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256 Economic crisis, health systems and health in Europe: country experience
The cuts applied to the health care sector were similar to or even somewhat less
than in other public sectors such as social welfare, defence or education. The
share of health care expenditure increased to 25.5% of total public expenditure
in 2012 (Ministry of Finance, 2012), while the loss of jobs that affected other
sectors was not felt in health care. The yearly nominal growth in health care
expenditure fell significantly between 2008 and 2011 (Fig. 8.2).
Fig. 8.2 Annual nominal growth in health care expenditure in the Netherlands, 2000–2013
14
12
10
Growth (%)
8
6
4
2
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 a 2013 a
Notes: a Provisional data; Dark blue: Total Dutch Health Accounts; Light green: Total OECD
System of Health Accounts (gap in this series at 2005 results from a change in definition, giving an
unreliable growth figure for that year).
Source: Based on: Zorgbalans (Fig. 8.1, p. 241), National Institute for Public Health and the
Environment, 2014.
In 2013, it was agreed that public expenditure growth could exceed 2.5%
for mental health care between 2013 and 2014, 2.5% for specialized care
between 2012 and 2015, and 2.5% for primary care between 2014 and 2017.
Nevertheless, planned government spending on health care (including premiums
for social security) for 2014 was €77.8 billion, or 29% of the total public budget
(Government of the Netherlands, 2014). This is higher than the 2012 share
of 25.5%, which means that the assumed growth in the share of health care
expenditure in total public spending between 2012 and 2014 is 7% per year
on average. Investment in the education of health care personnel was protected
from budget cuts until 2014 to ensure quality of care. In 2014, however, a
budget cut was implemented in the area of education of medical specialists:
the length of education was shortened and the number of new specialists was
reduced (Broersen & Visser, 2013). The education of physicians is the financial