Netherlands Health System Overview
Health System Rankings
Outcomes
Health System Coverage
Costs for Consumers
Health System Expenditures
Netherlands COVID-19 Policy
Total Health Spending, USD PPP Per Capita (2020): $6,189.7
(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 (2022), Health spending (indicator). doi: 10.1787/8643de7e-en (Accessed on 07 August 2022).
Current Health Expenditure Per Capita (USD) (2019): $5,335
Source: Global Health Observatory. Current health expenditure (CHE) per capita in US$. Geneva: World Health Organization. Last accessed July 26, 2022.
Current Health Expenditure As Percentage Of Gross Domestic Product (2019): 10.13%
Source: Global Health Observatory. Current health expenditure (CHE) as percentage of gross domestic product (GDP) (%). Geneva: World Health Organization. Last accessed July 26, 2022.
Out-Of-Pocket Expenditure As Percentage Of Current Health Expenditure (2019): 10.58%
Source: Global Health Observatory. Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed July 26, 2022.
Out-Of-Pocket Expenditure Per Capita (USD) (2019): $564.3
Source: Global Health Observatory. Out-of-pocket expenditure (OOP) per capita in US$. Geneva: World Health Organization. Last accessed July 26, 2022.
Domestic General Government Health Expenditure as Percentage of General Government Expenditure (%) (2019): 16.0%
Source: World health statistics 2022: monitoring health for the SDGs, sustainable development
goals. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.
Annual out-of-pocket payment, current PPP per capita (US$) (2019): $564
Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed Nov. 9, 2022.
Out-of-Pocket Spending as Share of Final Household Consumption (%) (2019): 2.5%
Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.
Remuneration of Doctors, Ratio to Average Wage (2019)
General Practitioners: 2.3 (Salaried); 2.4 (Self-Employed)
Specialists: 3.3 (Salaried); 3.4 (Self-Employed)
Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.
Remuneration of Hospital Nurses, Ratio to Average Wage (2019): 1.2
Remuneration of Hospital Nurses, USD PPP (2019): $65,700
Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.
“In 2019, the Netherlands spent 10.2 % of GDP in health – slightly above the EU average of 9.9 %. This translates to EUR 3,967 per capita (adjusted for differences in purchasing power), which is well above the EU average of EUR 3,523. Expenditure growth between 2013 and 2017 only increased by 1.0 % on average per year, following the introduction of a reform package that increased financial risk for insurers and providers and increased the share of out-of-pocket (OOP) health expenditure. In addition, the Dutch Ministry of Health signed several agreements with stakeholders that aim to keep spending growth within predefined levels. However, between 2017 and 2019, annual health expenditure growth rose to 2.3 % per year. During the COVID-19 pandemic, insurers and providers agreed on measures to compensate revenue losses and extra spending due to COVID-19. The government allocated additional tax revenues for 2020 and 2021 to the health sector, including for testing and contact tracing (EUR 476 million in 2020 and EUR 450 million in 2021) and intensive care unit (ICU) beds (EUR 80.1 million and EUR 93.9 million).”
Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.
“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 82.6 % in 2019. This remains slightly above the EU average of 79.7 % (Figure 8).
“OOP spending as a share of current health expenditure was about two thirds of the EU-wide average in 2019, at 10.6 % in the Netherlands compared to 15.4 % in the EU. Around 57 % of OOP payments are due to cost-sharing, although general practitioner (GP) care, maternal care and care from district nurses remain free at the point of delivery. In the Netherlands, health insurers may offer voluntary health insurance (VHI) policies to cover services outside the benefits package. This contributes to a relatively large VHI sector (6.8 % of health spending compared to 4.9 % in the EU in 2019), as individuals who expect to incur high OOP payments usually take out VHI (see Section 5.2).”
Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.
“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.
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Page last updated Nov. 9, 2022 by Doug McVay, Editor.
