JANUARY

How are costs contained?
THE NETHERLANDS
The main approach to controlling costs relies on market forces while regulating competition and improving
efficiency of care. In addition, provider payment reforms, including a shift from a budget-oriented
reimbursement system to a performance- and outcome-driven approach, have been implemented.
Cost containment was one of the most significant subjects of public debate surrounding the 2012 elections.
The most recent figures indicate that expenditure growth has fallen significantly, to 1.8 percent in 2014.
The pharmaceutical sector is generally considered to have contributed significantly to the decrease in spending
growth. Average prices for prescription drugs declined in 2014, although less than in previous years.
Reimbursement caps for the lowest-price generic have contributed to the decrease in average price.
Reimbursement for expensive drugs has to be negotiated between hospital and insurer. There is some concern
that this and other factors may limit access to expensive drugs in the near future.
The annual deductible, which accounts for the majority of patient cost-sharing, more than doubled between
2008 and 2015, from EUR170 (USD206) to EUR375 (USD454). There are some worries that this increase has led
to greater numbers of people abstaining from or postponing needed medical care.
Health technology assessment is gaining in importance and is used mainly for decisions concerning the benefit
package and the appropriate use of medical devices.
In 2013, an agreement signed by the Minister of Health, all health care providers, and insurers set a voluntary
ceiling for the annual growth of spending on hospital and mental care. When overall costs exceed that limit,
the government has the ability to control spending via generic budget cuts. The agreement included an extra
1 percent spending growth allowance for primary care practices in 2014 and 1.5 percent in 2015–17, provided
they demonstrate that their services are a substitute for hospital care.
Cost containment is most severe in long-term care. People with lower care needs are no longer entitled to
residential care. In addition, the devolution of services to the municipalities was accompanied by substantial
cuts to the available budgets (on average almost 10%).
What major innovations and reforms have been introduced?
After years of rapid spending growth, long-term care as of January 2015 is fundamentally reformed. The reform
program’s main goals were to guarantee fiscal sustainability and universal access in the future and to stimulate
greater individual and social responsibility. The new structure seems to be up and running, but its effects as yet
are unknown, and future amendments may be needed.
In curative health care, market reform and regulated competition remain somewhat controversial. The
government, determined to continue stimulating competition between insurers and providers, undertook some
measures to that effect, such as requiring insurers and providers to assume greater financial risk. In December
2014, however, the Dutch Senate rejected a new policy proposal restricting free provider choice in specific
insurance policies. The accessibility of expensive drugs has rapidly become a prominent issue in 2015.
As of the date of this report, the Health Insurance Act has undergone two evaluations. The latest evaluation
pointed to an imbalance of power, with providers having an advantage over insurers.
International Profiles of Health Care Systems, 2015 121