JANUARY

THE NETHERLANDS
Hospital payment rates (including doctor fees) are determined through negotiations between each insurer and
each hospital over price, quality, and volume. The great majority of payments take place through the casebased
diagnosis treatment combination system, and the rates for approximately 70 percent of hospital services
are freely negotiable; the remaining 30 percent are set nationally. The number of diagnosis treatment
combinations was reduced from 30,000 to 4,400 in 2012. Diagnosis treatment combinations cover both
outpatient and inpatient as well as specialist costs, strengthening the integration of specialist care within the
hospital organization.
Mental health care: Mental health care is provided in basic ambulatory care settings, such as GP offices, for
mild to moderate mental disorders. In cases of complicated and severe mental disorders, GPs will often refer
patients to a psychologist, an independent psychotherapist, or a specialized mental health care institution. The
delivery of preventive mental health care is the responsibility of municipalities and is governed by the Social
Support Act.
A policy of further integration of general practice and mental health was agreed on in 2012, with the goals of
ensuring that patients receive timely care from the right source and reducing the need for specialized care. For
several years, policymakers have been aiming to substitute outpatient care for inpatient care, reflected in the
steady increase in the number of GPs that employ primary care psychologists.
Long-term care and social supports: A substantial proportion of long-term care is financed through the Longterm
Care Act (Wet langdurige zorg), a statutory social insurance scheme for long-term care and uninsurable
medical risks and cost that cannot be reasonably borne by individuals. It operates nationally, and taxpayers pay
a contribution based on taxable income. The remainder of services are financed through the Social Support Act,
from general sources. Long-term care encompasses residential care; personal care, supervision, and nursing;
medical aids; medical treatment; and transport services. Cost-sharing depends on size of household, annual
income, indication, assets, age, and duration of care. In 2014, copayments covered 7 percent of total spending
in the compulsory long-term care (LTC) scheme.
With funding provided through a block grant from the national government, municipalities are responsible for
household services, medical aids, home modifications, services for informal caregivers, preventive mental health
care, transport facilities, and other assistance, in accordance with the Social Support Act (Wet Maatschappelijke
Ondersteuning). Municipalities have a great deal of freedom in how they organize services, including needs
assessments, and in how they support caregivers (e.g., through the provision of respite care or a small allowance).
Lont-term care is mostly provided by private, nonprofit organizations, including home care organizations,
residential homes, and nursing homes. Most palliative care is integrated into the health system and delivered by
general practitioners, home care providers, nursing homes, specialists, and volunteer workers.
Under both the Social Support Act and the Long-term Care Act, personal budgets are provided for patients
to buy and organize their own long-term care, and under the Long-term Care Act are set at 66 percent of rates
paid for in-kind services.
What are the key entities for health system governance?
Since 2006, the Ministry of Health’s role has been to safeguard health care from a distance rather than
managing it directly. It is responsible for the preconditions pertaining to access, quality, and cost of the health
system, has overall responsibility for setting priorities, and may, when necessary, introduce legislation to set
strategic priorities.
A number of arm’s-length agencies are responsible for setting operational priorities. At the national level, the
Health Council advises government on evidence-based medicine, health care, public health, and environmental
protection. The National Health Care Institute advises government on the components of the statutory benefits
package and has various tasks relating to quality of care, professions and training, and the insurance system
(e.g., risk adjustment). The Medicines Evaluation Board oversees the efficacy, safety, and quality of medicines.
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The Commonwealth Fund