All health care providers in the
Netherlands are also private parties. Their
salaries are mainly determined by regular
collective employment agreements but are
also subject to government-set salary caps
The Dutch health care system is a highly
regulated and very sophisticated system
with private organizations at its basis. While
health care costs are relatively high and
still rising, the Netherlands is often ranked
as having one of the best health care systems in the world on the basis of quality
and accessibility.[ 8]
Lessons for the United States
The NHS in the UK is an example of a
true single-payer health system. To keep
the national health budget in control, the
NHS must strive to keep it costs low. Rather
than using high out-of-pocket costs as a
mechanism to reduce utilization, as the
United States does, the NHS instead uses the
National Institute for Health and Clinical
Excellence (NICE) to makes decisions as
to the medications, tests, and procedures
the NHS will pay for.
France offers universal coverage through
a multi-payer model. While coverage for the
young and unemployed are paid for by the
government, employed worker or retirees
receive coverage based on occupation, with
the employer paying a portion of the costs.
There is no longer a role for an “insurer”
in this model, and instead France uses
“sickness funds” to pay claims and pool risk.
Instead of each sickness fund negotiating
independently, the government negotiates
on their behalf with doctors, hospitals, and
The Netherlands model is even more
similar to that of the United States, using
private insurance companies and pro-
viders. As with the provisions under the
Affordable Care Act, coverage is manda-
tory and employers and employees are
expected to contribute to pay the premium.
The key difference is that there is only
one “basic insurance” plan being offered
and all participants are rated together.
Because insurance companies must ac-
cept every applicant, and all residents
must purchase insurance, a robust risk
adjustment mechanism is needed to ensure
fairness and prevent selective marketing
to low-risk individuals.
THE AUTHORS are members of the
Academy’s Health Practice International
[ 1] Duncan Ian, Healthcare Risk Adjustment
and Predictive Modeling 2nd ed. 2017,
Winsted, Conn.: Actex Publications.
[ 2] Nicholas Timmins, Never Again: the
story of the Health & Social Care Act 2012.
A study in coalition government, The
Kings Fund and the Institute for
Government, Editor. 2012: London.
[ 3] Greer SL Jarman H and Azorsky A, A
reorganisation you can see from space:
The architecture of power in the new
NHS. 2014, Center for Health and the
Public Interest: Ann Arbor, Mich.
[ 4] The NHS Belongs to the People; 2013,
[ 5] 2014 data from the FFSA study; global
health expenditure: 191.8 billion euro.
[ 6] Fillon Law of 2015 states that health
private collective agreement is
mandatory (with a defined level of
[ 7] Marktscan Zorgverzekeringsmarkt 2016,
Nederlandse zorgautoriteit, September
2016 (Marketscan Healthcare 2016,
Dutch health authority, September 2016)
[ 8] Euro Consumer Health Index 2016
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While health care costs are relatively high and still
rising, the Netherlands is often ranked as having
one of the best health care systems in the world on
the basis of quality and accessibility.