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252 Economic crisis, health systems and health in Europe: country experience
Cost control
A number of measures had been put in place before the start of the financial
crisis to control increasing health care costs. These measures aimed to change
the behaviours of both health care users and providers and concerned both
curative care and long-term care.
Citizens were discouraged from consuming unnecessary care by the “no-claim”
regulation introduced in 2005. According to this regulation, citizens who had
spent less than €225 per year on health care were paid back the difference
between this amount and the sum spent, up to €225 for those who consumed
no health care. However, the no-claim regulation was found to be ineffective
(the refund being made only in the following year and so not a timely incentive
to consume less health care) and was replaced by the compulsory deductible
in 2008.
The reform of the GP remuneration system in 2006 1 (and the change in GPs'
claims behaviour and the increase in supplier-induced demand that followed
it) led to a rapid increase in GP remuneration from 2006 and budget overruns
(Schut, Sorbe & Høj, 2013). In 2007, the amount overspent on GP care
was €356 million (i.e. approximately 21% over the budget; Table 8.2). In
response, GP fees were frozen (not indexed for inflation) for two consecutive
years, 2007 and 2008; later, the freeze also continued in 2009 (Ministry of
Health, 2009).
Table 8.2 Overspending in health care in the Netherlands, 2007–2012
Care sector
Overspend (€ millions (%) a
2007 2008 2009 2010 2011 2012
GP care 356.4
(20.6%)
134.4
(6.8%)
50.8
(2.3%)
204.3
(10.1%)
168.6
(7.6%)
231.0
(11.0%)
Specialist medical care b 301.8
(17.6%)
113.8
(6.3%)
832.3
(52.4%)
401.6
(23.9%)
246.5
(13.3%)
63.0
(3.2%)
Use of hospital facilities c 585.9
(12.8%)
58.3
(0.4%)
413.5
2.9%)
869.9
(6.1%)
910.2
(6.0%)
324.0
(1.9%)
Pharmaceutical care 30.1
(0.6%)
28.2
(0.6%)
177.5
(3.3%)
306.7
(5.6%)
298.2
(5.3%)
710.6
(13.2%)
Notes: a Overspending: the difference between the actual amount spent and the amount foreseen
in the budgets; b Care provided directly by medical specialists, both in ambulatory and inpatient
settings; c Use of items such as hospital beds and food, plus provision of, among others, nursing care
and the use of laboratory facilities.
Source: Ministry of Health, 2008–2012.
1 Previously, GPs were remunerated via capitation for two-thirds of the population and FFS for the other third of the
population. The new system is a mix of capitation and FFS for all patients (Schut, Sorbe & Høj, 2013).