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270 Economic crisis, health systems and health in Europe: country experience
the subject of public debate. For example, measures aimed at further limiting
personal budgets in long-term care, introduced in 2012 as a cost-containment
measure but also partly because of fraud, were heavily criticized as fraud in
these cases was debatable and the measures had the potential to harm older
people and people with disabilities who were highly dependent on the
personal budgets.
4. Implications for health system performance
4.1 Equity in access and financing
Currently, no specific information is available on equity in the use of health
care services. Consumption levels of health care decreased for the first time in
decades in 2012, but it is difficult to estimate to what extent this was the result
of the economic crisis. Socioeconomic inequalities in access to health care have
always been relatively low in the Netherlands, according to several international
comparative studies (Westert, 2010) and so far there is not much evidence that
this has changed.
Financing
Interestingly, despite the measures to shift costs from the public purse to
citizens, the share of OOP expenditure in health care financing has not increased
(Table 8.6 and Fig. 8.3). The combined burden of the premiums for both acute
care (Health Insurance Act) and long-term care (Exceptional Medical Expenses
Act) also remained rather stable: 68.3% of total health expenditure in 2008
and 68.6% in 2011 (Fig. 8.3). However, it should be noted that the effect of
the substantial increase in the compulsory deductible from €210 in 2012 to
€350 in 2013 is not yet included in these data. Moreover, the net contribution
of the government to health care financing (i.e. from taxation, which is a
progressive source of financing) grew substantially from 11.6% of total health
care expenditure in 2006 to 14.2% in 2008 and 14.4% in 2011 (Statistics
Netherlands, 2013b).
4.2 Access to services
Few studies are available on the potential effects of the crisis on the financial
accessibility of health care. A few recent facts and figures have been documented,
but it is difficult to say whether they have been the effect of the crisis or not.
There has been an increase in the number of defaulters and uninsured: the
proportion of defaulters (i.e. people who have not paid their premiums for at
least six months) has increased from 1.5% in 2006 to 2.4% in 2009. In 2010,
a new, stricter definition of defaulter was introduced. According to the new