JANUARY

THE NETHERLANDS
receive faster access to any type of care, nor do they have increased choice of specialist or hospital. In 2013,
voluntary insurance accounted for 7.6 percent of total health spending.
What is covered?
Services: In defining the statutory benefits package, government relies on advice from the National Health Care
Institute. Health insurers are legally required to provide a standard benefits package including, among other
things, care provided by general practitioners (GPs), hospitals, and specialists; dental care through age 18
(coverage after that age is confined to specialist dental care and dentures); prescription drugs; physiotherapy
through age 18; basic ambulatory mental health care for mild-to-moderate mental disorders, including a
maximum of five sessions with a primary care psychologist; and specialized outpatient and inpatient mental care
for complicated and severe mental disorders. In case the duration exceeds three years, the last of these is
financed under the Long-term Care Act (see below).
Some treatments, such as general physiotherapy and pelvic physiotherapy for urinary incontinence, are only
partially covered for some people with specific chronic conditions, as are the first three attempts at in vitro
fertilization. Some elective procedures, such as cosmetic plastic surgery without a medical indication, dental
care above age 18, and optometry, are excluded. A limited number of effective health improvement programs
(e.g., smoking cessation) are covered, and weight management advice is limited to three hours per year.
As of 2015, home care is a shared responsibility of the national government, municipalities (day care, household
services), and insurers (nursing care at home), and is financed through the Health Insurance Act. Hospice care
is financed through the Long-term Care Act. Prevention is not covered by social health insurance, but falls under
the responsibility of municipalities.
Cost-sharing and out-of-pocket spending: As of 2015, every insured person over age 18 must pay an annual
deductible of EUR375 (USD455) for health care costs, including costs of hospital admission and prescription
drugs but excluding some services, such as GP visits. 1 Apart from the overall deductible, patients are required
to share some of the costs of selected services, such as medical transportation or medical devices, via
copayments, coinsurance, or direct payments for goods or services that are reimbursed up to a limit, such as
drugs in equivalent-drug groups. Providers are not allowed to balance-bill above the fee schedule. Patients with
an in-kind insurance policy may be required to share costs of care from a provider that is not contracted by the
insurance company. Out-of-pocket expenses represented 13.8 percent (45% through deductible) of health care
spending in 2013 (author’s calculation).
Safety net: GP care and children’s health care are exempt from cost-sharing. Government also pays for
children’s coverage up to the age of 18 and provides subsidies (health care allowances), subject to asset testing
and income ceilings, to cover community-rated premiums for low-income families (singles with annual income
of less than EUR26,316 [USD31,896] and households with income less than EUR32,655 [USD39,580]).
Approximately 5.4 million people receive allowances set on a sliding scale, ranging from EUR5.00 (USD6.10)
to EUR78.00 (USD95.00) per month for singles and from EUR9.00 (USD11.00) to EUR 149.00 (USD181.00) for
households, depending on income.
How is the delivery system organized and financed?
Primary care: There were more than 11,300 practicing primary care doctors (GPs) in 2014 and more than
20,400 specialists in 2013. Nearly 33 percent of practicing GPs worked in group practices of three to seven,
39 percent worked in two-person practices, and just over 28 percent worked solo. Most GPs work independently
or in a self-employed partnership; only 11 percent are employed in a practice owned by another GP.
1
Please note that, throughout this profile, all figures in USD were converted from EUR at a rate of about EUR0.83 per USD,
the purchasing power parity conversion rate for GDP in 2014 reported by OECD (2015) for the Netherlands.
116
The Commonwealth Fund