Netherlands Health System Overview
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“Health care in the Netherlands is mainly financed through insurance premiums and contributions under the Health Insurance Act and the Long-term Care Act (72%), and to a limited extent by general taxes (13%, figures for 2013). In 2015 the share of tax-financed care increased significantly compared to the previous years, as part of long-term care and youth care were transferred to the municipalities.
“Income-dependent employer contributions under the Health Insurance Act are collected by the Tax Office, which levies the contribution from a person’s salary together with payroll taxes. The contributions and taxes are paid directly to the Tax Office by the employer. In 2015 the income-dependent contribution amounted to 6.95% of income (with a ceiling of €3573 per year) for employees and social security recipients. For self-employed persons, the income-dependent contribution is based on the tax assessment of their income. For self-employed persons the contribution in 2015 was 4.85% of income (with a ceiling of €2494 per year). The different rates for employees and self-employed persons reflects the fact that employers and social security institutions pay the income-dependent contribution, thus lowering the taxable income of the employee, whereas self-employed persons have to pay this contribution themselves. The lower rate and ceiling therefore seek to alleviate the financial burden on self-employed persons (Ministry of Social Affairs and Employment, 2012). After collecting all the contributions, the Tax Office transfers the collected funds to the Health Insurance Fund (Zorgverzekeringsfonds), from which the money is allocated after risk adjustment to the health insurers.
“The premiums are collected directly by the health insurer where the health plan is purchased. Health insurers are free to set the community-rated premium level. The average premium was estimated by the Ministry of Health to be around €1211 per year in 2015, approximately 5% of a net “modal income” (defined by the Netherlands Bureau for Economic Policy Analysis (Centraal Planbureau, CPB) as gross €33 000 per year) for 2014 in the Netherlands. In 2015 the premium varied from €990 to €1300. For children below the age of 18, the government covers the premium through a contribution from general revenue into the Health Insurance Fund.”
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.
“To cover expenses arising from the Long-term Care Act, a contribution of 9.65% is levied on the salary of citizens, with a maximum of €3241 per year (2016). This contribution is collected by the Tax Office. The revenues are transferred to the Long-term Care Fund, administered by the Dutch Health care Institute. Direct taxes are mainly levied from income tax, while indirect taxes mainly consist of VAT. Income tax is progressive. For VAT, there is a high tariff (21% in 2015) and a low tariff (6% in 2015, mainly for food, books and some services).
“All taxes are collected by the National Tax Office and are not earmarked for healthcare. From general revenue, the government (1) contributes to the Health Insurance Fund to provide children under 18 with coverage under the Health Insurance Act; (2) pays the healthcare allowance to households that are eligible and have filed an application (through the Tax Office); and (3) transfers funds to the municipality fund. The latter is used to cover the cost of decentralized long-term care under the Wmo 2015 and Youth Acts.”
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.
“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.”
Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.
“In 2014, public spending on health and LTC [Long Term Care] accounted for 87% of total spending on health, while OOP [Out Of Pocket] payments and VHI [Voluntary Health Insurance] accounted for 5.2 and 5.9%, respectively (WHO, 2016). The Netherlands does not include the compulsory deductibles paid by all adults using health services as OOP spending. As the deductible amounts to €375 per adult per year (in 2015), OOP payments are underestimated in national health accounts data for the Netherlands (OECD & European Union, 2014). Public spending on health and LTC rose from 4.6% of GDP in 2000 to 9.5% of GDP in 2014 (WHO, 2016) due to the incorporation of the former private health insurance arrangements into a single universal and mandatory health insurance scheme.”
Source: Hans Maarse. “Netherlands.” In Voluntary health insurance in Europe: Country experience [Internet]. Sagan A, Thomson S, editors. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2016. Observatory Studies Series, No. 42.
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Page last updated Nov. 9, 2022 by Doug McVay, Editor.
