Spur for health reforms

The seeds for the 2006 reforms were sown in the late 1980s. In 1987 a committee, headed by the chief executive of Philips, Wisse Dekker, reported that the system lacked efficiency.1 The Dekker report pointed to a lack of cost awareness among consumers and providers and a fragmented funding system, with lack of alignment between the publicly and privately funded parts of the system. It also concluded that rigid governmental regulation inhibited flexible organisation and thwarted innovation.

Before the reforms, around two thirds of the Dutch population was covered by social health insurance, which was financed through fixed income based contributions; enrolment was mandatory for everyone under a certain income level. Most of the rest of the population (those on higher incomes) had to take out private insurance to get access to the same healthcare services. In the Netherlands most services are delivered by private providers and access is open for all, irrespective of type of insurance.

Quality of care

Health expenditure in the Netherlands as percentage of gross domestic product has been running close to the average in the first 15 European Union countries.1 It …