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“An early involvement of the government in the actual organization of public health was the gradual development of municipal health services (Gemeentelijk Gezondheidsdienten, GGDs) at the beginning of the twentieth century. Much later, in the 1980s, municipal health services were made a legal obligation and the municipalities became responsible for their management and funding.

“Vaccination and screening are public health tasks of the national government. The National Vaccination Programme (Rijksvaccinatieprogramma) started in 1957 and was gradually expanded, while several cancer screening programmes have been introduced since the mid-1980s.

“A system of state medical inspection was already established in 1865, following the Health Act (Gezondheidswet). In the twentieth century, four inspection areas were distinguished: healthcare, pharmaceutical care, mental healthcare and veterinary care. In 1995 the first three areas merged to become the Health Care Inspectorate (Inspectie Gezondheidszorg, IGZ), which is an independent advisory body to the Ministry of Health, Welfare and Sport.”

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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“Early predecessors of the sickness funds were mutual funds founded in the first half of the nineteenth century by charities, physicians, pharmacists and other private individuals, and in the late nineteenth century also by labour unions. Gradually, fragmented voluntary arrangements were replaced by obligatory state health schemes (de Swaan, 1989; Veraghtert & Widdershoven, 2002). The adoption in 1913 of the Sickness Act (Ziektewet) marked the start of government interference, but it took until the Second World War before the Germans occupying the country installed a compulsory insurance system with sickness funds for employees earning less than a certain income level.

“The benefit package was uniform, and relatives of employees were also covered. Contributions were paid by employees and employers in equal proportions. Services were provided on a benefit-in-kind basis. Those not employed could join a sickness fund on a voluntary basis (called “voluntary insurance”). Others, including those earning more than a defined income level, had to rely on one of the various private health insurance schemes (Boot & Knapen, 2001; Kappelhof, 2005; Veraghtert & Widdershoven, 2002).

“A new Sickness Fund Act (Ziekenfondswet, ZFW) entered into force in 1966. The new Act continued the scheme of compulsory, voluntary and private health insurance, but added a new compulsory insurance for the whole population to cover severe medical risks (Algemene Wet Zware Geneeskundige Risico’s, AWZ). The AWZ was replaced in 1967 with the Exceptional Medical Expenses Act (Algemene Wet Bijzondere Ziektekosten, AWBZ), which had a narrower scope.

“The voluntary health insurance system, which disproportionately included (older) persons with unfavourable risks, was abolished in 1986 by the Act on Access to Health Insurance (Wet op de Toegang tot Ziektekostenverzekeringen, WTZ). People insured in the voluntary scheme were re-allocated either to the compulsory sickness fund scheme, or to private health insurance. Additional legislation was needed to prevent undesired effects.”

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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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 August 8, 2025 by Doug McVay, Editor.