Netherlands Health System Overview
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Netherlands COVID-19 Policy
Annual household out-of-pocket payment in current USD per capita, 2021: $604
Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed May 13, 2023.
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.
“OOP [Out Of Pocket] spending fell from a peak of 11.6% of total health spending in 2014 to 10.6% in 2019, and stands well below the EU average of 15.4% (Figure 16). A large share of OOP spending in the Netherlands comes from the mandatory deductible, which requires patients to pay a minimum amount before the insurer begins to cover services. The mandatory deductible increased from EUR 150 in 2008 to EUR 385 in 2016. The intention was that it should grow in line with other items in the health budget, but in 2017 the government coalition decided to keep the deductible at its current level, while some opposition parties wanted to abolish it entirely. 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.
“The main categories of OOP spending include pharmaceuticals, inpatient and long-term care contributions under the Long-term Care Act. Since 2019, the Netherlands has capped OOP spending on pharmaceuticals at EUR 250 per year. For residential long-term care, the country applies income-dependent cost-sharing, ranging from no cost-sharing to EUR 2,419 per month, although not all OOP payments are related to care delivery and may include housing costs. Furthermore, the Social Support Act offers the opportunity for municipalities to provide financial compensation for health care costs incurred by patients with chronic conditions on low incomes, and some municipalities negotiate insurance policies with generous benefits targeted at low-income groups.”
OECD/European Observatory on Health Systems and Policies (2021), The Netherlands: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
“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.
“When measured in per capita terms, health spending in the Netherlands is above the EU average for outpatient care, long-term care and prevention, and is below the average on inpatient care, retail pharmaceuticals and medical devices (Figure 9). A large long-term care sector, which covers elderly care, care for disabled people and long-term mental care, contributes to the relatively high overall spending on health. Spending on retail pharmaceuticals and medical devices is well below the EU average and even decreased from 13.9% of total health spending in 2010 to 11.2% in 2019. The Netherlands has among the highest levels of spending on prevention, at EUR 131 per person, compared to an EU average of EUR 102, but this amount has not increased over time. Between 2010 and 2019, the share of spending on prevention dropped from 4.3% to 3.3% of total health spending.”
OECD/European Observatory on Health Systems and Policies (2021), The Netherlands: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
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Page last updated Nov. 9, 2022 by Doug McVay, Editor.
