Netherlands Health System Overview
Health System Rankings
Outcomes
Health System Coverage
Costs for Consumers
Health System Expenditures
Netherlands COVID-19 Policy
Population, Midyear 2022: 17,564,014
Population Density (Number of Persons per Square Kilometer): 521.64
Life Expectancy at Birth, 2022: 82.45
Infant Mortality Rate, 2022 (per 1,000 live births): 3.00
Under-Five Mortality Rate, 2022 (per 1,000 live births): 3.48
Projected Population, Midyear 2030: 17,943,803
Percentage of Total Population Aged 65 and Older, Midyear 2022: 20.31%
Projected Percentage of Total Population Aged 65 and Older, Midyear 2030: 23.86%
Projected Percentage of Total Population Aged 65 and Older, Midyear 2050: 27.16%
Source: United Nations, Department of Economic and Social Affairs, Population Division (2023). Data Portal, custom data acquired via website. United Nations: New York. Accessed 12 May 2023.
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.
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.
“The Dutch government regulates and oversees three schemes that together provide broad universal health coverage. First, competing health insurers administer a social health insurance (SHI) system for curative care. The system, introduced in 2006, mandates all residents to purchase insurance policies that cover a defined benefits package set by the government. Insurers must accept all applicants, and they negotiate and contract with providers based on quality and price. The SHI scheme covers all specialist care, primary care, pharmaceuticals and medical devices, adult mental health care, some allied care services and community nursing. The second scheme is a single-payer social insurance system for long-term care, which is carried out by the regionally dominant health insurer, and which was the subject of a large reform in 2015 to rein in the scope of the scheme and spending. The third is a tax-funded social care scheme implemented by the municipalities. The National Institute for Public Health and the Environment (RIVM) provides guidance for public health services at the national level, while municipalities cover most services such as screening, vaccination and health promotion (Box 2).”
Source: 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.
“Health services are overwhelmingly provided by private non-profit providers, and most physicians are self-employed. The Netherlands operates a strict gatekeeper system. Patients require a referral from a GP to visit hospital and specialist care, including for COVID-19 (see Section 5.3). Although the Netherlands reports comparatively high numbers of outpatient contacts, it also has relatively low rates of hospital discharges, suggesting that strong primary care and outpatient specialist treatment manage to keep people out of hospitals (Figure 10). Both long-term care and mental health care reforms were designed for delivery in outpatient settings to respond to historically high institutionalisation rates (Kroneman et al., 2016).”
Source: 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.
“The 2006 reforms shifted the focus to the demand side, introducing three managed markets for a defined universal health insurance package, plus healthcare purchasing and provision. The government stepped back from direct control of volumes and prices to a more distant role as supervisor of these markets (though planning of medical professionals remains by limiting the number of doctors trained). Both insurers and providers have been consolidating, in part to strengthen their position within the market. Currently, four insurer groups have 90% of the insurance market. The government provides a web site to help patients choose healthcare providers; other independent web sites are also available. Nevertheless, opportunities to make choices during the care process are limited, as is the extent to which patients exercise their notional choice.
“Long-term care was reformed in 2015 in order to contain costs (and was the subject of an EU recommendation through the European Semester). Care at home, preferably by informal carers, is now given greater priority over institutional care, which was seen as having become over-used. Municipalities became responsible for social care – and with a reduced budget, on the assumption that locally organized care will be more efficient. Health insurers took over responsibility for home nursing, with district nurses playing a key role in integrating different aspects of care and support.”
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 social insurance background of the healthcare system in the Netherlands, with dominant roles for not-for-profit sickness funds, independent providers and a modest role for the government, fits in a Bismarckian tradition. Special features of the Dutch system, however, are GPs in a gatekeeping position and independent community-based midwives responsible for uncomplicated deliveries. From its inception in 1941, social health insurance covered only the two-thirds of the population with lower incomes. For the other one-third a private health insurance scheme applied. In the later 1960s a social insurance scheme was also introduced for long-term care and later extended to elderly care and mental health services.
“The major healthcare reform of 2006 not only brought the long-desired unified compulsory insurance scheme, it also drastically changed the roles of actors in the healthcare system. For example, multiple private health insurers now had to compete, in a regulated environment, for insured persons, and relatively independent bodies, rather than the government, became largely responsible for the management of the system. Social support was delegated to the municipalities. In 2014 a stricter separation between generalist and specialist mental healthcare services was introduced, with a central role for general practice as care provider and point of referral to other services and institutions. Sustainability was a major driver of the long-term care reform in 2015. A new law only covered the most severe cases, while support for home-bound patients and the elderly became a municipal responsibility. Home nursing and part of mental healthcare were included in the basic health insurance package.”
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.
“Since the introduction of regulated competition in healthcare in 2006, choices made by patients have become more important. Patients select a health insurance policy with the health insurer of their choice; insurers cannot refuse or differentiate among patients. Each year patients have the option to switch to another insurer.
“Furthermore, patients can choose between restitution and benefit in-kind policies. In-kind policies may include a restricted choice of care providers but financial risk will be absent. With a restitution policy the choice of provider is free, and compensation of services is complete up to a maximum set by the health insurer. On top of the compulsory deductible (€385 in 2016) patients can opt for a voluntary deductible varying from €100 to €500 per year.
“In addition to the uniform basic health insurance, patients can choose to purchase, from any health insurer, a complementary VHI [Voluntary Health Insurance] policy. However, health insurers are not obliged to accept applications for complementary VHI policies.
“In 2006, at the start of the new health insurance system, 18% of insured persons changed insurer (Dutch Health Care Authority, 2006). After a drop in subsequent years, to 4.4% in 2007 and 3.6% in 2008 (Dutch Health Care Authority, 2007, 2008), the number of people switching insurers increased to 7.0% in 2014 and 7.3% in 2015. Young people switch more often than older ones (Dutch Healthcare Authority 2015d).
“Citizens are free to register with a GP of their choice. In practice, there may be limitations. For instance, GPs may only register patients living in a certain area, usually within easy reach of the practice. Sometimes, due to relative shortages of GPs at a local level, people can experience problems registering with a GP. Freedom of choice does also exist for other healthcare providers, although restrictions may apply for people who opt for an in-kind healthcare policy.”
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 2006 HIA (Zorgverzekeringswet) put an end to the traditional division between publicly financed health coverage operated by sickness funds, covering about 63% of the population, and a complex mix of substitutive private and other health insurance arrangements covering the remaining 37%. The new law integrated both forms of coverage into a single scheme covering all legal residents (including foreigners working in the Netherlands). It also made health insurance universally compulsory. Although the HIA scheme is based on private law and operated by competing private insurers, the many state regulations on access and consumer choice make it essentially public (Maarse, Jeurissen & Ruwaard, 2015).
“The HIA benefits package is relatively comprehensive and user charges are uncommon. Instead, all adults must pay a mandatory annual deductible (€375 in 2015) when using health services. GP visits, maternity care and children are exempt from the deductible. People can choose to pay a higher deductible (up to €500 more – that is, €875 in total) in exchange for paying a lower contribution to the HIA 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 May 14, 2023 by Doug McVay, Editor.
