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Chapter 8
The impact of the crisis on the health
system and health in the Netherlands
Ronald Batenburg, Madelon Kroneman and Anna Sagan
Introduction
At the onset of the crisis, the Dutch health care system was still in the process of
transition following a major reform in 2006 that had as its main aims an increase
in efficiency and a reduction in costs. Consequently, it is often unclear whether
changes that happened after 2008 were the result of the crisis or the result of
adjustments to enhance the operation of the new system. Moreover, health care
was one of the last sectors in the Netherlands to be affected by budget cuts.
Nevertheless, the worsening economic situation acted as a motivation for policymakers,
stakeholders and the public to discuss essential questions such as the
affordability of health care, the generosity of the benefits package and the extent
of user charges or compulsory deductibles within the health insurance system.
With the aim of controlling costs, a number of agreements were negotiated
between the government and stakeholders, the most important of which
was the 2013 Health Agreement with providers and health insurers. Mainly,
measures targeted a reduction in input costs, such as limiting the income of
medical specialists or encouraging GPs to prescribe cheaper drugs. Much more
complex structural measures, such as the reform of long-term care, are only
just beginning to be tackled and the outcomes remain to be seen. Within this
context, accessibility, quality and affordability of care remain key concerns.
1. The nature and magnitude of the financial and
economic crisis
1.1 The origins and immediate effects of the crisis
During the 1990s, the Netherlands recorded steady economic growth.
In 2001, the rate of GDP growth slowed sharply and almost ground to a halt