. Expenditure growth has levelled off since 2012 after the introduction of a reform package that increased financial risk for insurers and providers, and raised out-of-pocket (OOP) payments. In addition, several agreements with stakeholders have been made that aim to keep spending growth within predefined levels.”

Source: OECD/European Observatory on Health Systems and Policies (2019), The Netherlands: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
https://www.oecd.org/health/netherlands-country-health-profile-2019-9ac45ee0-en.htm

“Following the abolition of the private insurance scheme in 2006, public expenditure (government spending and compulsory insurance) increased from about two thirds (68.4 %) of health spending in 2005 to 83.8 % in 2006, before falling slightly to 81.5 % in 2017. This remains slightly above the EU average of 79.3 %. OOP spending is comparatively low at 11.1 % of current health expenditure in 2017, compared to an EU average of 15.8 %. OOP payments are mainly due to cost-sharing, although general practitioner (GP) care, maternal care and care from district nurses remain free at the point of delivery. A comparably large VHI sector (5.9 % of health spending compared to 3.6 % in the EU in 2017) also helps keep OOP costs down (Section 5.2).”

Source: OECD/European Observatory on Health Systems and Policies (2019), The Netherlands: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
https://www.oecd.org/health/netherlands-country-health-profile-2019-9ac45ee0-en.htm

“In 2013 the providers of GP care, health insurers and the Minister of Health agreed that a new payment system for GPs would be introduced in 2015. The new system should contribute to the central role of primary care in the Dutch healthcare system. It should stimulate integrated care and cooperation between healthcare providers. It should also stimulate substitution from secondary care to primary care (InEen, 2014; National Association of GPs et al., 2013).

“The new system consists of three segments. The first segment addresses the basic care of general practitioners. This is care for which the GP is the first contact and where the GP functions as a gatekeeper to secondary care. There are three different payment types in this segment. First, there is a capitation fee for each patient registered with the practice, which is differentiated according to age (above or under 65 years of age) and deprivation status (based on zip code). In addition, GPs may bill for each consultation and home visit. GPs can bill these two payment types even if they have no contract with a given health insurer. Furthermore, there is a fee for the practice nurse providing mental care and a few other types of care, but the GP needs a contract to receive payment. The Dutch Healthcare Authority establishes maximum tariffs for the care elements in this segment.

“The second segment applies to integrated care. In 2010 a bundled payment system was introduced for this type of care. Integrated care addresses care for patients with the following chronic conditions: diabetes type II, COPD, asthma and those at high risk of cardiovascular diseases. What is considered appropriate care is laid down in a care standard that has been developed for each of the four conditions. According to the system of bundled payments, a care group organizes all the care necessary for managing these diseases. Care groups are owned by GPs in a certain region, and vary in size from 4 to 150 GPs. The care group coordinates the care and remunerates the care providers involved. Patients are free to participate in a care group or choose their own care providers. About 80% of Dutch GP practices joined a care group in 2014 (van Hassel et al., 2015).

“The care group is responsible for all the care that is related to the chronic condition of the patient. The care group negotiates a fixed fee per patient with a health insurer. A contract with a health insurer is a necessary precondition for bundled payments. GPs continue to receive the existing capitation fee. Payment for consultations that address the chronic condition(s) are included in the integrated care fee, while for issues that are not related to the chronic condition, the GP still receives the consultation fee from the insurer. If there is no contract with health insurers, GPs do not receive payment for this type of care. The costs of practice nurses for somatic care are covered by this segment.

“The third segment is dedicated to pay-for-performance and innovation. These types of payment are also subject to having a contract with health insurers. The pay-for-performance scheme addresses, for example, the accessibility of the practice, efficiency of prescribing pharmaceuticals and efficiency in referring patients to secondary care, but also non-care-related issues such as accreditation of the practice (InEen, 2014; National Association of GPs et al., 2013). For 2015 the pay-for-performance scheme focused on adequate performance of the gatekeeping function and rational prescribing of medicines, as well as service and access (National Association of GPs et al., 2014).

“At the level of GPs, the first segment should cover about 77% of the practice turnover and the other two segments 23%. At macro level, the Minister of Health, insurers’ associations, patient associations and the primary care association have agreed a growth rate of 1.5% per year for basic GP care (segment 1) and integrated care (segment 2). For the substitution of secondary care to primary care, innovation and the introduction of pay-for-performance (segment 3) an additional annual growth of 1% is permitted (InEen, 2014; National Association of GPs et al., 2013).”

Source: Kroneman M, Boerma W, van den Berg M, Groenewegen P, de Jong J, van Ginneken E (2016). The Netherlands: health system review. Health Systems in Transition, 2016; 18(2):1–239.
https://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits
https://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits/netherlands-hit-2016

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated Jan. 27, 2021 by Doug McVay, Editor.