Opinions of Dutch Physicians, Nurses, and Citizens on Health Care Policy, Rationing, and Technology

Tjeerd Tymstra, PhD; Margriet Andela, MA
JAMA. 1993;270(24):2995-2999. doi:10.1001/jama.1993.03510240111049.
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In many Western countries, there is in-depth discussion about the health care system: how should the services be distributed and what criteria should play a role? The Dutch health care system is also under debate. In the Netherlands, public policy aims at ensuring that everyone has access to necessary health care. To this end, a system of compulsory and voluntary insurances has been organized.

In the Netherlands, both the public and private sectors make significant contributions to the health care services. Government regulations cover physician fees, hospital budgets, new medical technologies, and the provision of hospital beds. Some 62% of the population—the lower-income groups—obtain health services through the ziekenfonds, or sickness funds. The remaining 38% of the population purchase private health insurance from nonprofit and profit-making insurance companies. General practitioners are paid on a capitation basis for patients in the sickness funds and on a fee-for-service basis for patients with


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