Intended for healthcare professionals


Managing costs and access to healthcare in the Netherlands: impact on primary care

BMJ 2020; 369 doi: (Published 08 April 2020) Cite this as: BMJ 2020;369:m1181
  1. Chris van Weel, emeritus professor of general practice1 2,
  2. J André Knottnerus, professor of general practice3,
  3. Onno C P van Schayck, professor of preventive medicine3
  1. 1Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, Netherlands
  2. 2Department of Health Services Research and Policy, Australian National University, Canberra, Australia.
  3. 3Department of Family Medicine, Maastricht University, Maastricht, Netherlands
  1. Correspondence to: O C P van Schayck onno.vanschayck{at}

Dutch reforms show how an expanded role for primary care can help ensure that healthcare systems continue to meet population needs, say Chris van Weel and colleagues

Concerns about rising healthcare costs and the long term viability of healthcare in the Netherlands prompted the government to introduce statutory private health insurance in 2006. The move was accompanied by market mechanisms and competition between providers,12 based on the expectation that it would contain costs and improve quality (“the highest quality of care at the lowest price”). Additional policy measures were taken after 2006 to ensure that the healthcare system was able to deliver on these high expectations (table 1).3 We examine the effect of the changes on the population and the role of primary care.

View this table:
Table 1

Dutch health policy changes since 2006 and what they meant for primary care

Financing changes

Not-for-profit sickness funds, which until 2006 had covered about two thirds of the Dutch population, reformed into for-profit organisations or merged with private health insurers. All citizens were required to purchase a basic package of essential healthcare services that was set by the department of health, along with cover for “own risk” (the amount of their total annual claims that policy holders have to pay themselves). The premium for the basic package is set annually by insurers in competition with one another; they have to accept everyone who applies, without exception. People on low incomes receive a subsidy for the basic insurance.12 The primary care structure introduced in 19414 was largely maintained in the reform: patients continued to be registered with a general practitioner (GP) and were able to access specialised healthcare only through that practice. GPs thus continue to be responsible for access to care and for most health problems.125 The general …

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