Recent Changes in Dutch Health Insurance

Individual Mandate or Social Insurance?

Dutch health insurance changed dramatically in 2006 with the abolition of the sickness fund insurance that had covered wage earners and their dependents for over 100 years. A new form of population-wide health insurance replaced the former public and private health insurance systems.

This paper analyzes the new insurance model and its origins in earlier reform efforts. The article begins with some of the particular characteristics of social policy-making in the Netherlands and the core features of the 2006 health insurance reform. It then examines the changing positions of the main stakeholders in Dutch health care.

Key Findings:

  • Under the new system, all residents of the Netherlands have to take out health insurance with one of approximately 40 insurers. Insurers have to accept any applicant for the government-determined basic coverage. Half of insurers' income consists of the income-related contribution that employers withhold as earmarked taxation, and half is provided by premiums and modest user fees paid by residents. Low-income groups can apply for a fiscal subsidy.
  • After decades of consensual policy-making the focus shifted in the 1980s to reform models of individualized and decentralized decision-making. While those earlier health reforms did not succeed directly, they helped to change the political climate and opened the way for new forms of private care that did not previously have much public support.
  • Managers of health insurance and health care services alike adjusted their behavior in reaction to announced health reforms. Once such changed behavior became visible and generally accepted, it encouraged governments to change course and to take up reform proposals that were rejected a decade before. 

Dutch citizens have shown limited interest for individual consumer choice in health insurance, and the government is quick to act when facing popular dissatisfaction about the consequences of policy change.

Keywords: International Coverage Models, Mandates, Subsidies, Regulation

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