Table 2 The healthcare provision policy landscape of the Netherlands [20]

Curative care

The 2006 Health Insurance Act (Zorgverzekeringswet, Zvw) introduced managed competition to the health insurance sector. It aimed to reduce central governance, promote efficiency, and improves access at acceptable societal costs [21]. The reform gave citizens more financial responsibilities, and more influence and choice over their healthcare plan. All inhabitants of the Netherlands are by law obligated to participate in the insurance scheme [20]. The government adopted a more distant supervisory role with the 2006 Health Care Market Regulation Act (Wet Marktordening gezondheidszorg, Wmg) and remained responsible at national level for the accessibility, affordability and quality of care [21]. Although the insurance scheme is executed by private firms, its regulation is based on solidarity principles and can in essence be characterized as social [20]. The rational for introducing the competition was to improve quality and affordability of healthcare. Subsequently, three healthcare markets emerged between the insured people, healthcare providers and healthcare insurers [21]. The first one is the health insurance market, where citizens purchase a health insurance plan from one of the private health insurers. The second is the healthcare purchasing market, where insurers purchase care for insured population from the healthcare providers. Lastly, on the healthcare provision market patients utilize healthcare from the healthcare providers, although insurers may impose restrictions on the choice of providers in return for a discount on the insurance plan.

Long-term care and decentralized care

There are many services not covered by an insurance scheme under the Health Insurance Act. These services are financed through various other mechanisms and their legal basis are dispersed over multiple acts. The 1968 Exceptional Medical Expenses Act (Algemene wet bijzondere ziektekosten, Awbz) covered the high costs of nursing, treatment and personal care that was not part of the health insurance. It was abolished in 2015 followed by major reforms in the fields of long-term care, social support and youth care [21].

The Long-Term Care Act (Wet Langdurige Zorg, Wlz) provides institutional care for all citizens who need around the clock supervision, which can either be provided at home or in a residential long-term care facility [22]. The institutional care is financed through a general fund that consists of contributions from the state budget and income dependent cost-sharing.

The Social Support Act (Wet Maatschappelijke Ondersteuning, Wmo) provides help for domestic care or social support through a decentral and provision-based approach. Its objective is for municipalities to support citizens to participate in society. Municipalities are free to tailor the support for their citizens, and professional care can be substituted with other care solutions, for example care provided by volunteers, neighbors or family. Under the Youth Act (Jeugdwet), care is provided to all children under the age of 18, and their parents if parenting problems and mental problems are indicated [23]. Under the Public Health Act (Wet Publieke gezondheid, WPg), the municipalities are also responsible for services related to disease prevention, health promotion and health protection [21].