[The health care system reform in The Netherlands]

In the sixties, The Netherlands advanced from a voluntary health insurance system, that had an incomplete covering and was unfair, towards a still partial obligatory and solidary insurance system. The insurance paid the hospitals and specialists per action and there was a great rise in cost of the system. A committee, presided by W Dekker, proposed a reform to reduce costs and increase equity. It abolished the difference between private and obligatory insurance systems (that covered 60% of the population) and made possible the competence between both types of insurance. It also created a negotiation margin between insurance companies and providers and replaced the payment per action by more efficient resource allowances. The debate originated by the reform hindered its full application. Meanwhile, the government took steps to reduce costs. Social and private insurance systems continue to exist. This article summarizes the special context of Dutch health care system problems.