3.0. Introduction
According to WHO, the Dutch health system is among the most expensive in Europe, but it is also in the top five best valued systems in Europe and 91% of insured evaluate the health care system as good (TNS Opinion and Social, 2014). There are two main financing schemes: one for curative care (mainly directed towards curing the patient) and one for long-term care. The financing of the Dutch curative health care system is based on social health insurance and managed competition. Dutch citizens are obliged to purchase health insurance for a standard basic benefits package, and health insurers have to accept anyone who applies for an insurance policy. The health insurance for adults is paid for 50% by a community-rated premium and the other 50% via an income-dependent premium. Health care for children under the age of 18 is paid with a government contribution from taxes. The basic benefits package roughly includes GP-care, maternity care, hospital care, home nursing care, pharmaceutical care and mental health care. The first €385 (in 2016) of health care expenditure from this package is paid out of pocket, except for GP consultations, maternity care, home nursing care and care for children under the age of 18. Care that is not covered under the basic package can be insured via VHI, such as glasses and dental care.
For care that is regulated by the Zvw (mainly curative care), managed competition applies. Health insurers and providers negotiate on price and quality of care, although competition on quality is still in its infancy. The NZa oversees whether the competition is fair and establishes the care products for which prices can be negotiated. For care for which negotiation is not feasible, such as emergency care (not plannable) or organ transplantation (too few providers), the NZa establishes maximum prices. Health care providers are independent non-profit entrepreneurs. Hospitals are paid through an adapted type of DRG system: the Diagnosis Treatment Combinations. GPs are paid by a combination of fee-for-service, capitation and pay-for-performance.
Long-term care for persons needing 24-hour supervision is regulated by the Wlz and is financed from income-dependent contributions. Home nursing is part of the Zvw and all other forms of long-term care have been the responsibility of municipalities since January 2015. This large reform has come with a great deal of social unrest, because the reform also includes substantial savings targets and the organization of the care changed drastically (van Ginneken & Kroneman, 2015) (see also Chapter 6). Municipalities receive extra funding for these tasks (from general taxation), but these funds are not earmarked. This gives the municipalities the freedom to organize care to their own discretion. The idea behind the reform is that municipalities are closer to the citizens and better positioned to organize tailor-made care solutions for their population. Furthermore, long-term care seekers should first explore a solution within their personal social network. Only if that is not feasible or insufficient can professional care step in. However, the social network cannot be forced to provide care. As of 2015, it remains unclear how this will be effected in practice and if cost-containment targets will be met.
Preventive care targets the whole population and is financed from general taxation and regulated under the Preventive Care Act. This comprises vaccinations, cancer screening programmes and preventive care for children until the age of 13.
The references cited throughout this chapter can be found in the published PDF file of Health System Review for the Netherlands 2016.