How the healthcare system works in the Netherlands

The Netherlands is one of the countries with the best quality of life in the world, and according to the 2018 report by the Euro Health Consumer Index, in a list of 35 countries, the healthcare system in the Netherlands is classified as the second-best in the European Union, and for three consecutive years, it has been among the top three positions in hanking.

The healthcare system in the Netherlands is universal. Until 2006, the Dutch health system was based on social insurance combined with a private insurance scheme covering those who are better off. After reforming the system, all residents are now required to purchase insurance policies (health insurance), which cover a defined benefit package for each institution.

All primary and long-term care services must be offered at a fixed price. It is illegal for companies to refuse coverage to anyone or impose punitive fees or conditions based on someone's financial or health status.

Despite being mandatory by the government, insurance is a private service. The government assists those who are unable to pay for insurance, but this can be a bit bureaucratic. The citizen can choose the insurer and the doctor, making the system highly competitive among insurers to offer the best price. Only adults pay: all children (up to 18 years old) are covered by a government contribution, in addition to a non-independent employer contribution to a central fund, which is redistributed among insurers on a risk-adjusted basis.

The Dutch healthcare system is among the most expensive in Europe, although growth has stabilized since 2012, after being reverted to a system of sectoral spending agreements. The high overhead costs are mainly due to a comparatively large long-term care sector. With the abolition of the private insurance scheme in 2006, public expenditure increased by about two-thirds of the total in 2005 to 82.7% in 2006 and has since declined slightly to 80.7% in 2015 (the European Union average is 78.7%).

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Medical care - how does it work?

After obtaining health insurance, it is time to choose your Huisarts, which we also call a family doctor (general practitioner). For each neighborhood and region, there is a family doctor, and normally people register with the one who is closest to their home, about 15 minutes walk from where they live.

To consult with a specialist, it is necessary to go through the family doctor first. In the consultation, which must be previously scheduled, the family doctor will analyze the patient's symptoms and perform screening, and it will be he who decides whether a referral to the specialist is necessary or not. It is worth mentioning that the Netherlands is one of the main references in the world regarding the use of electronic medical records, which facilitates communication and identification of the patient's history.

Many offices offer a telephone consultation schedule to see new patients. Not all clinics will accept new patients, but there is a possibility of a waiting list to join. You can find a list of local doctors by visiting the city hall, which should provide a community guide, or by searching online at local Dutch websites. Most health insurers also offer a list of family doctors who will accept new patients.

Patients are rarely referred to specialists, and interestingly, the medicine most prescribed by doctors is paracetamol. Another fact is that doctors do everything for the body to heal itself. This practice means that people do not use drugs indiscriminately.

Most specialists work in a hospital environment and, unfortunately, the patient can face a long waiting period. The basic health insurance package covers a visit to a specialist, but an extra fee may be charged depending on the treatment.

In the Netherlands, there is also Buurtzorg, a home care organization that has attracted international attention for its innovative use of independent nursing teams in providing relatively low-cost care. It is used in the provision of nursing services at home to the elderly, people with limited mobility, recovering from surgery, or with some addiction, such as alcohol and drugs.

Created in 2007, Buurtzorg has 850 groups of nurses, adding 10,000 professionals who serve 70,000 patients. Each team of nurses is free to organize their work, and there are no managers or bosses on the team.

Assessment of the Dutch health system

Looking at trends over time, the Netherlands has witnessed a steady decline in mortality under the age of 75, around 30% between 2000 and 2013. This points to constant improvements in access and quality of health care in general.

The Netherlands has a low number of preventable hospitalizations, indicating that primary care and secondary outpatient care help prevent the development of severe symptoms, as well as relatively low preventable mortality. The numbers of preventable hospitalizations for asthma, congestive heart failure, chronic obstructive pulmonary disease, and acute complications of diabetes are lower than in most other countries in the European Union.

Access to health care is good, with few financial, geographic, or waiting time barriers. There are, however, concerns about increased waiting times and shortages of labor, especially nurses. General practitioners' care remains free, but there is much public debate over the increased cost-sharing, mainly due to mandatory deductibles, although direct expenditures remain comparatively low.

Source: WHO/Europe