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

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed Nov. 14, 2020.

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.

“Out-of-pocket expenditures increased between 2011 and 2015, mainly as a result of an increasing mandatory deductible (although this is not included in the national statistics) and shifting costs from public to private sources by excluding services from the basic benefit package (see Fig. 3.8). Over this period, the healthcare allowance decreased and out-of-pocket expenditure increased. The share of taxes increased in 2014 as a result of the shift of long-term care services to the municipalities. Consequently, the income-dependent contribution for residential long-term care has decreased, since care that was previously supplied under the Exceptional Medical Expenses Act has now shifted to the Health Insurance Act (home nursing and inpatient mental care from one to three years) and to the municipalities.”

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.

“The Netherlands does not include the compulsory deductibles paid by all adults using health services as OOP [Out Of Pocket] 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).”

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.

“For basic health insurance, a compulsory deductible of €385 (in 2016) is levied for all individuals aged 18 or older. The deductible is levied on all healthcare expenditures except general practice care, maternity care, home nursing care and integrated care (for diabetes, COPD, asthma and cardiovascular risk management). The deductible is also levied on pharmaceuticals and diagnostic tests prescribed by GPs. The deductible includes expenditures on out-patient pharmaceutical care, but excludes co-payments for pharmaceuticals. The deductible is paid to the health insurer and should reduce moral hazard, that is, the use of additional or more expensive medical services caused by the fact that expenditures are (partly) compensated by insurance (Schut & Rutten, 2009).

“About 51% of the insured paid the full deductible in 2013 (Vektis, 2015). Most health insurers allow payment in monthly instalments. Health insurers may choose not to charge this deductible, as a way to steer patients to good quality care. Since 2009 this option is used when patients (1) use preferred medicines (also see Section 3.7.2), or (2) follow preventive programmes for diabetes, depression, cardiovascular diseases, COPD (such as chronic bronchitis) or overweight. In 2015 a few health insurers applied this principle (Independer, 2015; Ziektekosten-vergelijken.nl, 2015). In the programme “Quality pays off” (“Kwaliteit loont”), launched in 2015, the Minister encouraged health insurers not to charge the deductible when the insured go to contracted providers (Ministry of Health, Welfare and Sport, 2015a).”

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.

“In addition to the compulsory deductible health insurers offer a voluntary deductible, varying between €100 and the legal maximum of €500 per year. The level can be chosen each year by the insured. The choice for a voluntary deductible results in a reduction of the premium. The reduction of the yearly premium usually equals about 50% of the voluntary deductible (in 2015, for a voluntary deductible of €500, an average reduction on the premium of €236 was given, with a range of €150 to €324) (Dutch Healthcare Authority, 2015d). Health care expenses are first balanced with the compulsory deductible and then with the voluntary deductible, so in 2016 a voluntary deductible of €500 results in a deductible of €885 (€385 + €500) for the patient. In 2015, 12% of the insured chose a voluntary deductible, and most of them (69%) chose the maximum voluntary deductible (Vektis, 2015). For the voluntary deductible the same exemptions are in place as for the compulsory deductible (general practice care, maternity care and home nursing care). Insurers are not allowed to extend the compulsory and voluntary deductibles to complementary VHI reimbursements.

“For outpatient mental care, since 2014, no out-of-pocket payments other than the mandatory deductible are levied. Before 2014, an out-of-pocket payment of €20 per session was levied and a maximum of five sessions was covered.

“The type of health plan also has potential influence over the total amount of cost-sharing. The insurers may offer two kinds of policy: a benefits in kind (natura) policy and a restitution (restitutie) policy. The type of policy influences the access the insured has to healthcare providers: with the in-kind policy the patient has a right to care, although full reimbursement may be limited to contracted providers, while the restitution policy gives the patient the right to have compensation for the costs of care.”

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.

“Looking at the pattern of spending, the Netherlands spends above the EU average in every category apart from pharmaceuticals and medical devices (Figure 10). The high overall spending is primarily due to a comparatively large long-term care sector, which absorbs more than double the EU average (Section 5.3). Spending on pharmaceuticals and medical devices is well below the EU average and reflects a long history of controlling pharmaceutical prices and volumes (Section 5.3). The Netherlands has among the highest spending on prevention at EUR 127 per person, compared to an average of EUR 89 in the EU.”

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.

“OOP [Out Of Pocket] expenditure has increased over the past decade, from 8.3 % in 2006 to 11.1 % in 2017, but growth has fallen since 2014. It stands well below the EU average of 15.8 % (Figure 18). The rise was mostly caused by a rapid increase in the mandatory deductible3, from EUR 150 in 2008 to EUR 385 in 2016, after which it remained stable. The deductible does not apply to GP care, maternity care, district nursing, and care for children under the age of 18, which are all available without cost-sharing.

“Pharmaceuticals, inpatient and long-term care are the main categories of OOP spending (Figure 18). Pharmaceutical reimbursements are based on internal reference pricing and insurers may list preferred medicines, so that patients who use a different brand may have to pay the difference in costs or the total amount. Since 2019, OOP spending on pharmaceuticals is capped at EUR 250 per year. For residential long-term care, income-dependent cost-sharing is applicable; the rate was lowered in 2018, and ranges from 0 to EUR 2 365 per month (2019). Furthermore, there are cash reimbursements for health care costs incurred by low-income chronic patients under the Social Support Act and some municipalities negotiate insurance policies with generous benefits targeted at low-income groups.

“Although the system seems to protect individuals from financial hardship and OOP payments are comparably low, OOP payments are still subject to public debate. There are vulnerable people for whom the deductible is a substantial amount of money. If these individuals also live in a municipality with less generous social care services, OOP payments can accumulate through direct payments made to obtain services that are not or only partly covered. Although the deductible was supposed to grow in line with other items in the health budget, the coalition that entered into power in 2017 decided to keep the deductible at its current level (EUR 385), while some opposition parties want to abolish it entirely.”

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.

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 Sept. 21, 2021 by Doug McVay, Editor.