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258 Economic crisis, health systems and health in Europe: country experience
Initially, from 2009, the measures were mainly targeted at reduction, shifting
costs from public to private sources by limiting the basic package, and efforts
to prevent improper health care consumption. From 2011 onwards, the
measures focused more on structural changes in the area of acute care, with
the government seeking to reach a consensus with stakeholders to agree on
further cost-containment, and in the area of long-term care, where there
was a shift towards more decentralization of care in combination with major
budgetary cuts.
Despite all the cost-saving initiatives taken between 2009 and 2012, falls in
expenditure were only recorded in the area of pharmaceutical care and medical
devices, mainly through the use of the preferred pharmaceuticals policy and
tendering by the insurers; instead, expenditure on all other types of care kept
increasing (Fig. 8.1).
The previous government fell in February 2010 (for reasons unrelated to the
financial crisis). As a result, cost-saving measures in the area of health care came
to a total standstill in a period when achieving savings was very important. No
new measures or reforms could be introduced between February and October
2010, when a new government took power.
3.1 Shifting costs from public to private sources
Costs were shifted from public to private sources by reducing service and
cost coverage, with patients bearing more of the costs, and by reducing
overspending on primary and specialized care by making health care providers
more responsible for the amounts overspent.
Population coverage (universality)
Universal population coverage for both curative care under the basic health
insurance scheme (regulated by the Health Insurance Act) and long-term
care under the Exceptional Medical Expenses Act has not changed since the
introduction of the Health Insurance Act in 2006. However, changes in service
coverage have resulted in narrower population coverage for certain services or
benefits. For example, the eligibility for a long-term care personal budget was
limited (Tables 8.3 and 8.4); however, people needing care can still receive it
through in-kind provision.
Service coverage (benefits package)
Several changes to the benefits package have been made since the emergence of
the financial crisis (Table 8.3). Changes in the benefit package are prepared by
the National Health Care Institute (Zorginstituut Nederland; previously the
College van Zorgverzekeringen) and approved by the government before they