Health is universally regarded as a basic necessity. The World Health Organisation defines health as a state of complete physical, mental and social well-being. The Netherlands has a high level of health care.

• Life expectancy
• Quality of care
• Controlling expenditure
• Healthcare insurance
• Developments in primary health care
• Long-term care
• Community support
• How we stay healthy
• Smoking
• Obesity
• Medicine
• Drugs
• Euthanasia
  

Life expectancy

Health is universally regarded as a basic necessity. The World Health Organisation defines health as a state of complete physical, mental and social well-being. The Netherlands has a high level of health care. This is reflected in the average life expectancy, which is 76.3 years for men and 81.1 years for women. Not all these years are healthy, however. Men spend an average of 14 and women an average of 20 years of their lives in less than good health.
The top five causes of mortality in the Netherlands come under the heading of cardiovascular and lung diseases. The most common causes of death are heart disease and lung cancer in men, and heart disease and stroke in women. A large proportion of the budget for health care goes to common illnesses that require lengthy and intensive treatment, such as mental disability (7.7% of total expenditure), dementia (4.9%) and stroke (2.9%).

Quality of care

In the Netherlands, health care is provided by a wide range of institutions and professionals. Affordability, quality and accessibility are the key concerns. Quality of care is regulated by a number of laws. Patient and consumer organisations also contribute to the quality of care and ensure that patients have a say.
They can for instance call insurance companies to account on the purchase of good quality care. Hospitals, homes for the elderly and other care providers are responsible for setting up and monitoring their own quality systems. The Health Care Inspectorate supervises the quality of care on behalf of the government.

Controlling expenditure

The Netherlands spent 46 billion euros on health care in 2005. Despite government efforts to keep care affordable, health care is the fastest growing item in the national budget. This is due in part to demographic ageing.
Because of the post-war baby boom and a birth rate that continued to rise until about 1970, roughly four million residents of the Netherlands will be over 65 in 2030. That is almost a quarter of the population. Currently, people over 65 make up about 17% of the population.
As the number of seniors grows, so too will the pressure on healthcare services. For this reason, cost control is currently a key issue in the Netherlands. The government is trying to introduce incentives into the healthcare system to increase efficiency. People, too, are being given more responsibility.

Healthcare insurance

Since 1 January 2006, there has been a single healthcare insurance system in the Netherlands. Everyone living in the Netherlands or paying income tax here is required to take out compulsory healthcare insurance. Although the basic package is fixed by law, people are free to choose their insurer.
Insurers have a duty to accept everyone for the basic package and older or chronically ill people may not be charged higher premiums for the basic coverage. The new system should lead to more efficient and client-centred healthcare services.

Developments in primary health care

Primary care providers like GPs, dentists, physiotherapists and midwives are the first point of contact for people with a health problem. Primary care providers prevent unnecessary use of more expensive, secondary health care (specialist and outpatient care). Primary health care is also relatively inexpensive, using only about 4% of the total annual healthcare budget.
Primary health care is currently in a transitional phase. Rather than being the exclusive domain of government, more responsibility for care is being devolved to people themselves. The government also supports and encourages local or regional commercial healthcare initiatives.

Long-term care

Recent years have seen a shift towards care in the community for the elderly and the disabled. The focus is no longer on the illness but the person with the illness, who wants to lead as independent a life as possible.
Care previously confined to institutions can now be provided at home, if the patient wishes. Patients who live independently need to have a suitable job or another useful activity. Care providers therefore work closely with employment services, welfare agencies and industry.

Community support

Dutch municipalities have a statutory duty of care to the elderly and the disabled, which means they must provide services like transport, wheelchairs and special facilities in the home. Patients can now apply to a special municipal agency for care services or a personal budget with which to purchase the care themselves. This has led to greater flexibility and a more demand-driven approach among care providers.

How we stay healthy

There are several ways in which the Netherlands seeks to prevent illness and disease. General practitioners are the first point of contact for people with health complaints and they play a key role in preventive care. Furthermore, all infants and children up to 9 years of age are vaccinated against diphtheria, whooping cough, tetanus and polio.
Screening (for example, for breast cancer) also helps to detect health risks at an early stage. The Health Council plays an important advisory role. A healthy diet, sufficient exercise, not smoking, drinking alcohol in moderation, practising safe sex and relaxing regularly – all contribute to good health. Various organisations inform the public about such matters and campaign to alter harmful patterns of behaviour.

Smoking

Currently, 28% of Dutch people over the age of 15 smoke, a habit actively discouraged by the Dutch government as smoking is still the largest preventable cause of death in the Netherlands. Each year, more than 20,000 people die of smoking-related diseases. The cost of smoking in terms of both healthcare expenditure and social impact is high. Smokers do not only damage their own health, they also put the health of others at risk.
The Tobacco Act introduces measures to restrict tobacco use, such as a ban on smoking in public buildings and institutions for health care, sports, education or welfare. Tobacco products may not be sold to children under 16. Since 2004, employers must protect their workers from nuisance resulting from smoking.
All forms of advertising for tobacco products are banned, except in tobacconist’s shops. Public transport and taxi companies are required by law to prevent nuisance resulting from smoking.

Obesity

Forty per cent of Dutch adults are overweight, the result of a poor diet, eating too much and a sedentary lifestyle. Overweight and obesity are responsible for about 40,000 new cases of cardiovascular disease, type 2 diabetes and cancer each year, culminating in an average of 20,000 deaths per year. People who are overweight, especially children, can be stigmatised and suffer psychological and social problems as a result.
Obesity is also a costly issue that deserves to be taken seriously. The Health Council of the Netherlands has calculated that health problems related to overweight and obesity cost us two billion euros per year and this amount is expected to grow. Although people are primarily responsible for their own health, the government does feel it has a duty to encourage people, through public information campaigns, to adopt a healthier lifestyle with more physical activity and a healthier diet.

Medicine

The Dutch use relatively few medicines compared with other Europeans, and prices in the Netherlands are at the European average. Nevertheless, as in other Western countries, expenditure on drug treatments has risen steeply, mainly due to the arrival of new, better and generally more expensive medicines.
To control costs, the government promotes a ‘prudent and economical’ approach to prescribing and using drug treatments. The government has opted for a hands-off approach, giving care insurers direct control over the supply of medicines (pharmaceutical care).
The idea is to bring health insurers closer to patients, doctors and pharmacists, since they are in a better position than the government to supply medicines effectively and control costs.

Drugs

The Ministry of Health, Welfare and Sport coordinates Dutch policy on drugs. The main objective is to prevent drug use and to limit the risks associated with it. Using drugs is not an offence in the Netherlands. Because drug users do not risk being prosecuted, it is easier for addicts to seek help when they want to kick the habit or improve their physical, mental and social situation.
The Ministry of Justice is responsible for combating drugs trafficking. The justice authorities and care agencies cooperate at both national and international level. Dutch policy on drugs makes a distinction between cannabis and hard drugs (e.g. heroin, cocaine and synthetic drugs), based on the different health risks.
The number of drug-related deaths in the Netherlands is the lowest in Europe, as emerged from a study performed by the European Monitoring Centre for Drugs and Drug Addiction in Lisbon.

Euthanasia

The Netherlands has legislation laying down criteria for due care in the terminal stages of life, for patients in a situation of unbearable suffering without prospect of improvement. In the Netherlands, euthanasia is defined as the termination of life on request, carried out by a physician.
Physician-assisted suicide also falls under this definition. Euthanasia is only carried out at a patient’s explicit request to die with dignity after all possibilities for treatment and palliative care have been exhausted.
Under Dutch euthanasia legislation, physicians who have carried out euthanasia are immune from criminal liability provided they have complied with the criteria of due care as described in the Act.

You can find more detailed information about Dutch policy on drugs or euthanasia elsewhere on the website (see Social Issues).