The Netherlands

All residents (and nonresidents who pay Dutch income tax) are mandated to purchase health insurance from private insurers. The reform split healthcare into three “compartments”. The first focuses on long-term care and is legislated under the Exceptional Medical Expenses Act (AWBZ). The second is the core component, which is for basic health insurance (regular care), which is legislated under the Health Insurance Act (ZVW). Finally, there is voluntary supplemental health insurance for treatments such as dental care, physiotherapy, cosmetic procedures, etc. The long-term care is covered by mandatory state insurance while regular (short-term) care is paid for by mandatory private insurance. Supplementary care, depending on the policy, may be covered under health insurance or paid for out of pocket.

The Dutch healthcare system is based on risk equalization through a risk equalization pool. A compulsory insurance package is available to all citizens at affordable cost without the need for the insured to be assessed for risk by the insurance company. Health insurers are, in fact, willing to take on high risk individuals because they receive compensation for the higher risks.

The system is primarily paid for by employers who pay an income-related contribution of 6.5% of their employees’ pay and by individual premiums. Of the total funding, 50% comes from the employer benefit, the government contributes about 5% and the rest paid by the individual in premiums. Most citizens pay the equivalent of about 1,000-2,000 USD in premiums, and children up to age 18 are covered for free. Those who cannot afford it are subsidized by the government.