Netherlands Health System Overview
Health System Rankings
Outcomes
Health System Coverage
Costs for Consumers
Health System Expenditures
Netherlands COVID-19 Policy
Population Insurance Coverage For A Core Set Of Healthcare Services* (%) (2019):
Public Coverage: %; Primary Private Health Coverage: 100%; Total: 100%
*”Population coverage for health care is defined here as the share of the population eligible for a core set of health care services – whether through public programmes or primary private health insurance. The set of services is country-specific but usually includes consultations with doctors, tests and examinations, and hospital care. Public coverage includes both national health systems and social health insurance. On national health systems, most of the financing comes from general taxation, whereas in social health insurance systems, financing typically comes from a combination of payroll contributions and taxation. Financing is linked to ability-to-pay. Primary private health insurance refers to insurance coverage for a core set of services, and can be voluntary or mandatory by law (for some or all of the population.”
Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.
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.
“Around 99.9 % of the Dutch population has health insurance, which covers a wide range of services. Among other things, the benefits package includes primary care, outpatient specialist care, hospital care, maternal services, in vitro fertilisation (maximum of three cycles), physiotherapy for chronic illness, mental health treatment and ambulance transport. Public spending accounts for 91 % of inpatient care, 85 % of outpatient care and 67 % of outpatient pharmaceuticals – all above the EU averages (Figure 15).
“The Netherlands covered the costs of COVID-19 testing, but individuals needed a physician referral for a test until June 2020 (see Section 5.3). In an unprecedented yet far-sighted measure, the Dutch Healthcare Institute, which advises the Minister of Health on the services to include in the basic benefits package, determined that rehabilitation care for COVID-19 patients should be included if recommended by a physician. Specifically, a maximum of 50 physical therapy sessions, 8 occupational therapist treatments and 7 dietician sessions are reimbursable for up to six months after COVID-19 infection.
“Dental care for adults and some paramedical care are not covered by the benefits package. Many Dutch people purchase VHI to cover these services – particularly dental care. Despite not being covered in the benefits package, a very low proportion of the population (0.4 %) report unmet needs for dental care, which is substantially below the EU average of 2.8 %.”
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.
“Basic health insurance is obligatory for all Dutch residents. Those working in the Netherlands and paying income tax to the Tax Office (Belastingdienst) but living abroad are also compulsorily insured. For two groups of persons an exception is made. There are special regulations for persons who refuse to insure themselves on grounds of religious beliefs or their philosophy of life (gemoedsbezwaarden) and for undocumented migrants (see Section 3.6.1). The Ministry of Defence finances and organizes healthcare for military personnel (see Section 3.6.1).
“Children under the age of 18 are insured free of charge but have to be included in one of the parents’ plans. Most insurers also offer free complementary VHI [Voluntary Health Insurance] for children together with the parents’ complementary VHI policy (Roos & Schut, 2008). Children are covered by a government contribution in the health insurance fund.
“All Dutch residents are compulsorily insured for long-term care under the Long-term Care Act. The same exemptions apply as with the Health Insurance Act.”
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.
“Although basic health insurance is compulsory, not every citizen is insured. In 2013, 28 000 persons were uninsured and 316 000 persons were defaulters with a payment delay of at least six months (Ministry of Health, Welfare and Sport, 2014c). The number of uninsured individuals has been on the decline after years of gradual growth, since the government started in 2011 to track down the uninsured. Every month the National Healthcare Institute receives a report from the SVB (Social Insurance Bank). If it finds that a person has failed to purchase insurance, it will send a letter requesting that they do so. From that moment they have three months to purchase a health plan. If after three months the person still does not have an insurance policy, a penalty of €352 will be charged. After another three months, another €352 penalty will be charged. If the person nevertheless fails to purchase insurance, the National Healthcare Institute will purchase a plan on behalf of the uninsured for the duration of 12 months. A legally established premium (€122.33 per month in 2016; the standard (estimated) premium for a normal insurance policy is €99 in 2015) has to be deducted from the uninsured’s income either directly by the employer or by the social security agency (National Healthcare Institute, 2015a).
“The problem with defaulters has been harder to rein in, as evidenced by the approximately 2% of the population that is failing to pay their premiums (2013). There is a special protocol that should protect individuals from losing coverage. After six months of non-payment, defaulters are registered with the National Healthcare Institute. The National Healthcare Institute charges a so-called “administrative premium” of approximately €153 (130% of the standard premium). This premium has to be deducted directly from income by the employer or by the social security agency. It is charged monthly until the defaulter settles all debts with the insurer. In the meantime, the defaulter remains insured, but cannot switch to another insurer until the debt is settled (National Healthcare Institute, 2015b). The level of the administrative premium has frequently been criticized for putting already vulnerable individuals in further financial trouble. There are plans to lower this premium in 2016.”
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 benefit package of the basic health insurance under the Health Insurance Act 2015 consisted of:
“• medical care, including care provided by GPs, hospitals, medical specialists and midwives;
“• hospital care;
“• home nursing care and personal care (assistance with eating, dressing, etc.);
“• dental care for children until the age of 18. For older people only, specialist dental care and a set of false teeth are covered;
“• medical aids and devices;
“• pharmaceutical care;
“• maternity care (midwifery care and maternity care assistance);
“• transportation of sick people by ambulance or taxi;
“• professions additional to medicine (allied healthcare): physiotherapy for persons with a chronic medical condition (the first 20 sessions relating to the condition are excluded; there is a limiting list of conditions) and for children below the age of 18; occupational therapy; exercise therapy and dietary advice to a limited extent; speech therapy;
“• quit-smoking programmes;
“• geriatric rehabilitation care;
“• care for people with sensory disabilities; and
“• mental care: ambulatory mental care and inpatient mental care for the first three years. (After three years inpatient mental care is considered long-term care and is financed by the Long-term Care Act (Wlz).)
“For some treatments, there are exclusions from the basic insurance package:
“• for allied healthcare, generally, a maximum number of sessions are reimbursed;
“• some elective procedures, for instance cosmetic plastic surgery without a medical indication, are excluded; and
“• in vitro fertilization: only the first three attempts are included.”
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.
“Social protection in the Netherlands is not a part of the healthcare system and thus is regulated differently under different acts. To compensate for undesired income effects for lower-income groups, a “healthcare allowance” funded from general tax was created under the Healthcare Allowance Act (Wet op de zorgtoeslag, Wzt). The allowance is based on a “standard premium”. This is the estimated average of the premiums offered by health insurers plus the compulsory deductible and is set by the Minister of Health (Ministry of Health, Welfare and Sport, 2005). As a result, insured persons who choose an insurer with a lower premium are not “punished” with a lower healthcare allowance. The allowance is an advance payment per month and is based on the final tax assessment. Any difference between the total advance payment and the final entitlement will be settled with the individual. In 2013, 57% of Dutch households received a healthcare allowance. On average 41% of the premium was compensated for (Statistics Netherlands, 2015b). The total expenditure on healthcare allowance doubled from 2006 to €5.1 billion in 2013, whereas the number of households eligible for the allowance decreased because of stricter eligibility rules. The increase in expenditure is mainly due to the increase in healthcare allowance for the lowest income groups as compensation for the increase in the mandatory deductible. The maximum monthly healthcare allowance was €78 for singles and €149 for families in 2015.”
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.
