OVERLEGEN 3-2014 31 The Netherlands has an additional two healthcare insurance packages in addition to the basic insurance package; the additional (extra) health insurance and the General Law for Exceptional Medical Expenses (GLEME). This additional insurance is not compulsory: it’s up to individual citizens to decide whether or not they want to take out an additional insurance policy. This will give the citizen more security of extra care or reimbursement of certain medical expenses. The health insurers offer healthcare packages, which means these insurers are in direct competition with each other. They decide on their own rates and tariffs and enter into contracts with the healthcare providers, like physiotherapists and hospitals. The citizen can decide for himself which health insurer he wants to go with. The costs for this additional insurance will vary per health insurer. Plus the health insurer may also choose to exclude someone from additional insurance. The GLEME covers costs for the long-term care of elderly people, chronically ill patients and disabled people. Anyone living or working in the Netherlands is entitled to reimbursement for GLEME care and will pay a premium for this. This is done via the citizen’s salary and the premium is income dependent. The Dutch healthcare system is based on three pillars: the patients, the health insurer and the healthcare provider. The government is responsible for the laws and legislation, but doesn’t have a direct role in the healthcare process. Monitoring the provision of healthcare The Healthcare Inspectorate monitors the quality of healthcare provided in the Netherlands, as well as the access to this care. The Healthcare Inspectorate (HCI) promotes public health by effectively enforcing the quality of healthcare, prevention and medical products. The inspectorate investigates and assesses impartially, expertly, carefully and independent of political influences or a dominant healthcare system. The HCI’s monitoring field consists of approximately 40.000 institutes and companies, which approximately 1.3 million people work for (approximately 800.000 of which are healthcare professionals). Costs The Dutch healthcare expenses have seen some significant increases over the past years. A total of €93 billion euro was spent on healthcare in 2012. For the Dutch citizen this means an annual average of over €5.000,- spent on healthcare expenses. The Netherlands spends 12% of its gross domestic product on healthcare spending. The Netherlands spends the most on healthcare after America. The most important cause of these rising healthcare costs is the fact that more care is available and it’s more easily accessible too. Illnesses or conditions which people used to die from are now very treatable. The improved healthcare means citizens are now staying healthy for longer and they are also living to a much older age, which inevitably means the healthcare costs increase too. Plus citizens now increasingly want to make use of all the treatment possibilities and innovations. Inconveniences are accepted to a lesser degree and much is demanded from healthcare and healthcare providers. Another important cause for the increase in healthcare costs is that the Netherlands invests in providing vulnerable people with
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