Netherlands
- Federica Andreoni
Country’s healthcare system in a nutshell
In the Netherlands, the health care system combines public funding with private insurance. Every resident must obtain statutory health insurance from private insurers, who are mandated to accept all applicants. The system is mainly funded through public sources, including premiums, taxes, and government grants. The national government sets health care priorities and oversees access, quality, and costs. Standard benefits encompass hospital care, physician services, home nursing, mental health care, and prescription medications. Adults are responsible for paying premiums, annual deductibles, and coinsurance or copayments for certain services and drugs, while the government covers health care costs for children up to 18 years of age.
The national government is in charge of establishing health care priorities, implementing legislative changes when needed, and overseeing the market-based system's access, quality, and cost aspects.
Municipalities handle specific health services, such as preventive screenings and outpatient long-term care, while the Federal Ministry of Health takes a regulatory role rather than managing health care directly.
Several independent bodies set operational priorities:
The Health Council provides guidance to the government on evidence-based medicine, public health, and environmental protection.
The Medicines Evaluation Board ensures the efficacy, safety, and quality of medicines.
The National Health Care Institute evaluates new technologies for effectiveness and cost and advises on their inclusion in the mandatory benefit package.
The Dutch Health Care Authority oversees the functioning of health insurance, purchasing, and care delivery markets.
The Dutch Competition Authority enforces competition laws among insurers and providers.
The Health Care Inspectorate monitors the quality, safety, and accessibility of care. Self-regulation by medical professionals is also a key element of the system.
Health information technology (IT) is not centralised. The Union of Providers for Health Care Communication manages the data exchange through IT infrastructure.
According to the most recent data from 2010, health insurance covered 98.9% of the population in the Netherlands. This coverage encompasses both those who are members of health insurance schemes and those who have free access to state-provided healthcare services (Our World in Data, n.p.).
Public vs private
The pink column refers to the public expenditure as a % of the country’s total healthcare expenditure. The blue dot is the country’s expenditure on health per capita, expressed in international dollars at purchasing power parity.
The national PHR
History
In 2011 there were the first discussions in the country about creating a national Electronic Patient File (EPD), which would have been the same for every patient in the Netherlands and would enable them to see their medical data. This project received no support from the Senate.
Afterward, the Dutch Patient Federation came up with another way to give people control over their medical data, i.e. MedMij and the personal health environment (PHE) (PGO.nl, 2023)
The MedMij foundation was established in 2015 by the Informatieberaad Zorg (Healthcare Information Council), a collaborative body comprising various stakeholders from the healthcare sector and the Ministry of Health, Welfare and Sport. This initiative by the Patiëntenfederatie Nederland (Dutch Patients Federation), aims to set standards for the secure exchange of health data in the Netherlands.
Currently, MedMij represents the benchmark for the secure transmission of health data between patients and healthcare providers. Organisations that meet the stringent criteria set by MedMij are authorised to use its label. This certification ensures that individuals can access their health data through a personal health environment (PHE) of their choosing. The MedMij label denotes adherence to the standards outlined in the MedMij Framework. It is awarded to apps, websites, or PHEs that meet these requirements and is also displayed at healthcare providers' locations that participate in the MedMij network. However, it is important to note that while the label guarantees secure data exchange, it does not provide information on the functionality or user-friendliness of these tools. The suitability and effectiveness of an app or website for individual needs are determined by the users themselves, who can choose which one to use.(MedMij, 2023)
At the moment, there are 13 PHEs that meet MedMij standards and that patients can choose from. An updated list is available at this link: https://medmij.nl/medmij-deelnemers/
Investments
The Dutch Ministry of Health, Welfare and Sport (VWS) has made significant investments in the digitalization of healthcare in recent years. One of the key initiatives is the Dutch Health Information Council, which oversees the National Health Information Exchange Infrastructure (VIPP) program. This program has received substantial funding aimed at enhancing digital information exchange across healthcare providers to improve patient care and efficiency (VIPPGGZ, n.d.).
The VWS has allocated hundreds of millions of euros towards various digital health initiatives.
The total was €900mln. The VIPP program itself received an initial investment of 400 million euros, targeting improvements in hospital information systems, patient access to their medical records, and inter-organizational data exchange. For hospitals (VIPP 1) € 105 mln. For GP's € 75 mln.
Additionally, the government has set aside €75mln for AI in healthcare and digital innovation, focusing on areas such as telehealth, digital diagnostics, and personalized medicine. These investments are part of a broader strategy to modernize the healthcare system, making it more resilient and efficient by leveraging technology.
Overall, the VWS's efforts reflect a growing commitment to integrating digital solutions within the healthcare sector, aiming at higher efficiency and population health management.
(PKB interviews)
Bibliography
MedMij, 2023. About MedMij [online] Available at: https://medmij.nl/en/home/ [Accessed 2 November 2023].
MedMij, 2023. MedMij participants [online] Available at: https://medmij.nl/medmij-deelnemers/ [Accessed 2 November 2023].
PGO, 2023. What is a PGO? [online] Available at: [Accessed 2 November 2023].
Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A. and Wharton, G.A., 2020. International Health Policy Center: Netherlands. The Commonwealth Fund. Available at: (Accessed: 2 November 2023)
VIPPGGZ, (n.d.). Regulation. The State Secretary of Health, Welfare and Sport. Available at: (Accessed 3 Sep. 2024)