Page 13 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

General Introduction
home care to municipalities (Maarse and Jeurissen, 2016). In 2006, the Netherlands spent €53 billion on healthcare (including long-term care) or 9.2 percent of GDP. Healthcare spending rose to €72.5 billion in 2015 (11% of GDP), a nominal growth percentage of 3.9% per year (CBS, 2016). Hospital care comprised a third of total spending and hospital costs increased on average by 4.9% nominally per year between 2006 and 2014 (Figure 1.1). From 2013, hospital expenditures have remained stable at slightly less than 4% of total spending.
12,0% 10,0% 8,0% 6,0% 4,0% 2,0% 0,0%
Health expenditures, international definition
Health Insurance Act expenditures (% of GDP)
Hospital expenditures (% of GDP)
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Figure 1.1: trends in spending on healthcare and hospital care in the Netherlands (source: CBS Statline)
Hospital care is part of the Health Insurance Act, which is designed based on principles of managed competition (Enthoven and van de Ven, 2007). A schematic overview of the system is given in figure 1.2 (van Ginneken et al., 2011). Insurance is mandatory and individuals choose between competing insurers. Currently, ten health insurers compete in the health insurance market on the price of their premiums and quality of contracted care within the network. Insurers are incentivised to selectively contract providers in the healthcare purchasing market based on costs and quality (van Ginneken et al., 2011). Active purchasing may reduce premiums, improve network quality and thereby attract new customers. Patients choose the most appropriate provider within the network, considering for example quality, waiting times and price.
The government sets a comprehensive mandatory benefit package and determines the height of the mandatory deductible (€385 in 2018). Furthermore, the Dutch government monitors and regulates the managed competition system, while keeping direct interventions at a minimum (Rekenkamer, 2016; van Ginneken et al., 2011). However, due to rapid cost growth in the years after the reform, from 2010 the government intervened by negotiating an agreement with the representative associations of hospitals, physicians and insurers on
5