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Chapter 8 | The impact of the crisis on the health system and health in the Netherlands
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responsibility of the Ministry of Education (Ministerie van Onderwijs, Cultuur
en Wetenschappen). The Ministry of Health (Ministerie van Volksgezondheid,
Welzijn en Sport) is responsible for educating a sufficient number of medical
specialists (education should be of good quality and at a reasonable cost). 6 The
Dutch Health Care Authority (Nederlandse Zorgautoriteit) decides on how
much hospitals are paid for educating physicians. This amount is financed from
public sources. If hospitals have to invest more than the amount set by the
Health Care Authority, they will have to finance the extra costs through their
own means.
The steep increase in the nominal growth in health care expenditure in the
early 2000s (Fig. 8.2) was mainly a result of government programmes to reduce
waiting lists. The sharp decrease observed between 2002 and 2005 cannot be
easily explained, but it seems to be related to a decrease in the use of and
referrals to (specialized) mental health care. Mental health care appears to have
been a major driver of health care costs until about 2002. The growth observed
since 2006 is from increases in both the volume of care and in tariffs. The
reduction in the nominal growth in health care expenditure after 2008 can
be attributed to a sharp decrease in pharmaceutical expenditure and, to some
extent, also to tariff cuts (see section 3.1).
3. Health system responses
Measures to control health care costs have been implemented by the government
since 2008 for acute care and since 2010 for long-term care. The breach of
the Stability and Growth Pact criteria in 2010 reinforced the government's
recognition that an effective control of public costs (including health care costs)
was needed.
The political drive of the current government (in office since 2012) to reduce
the national debt to no more than 3% of the national budget has led to
significant reductions in the health care budget. The measures that have been
implemented can be grouped into four categories:
• shifting costs from public to private sources;
• shifting costs between various statutory sources (e.g. transfer of care from
coverage by the Exceptional Medical Expenses Act to the municipalities),
mostly in combination with major cuts in the budgets;
• substitution between different types of care: institutional care with home
care, and secondary care with primary care; and
• increased focus on improving efficiency and eliminating fraud.
These are discussed in more detail below.
6 For more information, see the Care Training Fund (Opleidingsfonds Zorg; Ministry of Health, 2014).