Overview

The Caribbean Netherlands’ health system provides universal coverage for residents; services are delivered through island providers and others located off-island

Since the dissolution of the Netherlands Antilles in 2010, residents of the islands of Bonaire, St Eustatius and Saba (the BES islands, or Caribbean Netherlands) live in special municipalities of the Netherlands, one of four constituent countries of the Kingdom of the Netherlands. Given the unique context on the BES islands (i.e. geography, population size, limited provider network, absence of insurers), it was decided not to implement the health system of the European Netherlands in the Caribbean Netherlands. Limited on-island care capacity necessitates many off-island referrals to cross-border contracted providers, which are fully covered by insurance.  

Health financing comes from public sources and has doubled since 2012, but per capita spending is lower than in the European Netherlands

 As part of the effort undertaken to bring the level of care on the BES islands up to an “acceptable” standard, increases in the annual budget set current health expenditure at just over US$ 209.5 million in 2023. If the logistical costs of care provided off the BES islands (off-island) via referral (accommodation and ground transportation, flight tickets (public flights and charters), per diem allowances, etc.) are removed, per capita health spending on the BES islands is less than in the European Netherlands, though this has not been adjusted for purchasing power parity.

Many health workers on the BES islands are recruited from abroad and there can be significant turnover, given the small island contexts

Recruiting and retaining health professionals poses an ever-present challenge to operating the medical centers on St Eustatius and Saba. Bonaire has better access to health workers through agreements with institutions in the European Netherlands and its own training initiatives but also faces constraints (including language barriers and primary care accessibility). The application of the Healthcare Professionals Act (Wet BIG) also poses a challenge to certain staff working for longer time periods on the BES islands.   

Reforms have focused on improving accessibility and quality, and harmonizing regulations with those of the European Netherlands while adapting them to local needs

The initial aim of VWS in terms of improving healthcare on the BES islands after 10/10/10 was to work towards a level of service that would be “acceptable” within the Netherlands, given the circumstances of being small islands with high levels of poverty that are far away from the European Netherlands. Thus, the first areas of focus were to build an accessible health system that would improve on the pre-2010 system(s), including upgrading health facilities, increasing the availability and quality of emergency care and certain specialist services, introducing mandatory, universal health insurance coverage for all legal residents, and improving pharmaceutical care, home care and mental health services. The stated focus (from the State Secretary of VWS in late 2022) of the next stage of health system development on the BES islands is to achieve a level of services “equivalent” (gelijkwaardig) to the European Netherlands, updating it from the “acceptable” focus post-2010. This should concern both the quality and the scope of the services and involve an active dialogue with local stakeholders, providers, the public entities and others.