Intended for healthcare professionals


Demographic and epidemiological determinants of healthcare costs in Netherlands: cost of illness study

BMJ 1998; 317 doi: (Published 11 July 1998) Cite this as: BMJ 1998;317:111
  1. Willem Jan Meerding (meerding{at}, health economista,
  2. Luc Bonneux, medical epidemiologista,
  3. Johan J Polder, health economista,
  4. Marc A Koopmanschap, health economistb,
  5. Paul J van der Maas, professor of public healtha
  1. a Department of Public Health, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, Netherlands
  2. b Institute of Medical Technology Assessment, Department of Health Policy and Management, Erasmus University Rotterdam, Netherlands
  1. Correspondence to: Dr Meerding
  • Accepted 19 February 1998


Objectives: To determine the demands on healthcare resources caused by different types of illnesses and variation with age and sex.

Design: Information on healthcare use was obtained from all 22 healthcare sectors in the Netherlands. Most important sectors (hospitals, nursing homes, inpatient psychiatric care, institutions for mentally disabled people) have national registries. Total expenditures for each sector were subdivided into 21 age groups, sex, and 34 diagnostic groups.

Setting: Netherlands, 1994.

Main outcome measures: Proportion of healthcare budget spent on each category of disease and cost of health care per person at various ages.

Results: After the first year of life, costs per person for children were lowest. Costs rose slowly throughout adult life and increased exponentially from age 50 onwards till the oldest age group (95). The top five areas of healthcare costs were mental retardation, musculoskeletal disease (predominantly joint disease and dorsopathy), dementia, a heterogeneous group of other mental disorders, and ill defined conditions. Stroke, all cancers combined, and coronary heart disease ranked 7, 8, and 10, respectively.

Conclusions: The main determinants of healthcare use in the Netherlands are old age and disabling conditions, particularly mental disability. A large share of the healthcare budget is spent on long term nursing care, and this cost will inevitably increase further in an ageing population. Non-specific cost containment measures may endanger the quality of care for old and mentally disabled people.

Key messages

  • Little is known about demands for health care outside acute sectors

  • In the Netherlands health costs are strongly age dependent, increasing exponentially after age 50

  • The five highest healthcare costs are for mental retardation, musculoskeletal disease, dementia, other mental disorders, and ill defined conditions

  • Coronary heart disease, all cancers, and stroke accounted for only 9% of costs

  • The main healthcare costs are for care not cure and costs are likely to increase rapidly in an ageing society


    • Accepted 19 February 1998
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