Four essential acts of the Dutch Healthcare System

Four important acts form the foundation of the Dutch healthcare system. These acts help to provide access to care for all, solidarity through medical insurance and high-quality services.Four important acts form the foundation of the Dutch healthcare system. These acts help to provide access to care for all, solidarity through medical insurance and high-quality services. Some of them are administered by the central government, others, by the local authorities. In this article we discuss the features of these laws.

This article is based on the Dutch report ‘Healthcare in the Netherlands’ from the Ministry of Health, Welfare and Sport.This article is based on the Dutch report ‘Healthcare in the Netherlands’ from the Ministry of Health, Welfare and Sport.

The four most important basic healthcare-related acts in the Netherlands:

  1. The Health Insurance Act (Zorgverzekeringswet)
  2. The Long-term Care Act (Wet langdurige zorg)
  3. The Social Support Act (Wet maatschappelijke ondersteuning)
  4. Youth Act (Jeugdwet)

The Health Insurance Act and the Long-Term Care Act account for the bulk of the Dutch healthcare budget. The Health Insurance Act is a national act governing healthcare throughout the Netherlands. The local authorities are responsible for administering and implementing the Social Support Act and the Youth Act. They provide the support, assistance or care services or are supported in this process by a healthcare provider. The underlying idea is that local authorities are closer to the people and are therefore more able to provide effective, demand-orientated care.

Health Insurance Act

In 2006, the new Health Insurance Act came into force, under which all residents of
the Netherlands are entitled to a comprehensive basic health insurance package. Roughly sixty percent of the total healthcare budget is allocated towards services provided under the Health Insurance Act, including curative medicine.

A required basic health insurance package
Dutch people are required to purchase basic health insurance that consists of a basic health insurance package. They are free to choose their own insurer. The central government is in charge of the contents and size of the statutory health insurance package. Health insurers have freedom to organise who provides the care and where it is to be provided within certain boundaries. In addition, health insurers provide voluntary, supplemental insurance for additional care. Ninety percent of the Dutch population make use of this option. This includes, for example, a special dental insurance policy or alternative medicine.

There are two major financial flows: on the one hand, all insured persons aged 18 and over
pay a ‘nominal’ premium to their health insurer. On the other hand, there is an income-dependent contribution, which is paid by the employer. For some types of care under the basic insurance package, individuals are required to pay a co-payment on top of the policy excess. This includes items such as the transport of sick people, hearing aids, specific medications and orthopaedic shoes. Finally, many people with a lower income are entitled to a health insurance allowance, which is provided by the Tax and Customs Administration (the Dutch tax authorities).

The Long-Term Care Act

The Long-Term Care Act entered into force in its current form in 2015. The Centrum Indicatiestelling Zorg (Care Assessment Agency) gives special-needs assessments to people who need long-term health care. This assessment is based on a national, standardised format. The next step is for the Care Assessment Agency to notify the operating healthcare administration office, of which there are a total of 31 across the Netherlands. These special long-term care administrators work at the behest of the central government.

An act for vulnerable groups
The Long-Term Care Act applies to the most vulnerable groups in our society, such as older people in the advanced stages of dementia. People with serious physical or intellectual disabilities, and people with long-term psychiatric disorders. The Act provides care, such as a stay in a care facility, care that increases self-reliance in living at home, nursing care and transport to day treatment. The central government decides what types of care eventually end up in the healthcare package and is advised in this process by the National Health Care Institute.

The Long-Term Care Act is a statutory social insurance for which people pay an income-dependent premium via their payroll tax. In addition, adults who wish to take advantage of healthcare services under the Long-Term Care Act pay a personal contribution which is also income-dependent. All contributions are deposited into the Long-Term Care Fund, which is managed by the National Healthcare Institute. The central government tops up the fund using public funds if these turn out to be too low.

The Social Support Act

Under the Social Support Act 2015, the responsibility of providing support to people with disabilities has been transferred to the local authorities. The support is designed to ensure that people can continue to be productive members of society and to enable them to continue living at home. Furthermore, local authorities can provide sheltered accommodation and support to people who have no other options or who are unable to live at home.

Support for the community and individuals
The Social Support Act provides for the community. But the Act also enables individuals to submit requests for personalised solutions. It is then up to the local authority to provide the appropriate type of support and determine how this support is to be organised.

Local authorities receive funds from the central government through the Municipal Fund. They are free in deciding how to allocate the funds/resources under the law. The contracted support is paid by the local authority directly to the provider who provided the support.

Youth Act

The Youth Act, which was introduced in 2015, provides for the decentralisation of support, assistance and care for children and adolescents. The Youth Act covers support, assistance and care for young people and their families coping with parenting and developmental issues, psychological problems and disorders. The type of care provided, ranges from general prevention to specialised voluntary or compulsory care. In enforcing the Youth Act, the local authorities aim for children to grow up in safety and in good health and become productive members of society based on their own abilities.

Local authorities receive funds from the central government for the implementation of the Youth Act. The local authority provides the contracted youth services directly to the provider. The local authority transfers funds to the Social Insurance Bank for the youth services organised by parents or representatives of the children and adolescents themselves with a personal healthcare budget. A personal healthcare budget is an arrangement for individuals who prefer to select their own care provider. Parents with a personal healthcare budget can also send the invoices they receive for the youth health services to the Social Insurance Bank for payment. These parents can also serve as youth service providers themselves, and use the budget to pay for their services. This may be the case, for example, if they lose income as a result of caring for their child.

About Vilans
This article is offered to you by Vilans. Vilans is the national Centre of Expertise for Long-term Care in the Netherlands. In this field, Vilans engages in innovation and research, the development and dissemination of information and implementation of best-practices. Vilans primarily works for professionals and managers in care providing organisations in long-term care, primary care, social care, organisations of volunteers in this field, user organisations, health care insurers and authorities at local, provincial, national and EU level. Vilans is mainly funded by the Dutch government.

Contact for this project:

Director Strategy and Development