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Chapter 8 | The impact of the crisis on the health system and health in the Netherlands
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success with which the Act has been implemented varies among municipalities
given that the definition of compensation for disabilities also varies among
them and, as a result, there are differences in the generosity of care provision
among municipalities (Ursum et al., 2011). In 2008, extra funds were made
available for long-term care that was not transferred to the municipalities
(institutional care, home nursing care, all care under the Exceptional Medical
Expenses Act); these funds were intended to increase the number of longterm
care personnel to meet increased demand: €340 million was reserved
for 5000–6000 additional long-term care nurses, for the provision of daytime
activities for people with disabilities, and to increase the volume of long-term
care (Ministry of Health, 2008).
Fig. 8.1 Indexed growth in health care expenditure per sector in the Netherlands
150
145
140
135
130
125
120
115
110
105
100
Rehabilitation
care
Total
Long-term care
Curative care
Pharmaceutical
care and aid
Prevention and
public health
2005 2006 2007 2008 2009 2010 2011 a 2012 a
Notes: 2005 taken as the index value of 100; a Provisional data.
Source: Statistics Netherlands, (2013b).
Overall, the most successful cost-containment measure prior to the crisis was
the preferred pharmaceuticals policy, which is still in place in 2015. This policy
led to a structural decrease in the growth of health care expenditure. The area
where the least cost-saving was achieved before the crisis is specialist care.
2.2 Pressures emerging during the crisis
In 2009, the government's revenue from taxes and premiums fell short of the
estimates by €18 billion (i.e. by about 23%). Since health care expenditure kept
increasing at a steep rate (see Fig. 8.1) and accounts for a large and increasing
share of total public expenditure (20% in 2010 compared with 13% in 2000;
National Institute for Public Health and the Environment, 2013), the pressure to
contain health care costs, already apparent before the crisis, became even stronger.