Netherlands: Reforms and Challenges

“In the Dutch health care system, competing insurers are expected to play a key role in improving quality through contract negotiations with health care providers (see Section 4). In practice, insurers emphasise volume and price more than quality in their contracting decisions, partly due to the fragmentation and administrative burden of collecting quality indicators. The Dutch Health Care Institute has been tasked with developing reliable and meaningful quality indicators and drawing up a multi-year care improvement agenda, in consultation with all parties involved in health care. These initiatives can then be used to improve care, enhance shared decision making and ultimately guide contracting with providers.

“Furthermore, some insurers have started creating bottom-up longer-term contracts with providers centred on value-based care, where providers and professionals can define key performance indicators for quality of care and delivery innovations. Medical professional groups and the government also contribute to quality improvement activities, such as a new long-term care quality framework aims to improve the quality of care in nursing homes. An initiative to provide “the right care at the right place” (de juiste zorg op de juiste plek) also has gained momentum, and has helped physicians and patients to determine the appropriate setting for COVID-19 treatment (see Section 5.3).”

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 reform changed the role of government from direct controller of volumes and prices to rule-setting and overseeing a proper functioning of the markets. Insurers were supposed to act as quality-driven active purchasers and were given tools to selectively contract providers. More than a decade later considerable progress has been made, but the majority of hospital contracts have a one year duration and often lack agreements on quality of care or patient outcomes (Section 5.1). The Netherlands Council for Health and Society (RVS), an independent advisory body to the government, criticised current purchasing practices, arguing they have led to uniformity in care supply, low trust levels in insurers, high administrative costs, and limited care innovation and prevention. Several political parties including those in government have shifted their focus from competition in health care to achieving better care coordination and quality.”

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.

“In the Netherlands there is much debate about the question to what extent competing healthcare providers are allowed to cooperate with each other and whether the provision of healthcare should be more ‘regionalized’. The Dutch competition authority (ACM) has clearly indicated that such cooperation is allowed if the consumer substantially benefits from this cooperation. Nevertheless, under public and political pressure the role and effectiveness of the Dutch competition regulation in healthcare has been reduced.”

Source: van de Ven WP, Beck K, Buchner F, et al. Preconditions for efficiency and affordability in competitive healthcare markets: are they fulfilled in Belgium, Germany, Israel, the Netherlands and Switzerland? Health Policy. 2013;109(3):226-245. doi:10.1016/j.healthpol.2013.01.002

“In the Netherlands since 2014 the National Healthcare Institute (ZIN) has the task to improve the quality of care and to make it more transparent in cooperation with relevant stakeholders in the healthcare sector. ZIN has to assess quality standards (i.e., professional standards and guidelines) and quality indicators, which are published on the publicly accessible website ‘zorginzicht’ [18]. Compared to 2012 the information on quality in 2022 has become better accessible and has been improved, particularly in case of hospitals.”

“In the Netherlands since 2012 uninsured persons are traced via the merging of several databases. The Central Administration Office (CAK) sends them a letter and imposes a fine (equal to three times the average premium) if the person does not buy health insurance after three months; and, if necessary, a second fine (again three times the average premium) six months after the notification. After nine months, the CAK ex-officio enrolls the previously uninsured person as an insured with an insurer (chosen by the CAK) for a year and imposes an administrative premium (equal to the average premium). This premium is collected as much as possible by withholding it at the source of income (e.g., the wage or social security benefits). Insured people who have not paid their premium for more than 6 months (and are then officially labeled as “defaulters”) must pay 120 % of the average premium to the CAK. The number of uninsured people has decreased from 58,000 in 2012 to 24,000 (0.13 % of the population) in 2022 [44]. The number of defaulters has decreased from 304,000 in 2012 to 170,000 (0.96 % of the population) in 2022 [45].”

“Transparency remains a key issue in the Dutch healthcare system, since citizens can only make informed decisions if they have access to clear and comprehensible information. Currently there are many different health plans, which are difficult to compare. The Dutch Healthcare Authority plans to investigate whether this hampers the proper functioning of the market (Dutch Healthcare Authority, 2015b). In 2015 the Minister of Health agreed with Health Insurers Netherlands, the umbrella organization of the Dutch health insurers, to improve comparability of information for the insured population. Insurers should provide standardized information on the profit they make, the composition of the premium, whether financial reserves have been used to lower the premium, and the different conditions across offered health plans. In addition, they should clearly communicate that all citizens are accepted for the basic package. Furthermore, health insurers plan to make switching easier for persons who use medical devices or disposables by automatically adopting the authorizations of the former insurer. Lastly, health insurers decided to include care products (actual provided care) within the DBC on the patient’s bill (Ministry of Health, Welfare and Sport, 2015b).

“The Dutch Healthcare Authority is working on regulations that target clear communication on which care is subject to the mandatory deductible and on making transparent beforehand what will be the cost of treatment. Furthermore, the Authority is planning to bring in regulation of web sites that compare health plans, to make the information more reliable and comparable. In the first years after the reform, a government-funded agency provided a web site that compared health plans and providers, but more recently the site has only provided information on providers, since sufficient comparative information on health insurers was available on commercial web sites. However, commercial sites differ in the way they select and present their data, resulting in different results for similar requests for comparison, and the selection criteria are not always clear.”

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.

Netherlands: Health System Reforms and Challenges - National Policies - World Health Systems Facts

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Page last updated August 8, 2025 by Doug McVay, Editor.