The healthcare systems in Europe are in transition. While the market authorisation process has been harmonised in the EU, the pricing and reimbursement of surgical procedures and pharmaceutical medicines remains the competence of each individual country. In Europe, the health service coverage is more extensive than in the rest of the world. The coordination and split of expenses between private and public sectors are not always straight forward and differs between the European countries.
In order to bring some more clarity to this complicated topic, Medicalwriters.com will provide some more insights into the reimbursement system of some of the main European countries. First one out is The Netherlands!
Demographic overview – The Netherlands
Population: 16,773,554 (March 2013 est.)
Age structure (2011 est.):
- 0-14 years: 17% (male 1,466,218 / female 1,398,463)
- 15-64 years: 67.4% (male 5,732,042 / female 5,624,408)
- 65 years and over: 15.6% (male 1,141,507 / female 1,484,369)
Health expenditures: 12% of GDP (OECD 2010)
Physician density: 3.921 physicians/1,000 population (2007)
Hospital bed density: 4.25 beds/1,000 population (2008)
The Dutch baby boom, which took place after the end of World-War II, has influenced the age structure significantly. In the chart below this ageing effect is clearly visible. Since people older than 60 years have a higher need for health care consultation, an increased demand for health care services is expected in the nearby future.
The Dutch economy, stability and infrastructure
GDP growth rate in The Netherlands is reported by the Dutch Statistics Office (CBS). Historically, from 1988 until 2012, the Dutch GDP growth rate averaged 0.6 Percent reaching an all-time high of 2.0 percent in June of 1996 and a record low of -2.2 percent in March 2009. The Netherlands has the sixteenth-largest economy in the world and the sixth-largest in the European Union. The economy is dependent on foreign trade and derives more than 65 percent of GDP from both port activities and merchandise exports.
The economy of The Netherlands is noted for its stability, high skilled workforce and developed infrastructure. As a result, the country is the eleventh biggest destination of foreign direct investment in the world. (CIA World Factbook, December 2012)
The expenditure per capita in 2012 on healthcare averaged roughly USD 5,600 per person. That is double the amount than was spent in 2000. The rising healthcare expenditures in The Netherlands are a national economic problem. The Netherlands is ranked number four in the healthcare expenditure per capita list of OECD countries, just after the United States, Norway and Switzerland.
The government is initiating several measures to inhibit the expenditure growth, for example by reinforcing the free market forces and fostering innovation and efficiency improvements.
Curative vs. Disabled and Elderly care
The Dutch healthcare system is separated in two main areas: curative healthcare (Health Insurance Act, ZvW) and the long-term care, nursing and personal care for mainly disabled and elderly people (Exceptional Medical Expenses Act (AWBZ).
Between 1988 and 2004 there was a fixed reimbursement system which specified the reimbursement amounts for all separate operations within a treatment.
In 2005 the DRG, Diagnosis Related Groups system, was introduced in The Netherlands. This system specifies the reimbursable amounts for 30.000 different treatments and is regulated by the Dutch Healthcare Authority (NZA).
The DRGs are separated in two groups:
- Group A DRGs: the reimbursement amounts are regulated, non negotiable, and determined by the Dutch Healthcare Authority.
- Group B DRGs: the reimbursement amounts are directly negotiated between the healthcare insurers and the healthcare providers.
From 2005 until 2012 the share of group B DRGs has increased from 10% to 70% resulting in a stronger free market mechanism and increased competition amongst healthcare providers. The “profit” of healthcare providers equals the difference between the DRG reimbursement price minus their fixed and variable costs. The DRG system has increased transparency and the accountability of healthcare providers which has partly caused the increased pricing pressure on the healthcare industry.
All Dutch residents are obliged to take out a healthcare insurance. In The Netherlands there is no differentiation between private and public healthcare insurance. There are approximately 31 healthcare insurers in The Netherlands, offering both compulsory insurance policies and optional policies for additional coverage (e.g. dental care, homoeopathic medicine). In 2012 the mean price of a compulsory healthcare insurance policy was approximately € 105.- per month.
For the compulsory healthcare insurance there is an obligated excess deductible (2013: € 350.-). Excluded from this excess deductible are the following type of treatments:
- GP consultations.
- Obstetric and maternity care.
- Free population screening, such as breast cancer research.
- Influenza vaccination for risk groups.
- Non-compulsory healthcare insurance policies.
It is possible to opt for an additional voluntary excess deductible, ranging from EUR 100,- up to a maximum of EUR 500,-.
Financial flows within the Dutch curative healthcare system
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- CBS Statistics Netherlands, Population Counter [Online], Available at: http://www.cbs.nl/en-GB/menu/themas/bevolking/cijfers/extra/bevolkingsteller.htm?Languageswitch=on [accessed 23 March 2013]
- IndexMundi.com, Demographics Profile The Netherlands [Online], Available at: http://www.indexmundi.com/netherlands/demographics_profile.html [accessed 9 January 2013]
- OECD Health Data 2012 [Online], Available at:
http://www.oecd.org/unitedstates/BriefingNoteUSA2012.pdf [accessed 23 March 2013]
- Health Care Insurance Board [Online], Available at:
http://www.cvz.nl/en/home [accessed 23 March 2013]
- Financial flows in the Dutch curative healthcare system [Online], Available in Dutch at: http://www.argumentenfabriek.nl/informatiekaart-geldstromen-de-curatieve-zorg-a3 [accessed 23 March 2013]