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250 Economic crisis, health systems and health in Europe: country experience
injection in 2008. In addition, €200 billion was made available in 2012 to
financial institutions as a guarantee on bank loans. In 2008, in line with
the new European regulation (European Union Financial Sector Assessment
Programme – Deposit Guarantee Schemes; IMF, 2013), the guarantee on
deposit accounts (current and savings accounts) was increased from €40 000 to
€100 000 (Government of the Netherlands, 2013).
The rapid increase in public spending and the fall in tax revenues caused a
substantial increase in the public budget deficit. In 2013, a set of austerity
measures amounting to €6 billion was agreed by the government and the
political parties (see section 2.2). The most important of these measures were a
reduction of surcharges, stabilization of salaries in the public sector and cuts in
public expenditure. The aim of the consolidation programme was to significantly
reduce the public budget deficit and debt by 2015 to ensure compliance with
the public deficit limit imposed by the Stability and Growth Pact. While this
package was necessary to meet this limit, it may also have caused an increase in
the unemployment rate in the immediate future.
1.3 Broader consequences
The economic decline and cuts in government budgets continue to create
uncertainty for Dutch households and companies. Some optimistic signs could
be discerned at the end of 2013, with both GDP and house prices forecast to
grow at a minimal pace in 2014. At the same time, Standard and Poor's Financial
Services (a credit-rating agency) downgraded the Dutch economy in November
2013 from AAA to AA+, stating that the Dutch economy was lagging behind
other economies in Europe, which were recovering more quickly.
2. Health system pressures prior to the crisis
In 2006, a single health insurance scheme, compulsory for all Dutch residents,
was introduced, intended to radically change the roles of patients, insurers,
health care providers and the government. The main aims of the reform were
to increase solidarity and efficiency, decrease government involvement, ensure
good access to care and enhance freedom of choice (Schut & van de Ven, 2011).
Three “markets” can be distinguished in the Dutch health care system: the health
insurance market, the health provision market and the health care purchasing
market. Managed competition is now intended to be the major driver in the
health care system. Within the health care purchasing market, insurers have
to negotiate with providers on price, quality and volume of care. In the health
care provision market, patients can choose the provider they prefer. In the
health insurance market, citizens can purchase a health insurance plan that best
meets their needs. The system of managed competition is currently in place