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274 Economic crisis, health systems and health in Europe: country experience
5. Discussion
5.1 Drivers of change
The key changes in the Dutch health care system described in this chapter
date from before the start of the economic crisis and were mainly affected
by the 2006 reform that aimed to increase efficiency and reduce costs. The
economic crisis hit the Dutch health care sector relatively late and in an indirect
way compared with other countries and other sectors in the Dutch economy.
The crisis mainly reinforced the measures implemented in earlier years. Some
changes started to take place from 2014 and their effects remain to be seen.
5.2 Content and process of change
At the onset of the crisis, the Dutch health care system was still in the process of
transition following the 2006 reform. This reform came with many protective
measures aimed at preventing financial problems in the health care sector and
giving stakeholders the opportunity to become accustomed to their new roles.
It is, therefore, often unclear whether changes in the system that happened after
2008 were the result of the economic crisis or the result of adjustments to promote
good working of the new system and abolish protective measures.
With the export and financial services sectors hit first and with budget cuts first
affecting the defence and arts budgets, it seems that health care is one of the
last sectors in the Netherlands to be affected by the economic crisis. Indeed, the
cost-saving measures implemented in the health care sector between 2009 and
2011 have hardly had an impact on the distribution of health care expenditure
among the different financing agents (Fig. 8.3) and on the composition of
health care expenditure (Figs 8.4 and 8.5) between 2008 and 2011.
Fig. 8.3 Breakdown of total health care expenditure by financing agent in the Netherlands
at the beginning (2008) and during (2011) the crisis
2008 2011
3.6%
3.2%
9.9%
4.0%
14.2%
Government
Exceptional Medical
Expenses Act
9.6%
4.2%
14.4%
27.8%
Health Insurance Act
VHI
OOP payments
Other
28.3%
40.5%
40.3%
Source: Statistics Netherlands, 2013b.