The challenges in providing universal coverage of health and social care –
the Dutch experience
Solita Sarwono* and Santo Koesoebjono**
The Netherlands applies health insurance and social care systems that cover all population groups, with a total of 16.8 million people in January 2013. This paper describes the history, philosophy and practice of the health insurance and social care in the Netherlands and discusses the systems’ strengths and weaknesses.
The Dutch health care is aimed at providing good quality of services to anyone who needs it. The costs are shared by all members of the population, through health insurance schemes developed since 1940. Until the end of 2005 the participation in health insurance was partly compulsory and partly voluntary. Since 1 January 2006 the law obliges all people living in the Netherlands to take health insurance.
The Dutch government also helps and protects the ‘weak’ (old, disabled, poor, unemployed and minority groups) by providing various services and financial support. The desire to help the weak stems from the Dutch beliefs in solidarity, individual rights for equity and freedom and the compassion to help the poor and the oppressed. This humanistic approach facilitates common concern, and thus, common support to make health and social care accessible to everyone.
The Dutch people take an active part in the planning, financing and implementing care services. Millions of Dutch people provide regular unpaid-work in the care sector to help the elderly and disabled, together with health professionals. The people are also empowered to control the quality of care by giving feedback individually or through consumer groups.
The implementation of the health insurance and provision of social care are challenged by demographic changes (i.e. population ageing and immigration) and the global economic crisis. Moreover, the health personnel cannot cope with the rapid population dynamics. It is increasingly difficult for the Dutch government to provide good quality of care for all. Policies are constantly adjusted to keep health and social care affordable and accessible to most citizens.
The Dutch experience shows most important aspects in ensuring good quality of care and effective universal health insurance scheme are: strong commitment of all stakeholders, empowerment of care receivers and transparency in the management of health insurance and provision of care services.
Table of Content
3. Data collection method
4. Principles of solidarity and individual rights for equity
5. Health care system
6. Health care financing
7. Types and coverage of social care
8. Discussion: Strengths and weaknesses of the Dutch health insurance and social care
8.1. Basic principles of health and social care and the people’s attitude
8.2. Health care delivery system and health insurance schemes
8.3. Coverage and social care
8.4. Role of government, insurance companies and the consumers in the development and financing of health and soocial care
9. Conclusions: What can we learn from the Dutch health insurance and social care?
Wassenaar, Netherlands, 2011
Presented at the “International Seminar on Social Determinants of Health: The MDGs and Beyond”, Bali, 29-30 August 2013.
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* Solita Sarwono, MA, MPH, PhD, psychologist, public health educator, medical sociologist, gender specialist, consultant at NEDWORC Association, Networking for Development Cooperation in Bunnik, the Netherlands.
** Santo Koesoebjono, Economics (University of Amsterdam), Démography (Université de Paris), guest lecturer at UNESCO-IHE Institute for Water Education, Delft, the Netherlands, independent consultant.