Netherlands

The Dutch government is responsible for the regulation and governance of three systems that together provide broad universal coverage: 1) a social insurance system for curative care carried out by competing private health insurers; 2) a single payer social insurance for long-term care; and 3) a social care system funded from tax and implemented by the municipalities. 

A very high level of pooling applies to all three pillars and a sophisticated risk-adjustment system exists to allocate funds among the private insurers responsible for purchasing curative care. The burden of out-of-pocket payments is comparatively low, at 9.3% of current health expenditure in 2021. 

The government also sets the benefits as well as available resources and can intervene in the case of overspending. The curative insurance scheme is the largest and covers all specialist care, primary care, pharmaceuticals and medical aids, mental health, some allied care services and community nursing. Long-term care is meant for those people who need intensive and continuous care and is generally delivered on an inpatient basis. The social care system aims to help people to age-in-place and enable them to fully participate in society. Social services include housekeeping, help with daily activities and sheltered living. 

The Netherlands operates a strict gatekeeper system and patients require a referral from a GP to visit hospital and specialist care, although they have a free choice of hospital. Solo general practitioner (GP) practices are becoming less common and the share of GP partnerships, group practices, and multidis­ciplinary health centres is increasing. Most hospitals are non-profit-making foundations.