The Dutch health services before compulsory health insurance, 1900-1941

By 1930, almost all the Dutch population had access to basic medical care encompassing general and specialized medical services, hospital care and community services. The system by which this had been accomplished was determined by the fact that central government was unwilling to accept responsibility for health care by stimulating public services or regulating health insurance. In general, the poor were cared for out of municipal medical relief funds while the rest of the working classes were able to participate in voluntary sickness fund insurance schemes. The middle and upper classes had to rely on private practice, yet they found it increasingly difficult to pay for expensive hospital admissions. Moreover, the financial limitations of voluntary insurance, as well as the dominant position of the medical profession vis-à-vis sickness funds, meant that most funds did not cover hospital care or community services. The actual delivery of these services was often in the hands of private organizations but the municipal authorities paid most of the costs, either through direct payment or through subsidies. Before the introduction of compulsory health insurance in 1941, the highly independent Dutch municipalities did not only care for the poor; they also provided hospital care and community services for almost the entire population. This brought about wide geographical variations in the Dutch health services.