Private health insurance in the Netherlands

Private health insurance has been a constituent part of the Dutch health system since the early 20th century. Before the major reform in 2006, almost a quarter of the population held so-called pure private health insurance cover as a substitute for sickness fund cover. The 2006 Health Insurance Act created a single, mandatory health insurance scheme covering the whole population under private law. One of its most important consequences was the abolition of the traditional division between statutory health insurance operated by sickness funds and all other insurance schemes including substitutive private health insurance with experience-based underwriting. However, the newly created scheme is not a pure private arrangement (the term ‘pure’ will be explained later in this chapter) but one extensively regulated by the state to protect public interests including, among others, solidarity in health care financing and access to health care. This chapter starts with a brief overview of the history of private health insurance in the Netherlands and its structure in the 1990s and early 2000s. The focus in the second part is on the 2006 reform and its consequences for the health insurance market. Developments in longterm care insurance are beyond the scope of the chapter.