Healthcare in the Netherlands is differentiated along three dimensions (1) level (2) physical versus mental and (3) short term versus long term care.
The three levels indicate how a patient is referred throughout the system. The first level is the level where people go to with health issues. This consists of mainly Huisartsen (U.S.: physicians / U.K.: general practitioners; lit.: home doctors), often organised in "huisartsenposten" ((acute) GP/primary medical centers) to ensure 24/7 availability, and emergency rooms ("SpoedEisende Hulp / SEH") at hospitals. These first level caretakers can refer patient to specialised care, at hospital, extramural or long term care. Without such referral access to second level care public healthcare centers, and under most health insurance schemes is generally not possible. For specialised care patients can be referred to third level care - either by first level or second level practitioners. Third level care consists of highly specialised care such as nuclear treatment. Third level care is generally embedded in University Hospitals.J.M. Boot, 'De Nederlandse Gezondheidszorg', Bohn Stafleu van Loghum 2011
From 2012 to 2020, health care spending declined from 10.9 percent to 10.5 percent of GDP.
History
From 1941 to 2006, there were separate public and private systems of short-term health insurance. The public insurance system was implemented by non-profit health funds, and financed by premiums taken directly out of the wages (together with income taxes). Everyone earning less than a certain threshold qualified for the public insurance system, while anyone with income over that threshold was obliged to have private insurance instead.World Health Organization: The WORLD HEALTH REPORT 2000 About two-thirds of the country's residents were covered under the health fund, while the remaining third had private health insurance. With increasing healthcare costs this system was no longer sustainable. Patrick Jeurissen, a professor at Radboud University Nijmegen was quoted in Vox as saying "The old system had really hit a wall" due to rising costs.
In 2006, a new system of health care insurance plan was implemented, based on risk equalization through a risk equalization pool. A compulsory insurance basic package is available to all citizens. Dutch residents who do not enrol for insurance are automatically signed up for a basic insurance package and charged additional rates of 20% on top of voluntary tariffs. Insurance companies have to accept everyone applying to this package and are not allowed to differentiate or assess health risk of individuals when setting price levels. Health insurers receive compensation for high risk individuals from the government, and government subsidies pay about 75% of insurance costs. Most insurance companies operate as not for profits. As of January 2020, the average annual insurance premium was about 1,400 Euro. Payments can be either direct or a refund of costs made with a healthcare service contracted by the insurance company. The basic package requires patients to pay the first €385 annually themselves. Individuals can choose for a higher initial personal payment (up to €885) for a discount. Basic care such as first appointments with the family doctor, flu vaccinations are exempted from personal payment to ensure everyone can access such basic care.
Acute and primary care
The Netherlands has a network of 160 acute primary care centres, open 24 hours a day, 7 days a week, making an open clinic within easy reach for most people. Acute primary care is offered by a combination of 121 general practice health centers, that are open outside office hours, and a total of 94 medical emergency units with surgery facilities, of which 90 are at hospital locations, open 24/7. In 71 cases general practice services and emergency rooms are found in one hospital location, bringing the total number of locations where acute care is offered to 160. Analysis by the Netherlands National Institute for Public Health and the Environment showed that 99.8 percent of the people can be transported to an emergency unit / casualty ward, or a hospital offering emergency obstetrics within 45 minutes in 2015.
For acute medical questions outside one's home doctor's office hours, a general doctors health practice can be called by phone, and advice will be given by the doctor and their assistant. If the issue seems to be urgent, the caller will be advised to come to the practice, and if necessary referred to an emergency room for more serious treatment. For severe medical emergencies, the Netherlands uses 112 to call an ambulance.
As measured in defined daily doses per 1,000 inhabitants per day the Netherlands had a very low rate of consumption of antibiotics in 2015 with a rate of 9.8.
Electronic health records
The vast majority of GPs and all pharmacies and hospitals use Electronic health records. In hospitals, computerized order management and medical imaging systems (PACS) are widely accepted. Whereas healthcare institutions continue to upgrade their EHR's functionalities, the national infrastructure is still far from being generally accepted.
In 2012 the national EHR restarted under the joint ownership of GPs, pharmacies and hospitals. A major change is that, as of January 2013, patients have to give their explicit permission that their data may be exchanged over the national infrastructure.
The national EHR is a virtual EHR and is a reference server which "knows" in which local EHR what kind of patient record is stored.
EDIFACT still is the most common way to exchange patient information electronically between hospitals and GP's.
Screening The Dutch government mandates three screenings for its citizens, including breast (every two years for women between the ages of 50 and 75), cervical (every five years for women between the ages of 30 and 60) and colorectal cancer (every five years for men and women between the ages of 55 and 75). In addition, there is prenatal screening for infectious diseases for pregnant women and foetuses, testing for Down's syndrome, Edward's syndrome and Patau's syndrome, structural ultrasound scanning, SEO ultrasound, hearing tests for newborns, and neonatal heel prick.
GPs in the Netherlands do not recommend annual health screening. However, companies are still required to conduct annual physicals for their employees.
Hospitals
Most hospitals and health insurers in the Netherlands are privately run, non-profit foundations, whereas most healthcare insurers are non-profit companies.Ralf Götze (2010): "The Changing Role of the State in the Dutch Healthcare System", TranState Working Papers 141
In general, there are three types of hospitals in the Netherlands: university hospitals, general hospitals, and a category in between that call themselves "top-clinical" teaching hospitals. There are eight academic hospitals, or university medical centers, each of which is directly connected with the medicine faculty of a major Dutch university. These are the largest hospitals in the country, and they have the largest number and greatest variety of specialists and researchers working in them. They are able to provide the most complex and specialised treatment.
There are some 90 hospital organisations in the Netherlands, with some of them running multiple actual physical hospitals, usually as a result of mergers of previously independent hospitals. Between 26 and 28 hospital organizations are members of the STZ (Samenwerkende Topklinische opleidingsZiekenhuizen), the collaborative association of top-clinical teaching hospitals. Although not directly tied to one particular university, these are large hospitals that house the full range of medical specialists (hence "top-clinical"), and that can offer both standard and complex care. The top-clinical teaching hospitals collaborate with university hospitals to aid in the education of nurses and medicine students, as well as to offer certain more specialised treatments. Interns frequently accompany doctors during procedures. Aside from training a lot of medical professionals, each top-clinical hospital specializes in one or two specific disciplines, and conducts its own research to stay ahead in its particular field of expertise. The research done is particularly patient-centric, and focused on improving the practical application and achieving the best results for patients. The remaining general hospitals provide high standard healthcare for less specialised problems. They will, if necessary, refer patients to more specialised facilities.
Unless it is an emergency, a hospital visit in the Netherlands must require a referral from a medical professional (e.g. GP).
International comparisons
As of 2025, the Netherlands had the 7th lowest share of out-of-pocket payments for healthcare in Europe, but was significantly above the European average in amounts of money paid out of pocket, with 707€ per year per inhabitant compared to the EU average of 542€.
In 2015 the Netherlands maintained its number one position at the top of the annual Euro health consumer index, which compares healthcare systems in Europe, scoring 916 of a maximum 1,000 points. The Netherlands is the only country that has been in the top three ranking in every Euro health consumer index published since 2005. On 48 indicators such as patient rights and information, accessibility, prevention and outcomes, the Netherlands secured its top position among 37 European countries for the fifth year in a row. The Netherlands was also ranked first in a study comparing the health care systems of the United States, Australia, Canada, Germany and New Zealand.
Ever since a major reform of the health care system in 2006, the Dutch system received more points in the Index each year. According to the Health Consumer Powerhouse, the Netherlands has 'a chaos system', meaning patients have a great degree of freedom from where to buy their health insurance, to where they get their healthcare service. But the difference between the Netherlands and other countries is that the chaos is managed. Healthcare decisions are being made in a dialogue between the patients and healthcare professionals.
In November 2007 the leading peer-reviewed journal of health policy thought and research published the results of a survey of adults' health care experiences in the Netherlands, Germany and five English-speaking countries. The survey Toward Higher-Performance Health Systems concluded that the Dutch public stood out for its positive views. Of the Dutch adults surveyed, 59 percent said that they were very confident of receiving high quality and safe health care, compared to only 35 percent of the American adults surveyed.
Based on public statistics, patient polls, and independent research the Netherlands ranks at or near the best health care system of 32 European countries. In 2009, Health Consumer Powerhouse research director, Dr. Arne Bjornberg, commented:
About 2.7% of the doctors are from overseas, as compared with the United Kingdom, where almost 30% are.
Waiting times
Waiting lists in the Netherlands increased since the 1980s due to budgets imposed on the hospital sector Several changes were implemented to reduce waiting times by increasing supply of hospital care. In 2001, fixed hospital budgets were replaced with (capped) activity-based payments to hospitals. In addition government limits which had lengthened waits by limiting the number of hospital specialists eligible for payment from Social Health Insurance funds (covering 2/3s of the population) was removed. Mean waits for all inpatient cases fell from 8.6 weeks to 5.5 in 2003, and from 6.4 to 5.1 weeks for outpatient cases.