1. Brief Introduction to the Health System of the Netherlands
9 February 2011
Presentation by Bibiche Wymenga,
Department of International Affairs

2. Introduction: Health System. 1. Health in The Netherlands 2
Introduction: Health System? 1. Health in The Netherlands 2. The Ministry of Health, Welfare & Sport 3. From former to current health system 4. Facing the challenges: Policy strategy

3. Introduction: Health System?

4. The condensed version:Health Care System since 2006
For in depth background: Health Systems
in Transition Report 2010 (on USB-stick)

5. 1. Health in The Netherlands

6. 16,7 million inhabitants
100 hospitals
16000 medical specialists
8000 general practitioners
21 insurance companies
€ 63 billion spent on health
care = 10% GDP

7. Challenges: Top 10 diseases in the Netherlands
Mortality
Lost Years of Life
Burden (DALY’s) 1
Coronary Heart Disease
Lung Cancer
Lung Cancer 2
Lung Cancer
Coronary Heart Disease
Depression 3
Stroke
Stroke
Stroke 4
Dementia
Colon Cancer
Anxiety Disorder 5
Heart Failure
Respiratory COPD
Diabetes 6
Respiratory COPD
Breast Cancer
Lung Cancer 7
Pneumonia
Heart Failure
Respiratory COPD 8
Colon Cancer
Dementia
Arthrosis 9
Diabetes
Self-inflicted Injury
Accidents 10
Breast Cancer
Pneumonia
Dementia
(Source: VTV Public Health Forecast 2010, National Institute for Public Health & the Environment (RIVM))

8. 2. The Ministry of Health, Welfare & Sport

9. Minister Ministry of Health, Welfare & Sport State Secretary
Ms. Edith Schippers
Portfolio
Financial Policy & Administration
Health Care & Public Health
Infectious Disease Control
Pharmaceuticals & Devices
Markets, Quality, Consumers
Sport
Innovation & Technology
Education, Labour Market, Ethics
Agencies & Inspections
State Secretary
Ms. Marlies Veldhuijzen van Zanten - Hyllner
Portfolio
Long-Term Care
Social Support
Youth Care, Elderly Care
Disability Care
Biotechnology & Research
Policy department:
International Affairs Dept. Advisory and support departments:
Financial & Economic Affairs Dept.
Operational Management Dept.
Legislation & Legal Affairs Dept.
Personnel & Organisation Dept.
Information & Communication Dept.
Management Support Dept.
A. Kleinmeulman
Deputy SG
Secretary General
G. van Maanen
DG Public Health
Dept. Public Health
Dept. Nutrition, Protection and
Prevention
Dept. Sports
P. Huijts
DG General Health Care
L. van Halder
Dept. Health Care
Dept. Medicines & Medical
Technology
Dept. Market & Consumer
DG Long-term Care
M. Boereboom
Long-Term Care Dept.
Health Insurance Dept.
Macroeconomic Issues &
Employment Conditions Dept.
DG Youth & Social Care
M. van Gastel
Social Support Department
WW II Victims Remembrance Unit
Youth Care Department
Youth & Families Programme
Stichting Fonds PGO verstrekt subsidies aan landelijk werkzame patiëntenorganisaties, gehandicaptenorganisaties en ouderenbonden in Nederland 9

10. AGENCIES WITHIN THE MINISTRY INDEPENDENT GOVERNMENTAL BODIES
(3500 employees)
INDEPENDENT GOVERNMENTAL BODIES
(600 employees)
Health Care Inspectorate (IGZ)
RIVM - National Institute for Public Health and the Environment (including Centre for Infectious Disease Control)
Netherlands Vaccine Institute (NVI)
Food and Consumer Product Safety Authority (VWA)
Health Council (GR)
Social Cultural Planning Office (SCP)
Central Information Unit on Health Care Professions (CIBG)
Health Care Authority (NZA)
Health Care Insurance Board (CVZ)
Medicines Evaluation Board
Netherlands Organization for Health Research and Development (ZonMW)
Stichting Fonds PGO (funding for national patient & disability organizations and senior citizens’associations)

11. 3. From former to current health system

12. Characteristics of the Dutch Health Care system
Tradition of private initiative
Hospitals, nursery homes are privately owned
Medical specialists and general practitioners are mostly private entrepreneurs
Former health insurance system
60% social insurance (below average income level)
30% private insurance (no government interference)
10% civil servants, elderly etc.
Growing government interference (from ± onwards)
Main objective: cost containment
Detailed price regulation, budgeting
National & regional planning & licensing

13. Pros & cons of the former system
Cost containment on macro (national) level
Policy implementation through intervening in the system
Quality (of health care delivery)
Cons
Macro efficiency, micro inefficiency
Lack of spirit of enterprise & innovative climate
Rationing → waiting lists
Growing pressure on the system
Demographics (ageing & labor market)
Technology developments
Law suits because of waiting lists !

14. Health Insurance Act The insurance reform 2006 Equity Efficiency
Compulsory insurance (consumers)
Open enrolment (insurer)
Legally defined coverage (insurer)
No premium differentiation (insurer)
Submission to risk adjustment (insurer)
Income related contribution (consumer)
Equity
Sickness
funds (2/3)
Managed competition
Private
insurance (1/3)
Compulsory deductible (consumers)
Free to set nominal premium (insurer)
Free to offer different policies (insurer)
Free to offer suppl. deductible (insurer)
Free to engage group contracts (insurer)
Efficiency
Public Insurance
Civil servants

15. 4. Facing the challenges: Policy strategy

16. How to build a sustainable health care system?
Fair share of solidarity
High responsiveness to change
Efficiency seeking

17. Coalition agreement (30/09/10)
Move ahead! - increase free pricing - increase amount of risk bearing - allow for private capital
Health care is only sector with significant growth
Integrated care nearby: doctor around the corner
Coverage shrinking (lower disease burden)
More copayments
Establish Health Care Quality Institute

18. New government, new policy priorities
Published end of January 2011:
Strategic policy document Minister
Strategic policy document State Secretary

19. More dynamics Trust in care in health care 1 2 3 4 5 6 7 8 9
Sustainable care and social
assistance
Carefulness close to home
People
makes care
Zero tolerance of dependency abuse
Empowerment 7 6
Appreciation for professionals 8
Reciprocity between
client and professional 9
Appreciation for good quality
and continuous improvement
Organisation of long term care
and youth care in order 4 3
More quality 5
Tailored care with affection
Municipalities facilitate easy access
to youth care and social assistance 2 1
Value and
quality for
your money
Health care
and sports
nearby
Opportunities
for people
and
entrepreneurs
Autonomy of decision on lifestyle choices
More freedom of choice
More freedom and accountability
for health care providers
Simplification and reduction of
administrative burden
More quality, safety and transparency
Pay for performance
The right professional
in the right place
Sports in your neighbourhood
Basic care close to home
Trust
in care
More dynamics
in health care

20. Additional information is available on USB-stick:
Health Care Systems in Transition Report of 2010 by the European Observatory on Health Systems
Dutch Health Care Performance Report 2010 by the National Institute of Public Health and the Environment (2010)
Legal Framework – the basis of the 2006 Health System Reform
Links to health policy and system research publications:
Nivel – Netherlands Institute for Health Services research
National Institute of Public Health & the Environment
Netherlands Organisation for Health Research & Development

21. Thank you for your attention.