Netherlands: Health System Overview

Life expectancy at birth (years), 2021: 81.1
Maternal mortality ratio (per 100,000 live births), 2023: 4
Under-five mortality rate (per 1000 live births), 2023: 4.0
Neonatal mortality rate (per 1000 live births), 2023: 2.6
Tuberculosis incidence (per 100,000 population), 2023: 4.5
Probability of dying from any of cardiovascular disease, cancer, diabetes, chronic respiratory disease between age 30 and exact age 70 (%), 2021: 9.9%
Suicide mortality rate (per 100,000 population), 2021: 11.5
Adolescent birth rate (per 1000 women aged 15-19 years), 2015-2024: 2.2
Adolescent birth rate (per 1000 women aged 10-14 years), 2015-2024: 0
Universal Health Coverage: Service coverage index, 2021: ≥80
Diphtheria-tetanus-pertussis (DTP3) immunization coverage among 1-year-olds (%), 2023: 92%
Measles-containing-vaccine second-dose (MCV2) immunization coverage by the locally recommended age (%), 2023: 81%
Pneumococcal conjugate 3rd dose (PCV3) immunization coverage among 1-year olds (%), 2023: 88%
Human papillomavirus (HPV) immunization coverage estimates among 15 year-old girls (%), 2023: 60%
Density of medical doctors (per 10,000 population), 2015-2023: 38.76
Density of nursing and midwifery personnel (per 10,000 population), 2016-2023: 116.65
Density of dentists (per 10,000 population), 2016-2023: 2.17
Density of pharmacists (per 10,000 population), 2015-2023: 2.17
Domestic general government health expenditure (GGHE-D) as percentage of general government expenditure (GGE) (%), 2022: 15.92%
Prevalence of stunting in children under 5 (%), 2024: 1.6%
Prevalence of overweight in children under 5 (%), 2024: 5.4%
Prevalence of anaemia in women aged 15-49 years (%), 2023: 16.5%

Source: World health statistics 2025: monitoring health for the SDGs, Sustainable Development Goals. Tables of health statistics by country and area, WHO region and globally. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.

Health expenditure per capita, USD PPP, 2022
– Government/compulsory: $5,672
– Voluntary/Out-of-pocket: $1,057
– Total: $6,729
Health expenditure as a share of GDP, 2022
– Government/compulsory: 8.6%
– Voluntary/out-of-pocket: 1.6%
Health expenditure by type of financing, 2021
– Government schemes: 13%
– Compulsory health insurance: 72%
– Voluntary health insurance: 4%
– Out-of-pocket: 9%
– Other: 1%
Out-of-pocket spending on health as share of final household consumption, 2021: 2.2%
Price levels in the healthcare sector, 2021 (OECD average = 100): 70
Population reporting unmet needs for medical care, by income level, 2021
– Lowest quintile: 0.5%
– Highest quintile: 0%
– Total: 0.1%
Main reason for reporting unmet needs for medical care, 2021
– Waiting list: 0.1%
– Too expensive: 0%
– Too far to travel: 0%
Population reporting unmet needs for dental care, by income level, 2021
– Lowest quintile: 0.8%
– Highest quintile: 0.0%
– Total: 0.2%
Population coverage for a core set of services, 2021
– Primary private health coverage: 100%
Population aged 15 years and over rating their own health as bad or very bad, 2021: 5.2%
Population aged 15 years and over rating their own health as good or very good, by income quintile, 2021
– Highest quintile: 85.2%
– Lowest quintile: 58.7%
– Total: 73.1%
Life expectancy at birth, 2021: 81.4 years
Infant mortality, deaths per 1,000 live births, 2021: 3.3
Maternal mortality rate, deaths per 100,000 live births, 2020: 4.3
Congestive heart failure hospital admission in adults, age-sex standardized rate per 100,000 population, 2021: 148
Asthma and chronic obstructive pulmonary disease hospital admissions in adults, age-sex standardized rate per 100,000 population, 2021: 125
Hospital workforce per 1,000 population, 2021
– Physicians: 1.37
– Nurses and midwives: 4.49
– Healthcare assistants: 1.11
– Other health service providers: 9.82
Practicing doctors per 1,000 population, 2021: 3.9
Share of different categories of doctors, 2021
– General practitioners: 23.6%
– Specialists: 53.1%
– Other doctors: 23.3%
Share of foreign-trained doctors, 2021: 3.6%
Medical graduates per 100,000 population, 2021: 15.5
Practicing nurses per 1,000 population, 2021: 11.4
Share of foreign-trained nurses, 2021: 1.5%
Nursing graduates per 100,000 population, 2021: 62.8
Ratio of nurses to doctors, 2021: 2.9
Practicing pharmacists per 100,000 population, 2021: 22
Community pharmacies per 100,000 population, 2021: 11
Remuneration of doctors, ratio to average wage, 2021
– General Practitioners
– Salaried: 2.2
– Self-employed: 2.5
– Specialists
– Salaried: 3.2
– Self-employed: 3.3
Remuneration of hospital nurses, ratio to average wage, 2021: 1.2
Remuneration of hospital nurses, USD PPP, 2021: $72,000
Hospital beds per 1,000 population, 2021: 3.0
Average length of stay in hospital, 2021: 5.2 days
(Note: Data refer to curative (acute) care only, resulting in an underestimation.)
Average number of in-person doctor consultations per person, 2021: 8.6
CT scanners per million population, 2021: 16
CT exams per 1,000 population, 2021: 134
MRI units per million population, 2021: 15
MRI exams per 1,000 population, 2021: 58
PET scanners per million population, 2021: 5
PET exams per 1,000 population, 2021: 9
Proportion of primary care practices using electronic medical records, 2021: 100%
Expenditure on retail pharmaceuticals per capita, USD PPP, 2021
– Total: $456
Expenditure on retail pharmaceuticals by type of financing, 2021:
– Government/compulsory schemes: 68%
– Voluntary health insurance schemes: 1%
– Out-of-pocket spending: 31%
– Other:
Share of the population aged 65 and over, 2021: 19.7%
Share of the population aged 65 and over, 2050: 24.8%
Share of the population aged 80 and over, 2021: 4.8%
Share of the population aged 80 and over, 2050: 10.3%
Adults aged 65 and over rating their own health as good or very good, 2021: 58%
Adults aged 65 and over rating their own health as poor or very poor, by income, 2021
– Lowest quintile: 11%
– Highest quintile: 2%
– Total: 8%
Limitations in daily activities in adults aged 65 and over, 2021
– Some Limitations: 42%
– Severe Limitations: 8%
Share of adults aged 65 and over receiving long-term care, 2021: 11.7%
Estimated prevalence of dementia per 1,000 population, 2021: 15.6
Estimated prevalence of dementia per 1,000 population, 2040: 23.1
Total long-term care spending as a share of GDP, 2021: 4.4%
Long-term care workers per 100 people aged 65 and over, 2021: 8.2
Share of informal carers among the population aged 50 and over, 2019
– Daily carers: 7%
– Weekly carers: 9%
Share of long-term care workers who work part time or on fixed contracts, 2021
– Part-time: 77%
– Fixed-term contract: 20.1%
Average hourly wages of personal care workers, as a share of economy-wide average wage, 2018
– Residential (facility-based) care: 95
– Home-based care: 91
Long-term care beds in institutions and hospitals per 1,000 population aged 65 years and over, 2021
– Institutions: 73.9
– Hospitals: 3.2
Long-term care recipients aged 65 and over receiving care at home, 2021: 66%
Total long-term care spending by provider, 2021
– Nursing home: 82%
– Hospital: 7%
– Home care: 1%
– Households: 6%
– Social providers: 4%
– Other: 0.04%

Source: OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/7a7afb35-en.

Population, 2021: 17,502,000
Annual Population Growth Rate, 2020-2030 (%): 0.3%
Life Expectancy at Birth, 2021: 82
Share of Urban Population, 2021: 93%
Annual Growth Rate of Urban Population, 2020-2030 (%): 0.5%
Neonatal Mortality Rate, 2021: 3
Infant Mortality Rate, 2021: 4
Under-5 Mortality Rate, 2021: 4
Maternal Mortality Ratio, 2020: 4
Gross Domestic Product Per Capita (Current USD) (2010-2019): $52,295
Share of Household Income (2010-2019):
Bottom 40%: 23%; Top 20%: 37%; Bottom 20%: 9%
Gini Coefficient (2010-2019): 28
Palma Index of Income Inequality (2010-2019): 1.0

Note: “Under-5 mortality rate – Probability of dying between birth and exactly 5 years of age, expressed per 1,000 live births.
“Infant mortality rate – Probability of dying between birth and exactly 1 year of age, expressed per 1,000 live births.
“Neonatal mortality rate – Probability of dying during the first 28 days of life, expressed per 1,000 live births.”
“Maternal mortality ratio – Number of deaths of women from pregnancy-related causes per 100,000 live births during the same time period (modelled estimates).”
Gini coefficient – Gini index measures the extent to which the distribution of income (or, in some cases, consumption expenditure) among individuals or households within an economy deviates from a perfectly equal distribution. A Gini index of 0 represents perfect equality, while an index of 100 implies perfect inequality.
Palma index of income inequality – Palma index is defined as the ratio of the richest 10% of the population’s share of gross national income divided by the poorest 40%’s share.

Source: United Nations Children’s Fund, The State of the World’s Children 2023: For every child, vaccination, UNICEF Innocenti – Global Office of Research and Foresight, Florence, April 2023.

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.

Current health expenditure (CHE) per capita in US$, 2022: $5,796.03

Source: Global Health Observatory. Current health expenditure (CHE) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Out-of-pocket expenditure (OOP) per capita in US$, 2022: $580.92

Source: Global Health Observatory. Out-of-pocket expenditure (OOP) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%), 2022: 10.02%

Source: Global Health Observatory. Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic private health expenditure (PVT-D) as percentage of current health expenditure (CHE) (%), 2022: 31.45%

Source: Global Health Observatory. Domestic private health expenditure (PVT-D) as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic private health expenditure (PVT-D) per capita in US$, 2022: $1,823.10

Source: Global Health Observatory. Domestic private health expenditure (PVT-D) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic general government health expenditure (GGHE-D) as percentage of current health expenditure (CHE) (%), 2022: 68.54%

Source: Global Health Observatory. Domestic general government health expenditure (GGHE-D) as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic general government health expenditure (GGHE-D) as percentage of gross domestic product (GDP) (%), 2022: 6.92%

Source: Global Health Observatory. Domestic general government health expenditure (GGHE-D) as percentage of gross domestic product (GDP) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic general government health expenditure (GGHE-D) per capita in US$, 2022: $3,972.34

Source: Global Health Observatory. Domestic general government health expenditure (GGHE-D) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

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.

“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).”

“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.

Netherlands: Health System Overview - World Health Systems Facts

World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other nations.

Page last updated July 10, 2025 by Doug McVay, Editor.