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Health
care
Health is universally regarded as a primary necessity. The
World
Health Organisation defines health as a state of complete physical,
mental and social well-being.
The Netherlands has a high level of health care. This is
reflected
in the average life expectancy, which is 76 years for men and 80.9
years for women. Not all these years are healthy, however. Men spend an
average of 14 years and women an average of 20 years of their lives in
less than good health.
Quality of care
In the
Netherlands, health care is provided by a wide range of institutions
and professionals. Affordability, quality and accessibility are the key
concerns. Quality of care is regulated by a number of laws. Patient and
consumer organisations also contribute to the quality of care and
ensure that patients have a say. They can for instance call insurance
companies to account on the purchase of good quality care.
Hospitals, homes for the elderly and other care providers are
responsible for setting up and monitoring their own quality systems.
The Health Care Inspectorate supervises the quality of care on behalf
of the government.
How we stay healthy
There
are several ways in which the Netherlands seeks to prevent illness and
disease. General practitioners are the first point of contact for
people with health complaints, and they play a key role in preventive
care. Furthermore, all babies and infants are vaccinated against
diphtheria, whooping cough, tetanus and polio. Screening (for example,
for breast cancer) also helps to detect health risks at an early stage.
The Health Council plays an important advisory role. A healthy
diet, sufficient exercise, not smoking, drinking alcohol in moderation,
practising safe sex and relaxing regularly – all contribute to good
health. Various organisations inform the public about such matters and
campaign to alter harmful patterns of behaviour.
Accessibility
In
the first place, medical services must be affordable. Several statutory
insurance schemes exist to make care financially accessible for
everyone. There are various types of insurance covering hospital care,
GP consultations and paramedical care, which together account for 43%
of all expenditure on care. About 60% of the Dutch population
is compulsorily insured with
public health insurance funds. The government determines the cover
provided and the income-linked contribution. People who earn too much
to be publicly insured have to take out private insurance. Private
insurance companies set their own premiums, generally based on the risk
of illness. A special private insurance scheme ensures affordable care
for the elderly and the chronically ill. A new health insurance system
will be introduced in 2006, consisting of a single compulsory standard
insurance scheme for curative care. There will no longer be a
distinction between public and private health insurance. The new system
will make health care more efficient and customer-oriented.
Cost control
Health
care in the Netherlands costs nearly €43 billion a year. The government
is trying to keep care affordable. Yet health care is the fastest
growing item in its budget. This is partly due to the demographic
ageing of Dutch society, which is increasing the demand for health care
and lengthening waiting lists. The extra money that has been made
available in recent years has been used to cut waiting lists and
increase the salaries of health care workers to make their work more
attractive. Cost management is currently a key focus of
attention. The
government is trying to introduce incentives into the system in order
to increase efficiency. People are also being given more
responsibility. In 2005, a general excess will be introduced into the
public health insurance scheme and the cover will be reduced in order
to make people more cost-conscious.
Long-term care
Recent
years have seen a shift towards care in the community for the
elderly
and the disabled. The focus is no longer on the illness but the person
with the illness, who wants to lead as independent a life as possible.
Care previously confined to institutions can now be provided at home,
if the patient wishes. Patients who live independently need to have a
suitable job or another useful activity. Care providers therefore work
closely with manpower services, welfare agencies and industry.
Dutch municipalities are legally obliged to provide care
services
for the elderly and the disabled – transport, wheelchairs and special
facilities in the home. Patients can now apply to a special municipal
agency for care services or for an allowance with which to purchase the
care themselves. This has led to greater flexibility and a more
demand-driven approach among care providers.
Developments in primary health care
Primary
health care (GP, paramedical, obstetric, maternity and dental care) has
been undergoing a transition since 2003. The planned changes will make
care less centrally regulated and more indivually focused. Eventually,
it should become more efficient in response to factors such as market
forces. The focus of the reforms is on improved cooperation between GPs
and other primary health care providers, such as physiotherapists. The
government also plans to support and encourage local entrepreneurship
in the health care sector. In secondary health care
(specialist and outpatient care), the
introduction of a new funding system has the highest priority. The
system will give hospitals more autonomy and make people more
cost-conscious. Hospitals have already undergone change. The number of
beds and the duration of admissions have both been cut drastically,
while one-day admissions and outpatient treatment have increased.
Medical technology and organisational change make it
increasingly
possible to provide care to patients at home. Some hospitals have
outpatient clinics, so that patients do not always have to go to the
specialist central hospital. In addition, new care providers have
emerged in the form of private clinics.
Medicine
The
Dutch use relatively few medicines compared with other Europeans, and
prices in the Netherlands are at the European average. Nevertheless, as
in other Western countries, expenditure on drug treatments has risen
steeply, mainly due to the arrival of new, better and generally more
expensive medicines. To control costs, the government promotes a
'sensible and economical' approach to prescribing and using drug
treatments.
The government has opted for a hands-off approach,
giving care
insurers direct control over the supply of medicines (pharmaceutical
care). The idea is to bring health insurers closer to patients, doctors
and pharmacists, since they are in a better position than the
government to supply medicines effectively and control costs.
Drugs
The
Ministry of Health, Welfare and Sport coordinates Dutch policy on
drugs. The main objective is to prevent drug use and to limit the risks
associated with it. The Ministry of Justice is responsible for
combating drugs trafficking. The justice authorities and care agencies
cooperate at both national and international level. Dutch
policy on drugs makes a distinction between cannabis and
hard drugs (e.g. heroin, cocaine and synthetic drugs), based on the
different health risks. The number of drug-related deaths in the
Netherlands is the lowest in Europe, as emerged from a study performed
by the European Monitoring Centre for Drugs and Drug Addiction in
Lisbon.
More detailed information about Dutch policy on drugs can be
found
in the booklet "Q&A Drugs", published by the Ministry of
Foreign
Affairs, which is available on the ministry's website: minbuza.nl/drugspolicy
For more information on the topics discussed in this chapter, contact
the Ministry of Health,
Welfare and Sport.
