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    The Dutch health care system

    Part 2: Organizations, information-

    sharing, payment structures, and increasing health care expenditure

    Report for the Institute of Future Welfare

    Japan 2012/2013, by

    Rijnsburgerweg 10 2333 AA Leiden, the Netherlands

  • - 1 -


    Before you lies the second report by the Leyden Academy on Vitality and Ageing on the

    Dutch health care system, written for the Institute of Future Welfare in Japan. In this

    report the focus lies on:

    the different institutions supporting the Dutch health care system;

    systems of communication and information-sharing between health care providers;

    systems of payments and incentives in the health care system, and its strengths and


    past, current and (potential) future ways of dealing with population ageing and

    increasing health care expenditure (cutbacks and increasing efficiency).

    Before continuing with these subjects, we first want to clarify some important terms

    and recent changes in the health care system. We use the term medical care to specify

    all the care that was delivered within the confounds of the ZVW. Medical care thus

    pertains to care given by general practitioners, medical specialists (or other hospital

    care), allied health care, dental care, and others. We use the term long-term care to

    specify all the care that was delivered within the confounds of the AWBZ. Long-term

    care can refer to personal care, nursing care, treatment by nursing home doctors and

    nurses, and residence for the frail elderly, mentally ill, or handicapped. Medical care and

    long-term care is separated from social support. Social support is officially not a part of

    the Dutch health care system, but rather a law that ensures the Dutch can be

    independent, socially active, and that they feel mobile, safe and satisfied in their

    neighbourhood or village. In the report, social support mainly refers to domiciliary care

    (housecleaning, grocery shopping, etc.), provision of instrumental aids (wheelchairs,

    scoot mobiles), adjustments in the house, support to informal care-givers and voluntary

    workers, and other initiatives to improve the social and personal wellbeing of older


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    This report is written in a time of economic and political turmoil in the Netherlands.

    In the last few years, as well as the coming years, many changes will take place in the

    Dutch health care system. For example, important changes already took place in the

    AWBZ and more changes have yet to come. AWBZ care no longer includes domiciliary

    care (from 2008), because it relates more to social support than long-term care.

    Rehabilatition will be transferred to the ZVW (from 2013), and personal care and

    counselling will also become part of the WMO (starting from 2015). We anticipate

    future changes in the AWBZ, since population ageing is expected to cause increasing

    pressure on available care staff and collective finances. Our new government (installed

    in November 2012) has announced new changes. These changes mainly entail a

    decrease in the number of people who are eligible for AWBZ care, as well as a focus on

    independent living and active citizenship.

    The list of abbreviations in the next section might aid the reader in coming to grips

    with the many laws, systems and institutions, as well as its abbreviations. As in the first

    report, patients, health insurance consumers, and those eligible for AWBZ and WMO

    will be called clients in this report. And of course, similar to the first report, if any

    questions remain unanswered, or the reader needs further information, the Leyden

    Academy is more than willing to answer them.

    Herbert Rolden & Marieke van der Waal

  • - 3 -

    Table of contents

    Index of abbreviations 5

    General abbrevations 5

    Dutch branch organizations in health care 6

    1. Institutions concerned with cordinating and or financing health care 8

    1.1 Central Administration Office (CAK) 8

    1.2 Centre for Needs Assessment (CIZ) 9

    1.3 Health Insurance Board (CVZ) 10

    1.4 Dutch Competition Authority (NMa) 10

    1.5 Dutch Health care Authority (NZa) 12

    1.6 Social Security Bank (SVB) 14

    2. Information sharing in the Dutch health care system 16

    2.1 Information sharing within the ZVW 16

    2.1.1 Legislation concerning information-sharing 16

    2.1.2 AIS, HIS and ZIS 18

    2.1.3 National Switching Point 20

    2.1.4 Regional IT infrastructures for medical care communication 21

    2.2 Information sharing within the AWBZ 22

    2.3 Information sharing within the WMO 26

    2.3.1 The WMO: The role of the municipality 26

    2.3.2 Information sharing in the WMO 31

    2.4 Information sharing between institutions in the ZVW, AWBZ and WMO 32

    2.4.1 The ZVW and AWBZ 32

    2.4.2 The ZVW and WMO 34

    2.4.3 The AWBZ and WMO 34

    2.5 Improving information-sharing in the Dutch health care system 35

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    3. Payment and incentives in the Dutch health care system 43

    3.1 Payment structures and incentives 43

    3.2 Payments within the ZVW 44

    3.2.1 From client to health insurer and medical care provider 44

    3.2.2 From health insurer to medical care provider 46

    3.2.3 From medical care provider to personnel 47

    3.3 Payments within the AWBZ 47

    3.4 Payments within the WMO 49

    4. Measures to contain costs or increase efficiency 50

    4.1 Rising health care expenditure in the Netherlands 50

    4.2 Current trends in health care 52

    4.2.1 Macro-level: Life expectancy 52

    4.2.2 Macro-level: Health care expenditure 55

    4.2.3 Institutional level: Hospitals 58

    4.2.4 Institutional level: Long-term care 61

    4.2.5 Institutional level: Social support 63

    4.3 Past measures to deal with rising health care costs 65

    4.3.1 Political environment 65

    4.3.2 Medical care 66

    4.3.3 Long-term care 67

    4.3.4 Social support 68

    4.4 (Potential) Future measures to deal with rising health care costs 68

    4.4.1 Broad and long-term aims 69

    4.4.2 Policy measures for 2013 70

    4.4.3 Social support 72

    Appendix 74

  • - 5 -

    Index of abbreviations

    General abbreviations

    AIO Supplementary Income security Aanvullende Inkomensvoorziening voor

    for the Elderly Ouderen

    AIS Information System for Pharmacists Apotheek Informatiesysteem

    AOW State pension law Algemene Ouderdomswet

    Anw Surviving relatives pension Algemene nabestaandenwet

    AWBZ Exceptional Medical Expenses Act Algemene Wet Bijzondere Ziektekosten

    AZR AWBZ Care Registration AWBZ-brede Zorgregistratie

    BKZ Budget for Health Care Budgetair Kader Zorg

    BSN Citizen Service Number Burgerservicenummer

    CAK Central Administration Office Centraal Administratiekantoor

    CBP Dutch Data Protection Agency College Bescherming


    CBS Central Bureau for Statistics Centraal Bureau voor de Statistiek

    CIC Compliment for Informal Care-givers Mantelzorgcompliment

    CIZ Centre for Needs Assessment Centrum Indicatiestelling Zorg

    CVZ Health Insurance Board College voor Zorgverzekeringen

    DBC Diagnosis Treatment Combination Diagnose Behandeling Combinatie

    DOT DBC On the way to Transparency DBC op weg naar Transparantie

    GP General Practitioner Huisarts

    GPC General Practitioner Center* Huisartsenpost

    GuWA Data exchange WMO-AWBZ Gegegevensuitwisseling WMO-AWBZ

    HIF Health Insurance Fund Zorgverzekeringsfonds

    HIS Information System for GPs Huisartsen Informatiesysteem

    LSP National Switching Point Landelijk Schakelpunt

    NZa Dutch Health Care Authority Nederlandse Zorgautoriteit

  • - 6 -

    PGB Personal Budget (from the AWBZ Persoongebonden Budget

    or WMO)

    RIO Regional Indication Office Regionaal Indicatie Orgaan

    RIVM National Institute for Public Health Rijksinstituut voor Volksgezondheid

    and the Environment en Milieu

    SSP SVB Service Center for PGB SVB Service Centrum voor PGBs

    SVB Social Insurance Bank Sociale Verzekeringsbank

    UZI Unique Identification of Health care Unieke Zorgverlener Identificatie


    VWS Public Health, Welfare, and Sports Volksgezondheid, Welzijn en Sport

    VZVZ Alliance of Health care providers Vereniging van Zorgaanbieders Voor

    For Health care Communication Zorgcommunicatie

    WBSN-Z Law on the Use of the Citizen Wet Gebruik Burgerservicenummer in

    Service Number in Health Care de Zorg

    WMG Law on Market structuring Wet Marktordening Gezondheidszorg

    Health care

    WMO Social Support Act Wet Maatschappelijke Ondersteuning

    ZIS Information System for Hospitals Ziekenhuis Informatiesysteem

    ZVW Health Insurance Act Zorgverzekeringswet

    ZZP Care Weight Package Zorgzwaartepakket

    *A GP centre is a central GP practice that is open for emergency doctor visits outside regular

    clinical hours (regular clinical hours are usually workdays 8.00 17.00).

    Dutch branch organizations in health care

    Actiz Branch organization for health care entrepeneurs

    Federatie Opvang Branch organization for shelters for the homeless, victims of

    domestic violence, and other vulnerable population groups

    GGZ Mental Health care association Geestelijke Gezond


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