Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Fund Reports


Quality Development in Health Care in the Netherlands



While no nation can be deemed "the best" in terms of its health care system, the United States is consistently outperformed in such areas as the prevention of medical errors, the provision of timely care for all citizens, and coordination of care. The U.S., it would seem, could learn from models and best practices used in countries that have achieved these higher levels of performance. One such country is the Netherlands. In 2003, this nation of just over 16 million people spent 9.8 percent of its gross domestic product on health care, below the spending levels in Germany, France, and Canada and more than one-third less than the percentage spent in the United States (Table 1). Even under the constraints of this budget, the Netherlands has implemented a number of health sector reforms that have led to important quality improvements.

This report discusses several Dutch initiatives, including the establishment of a central focus on primary care; the reorganization of after-hours and emergency care; utilization of clinical guidelines, performance indicators, diagnostic treatment combinations; local collaboratives; and introduction of more stringent accreditation and evaluation procedures. The report identifies lessons that may help the United States further its goal of enhancing the performance of its health system.

Table 1. Health Care Spending and Physician and Nurse Ratios, 2003

  Health Expenditure as Percent of GDP Total Expenditure on Health Care per Capita (USD PPP) Public Expenditure on Health Care per Capita (USD PPP) Private Expenditure on Health Care per Capita (USD PPP) Physicians per 1,000 Population Nurses per 1,000 Population

Australia 9.3% $2,699a $1,821a $878a 2.5a 10.2
Canada 9.9c 3,001c 2,098c 903c 2.1 9.8
Finland 7.4 2,118 1,622 497 2.6 9.3
France 10.1c 2,903c 2,214c 689c 3.4 7.3
Germany 11.1 2,996 2,343 653 3.4 9.7
Netherlands 9.8 2,976 1,856 1,119 3.1 12.8a
Spain 7.7 1,835 1,306 529 3.2 7.5
Sweden 9.4 2,703 2,304 399 3.3 10.2a
United Kingdom 7.7a 2,231a 1,860a 371a 2.2 9.1
United States 15.0 5,635 2,503 3,131 2.3a 7.9a

Note: PPP = Purchasing power parity—an estimate of the exchange rate required to equalize the purchasing power of different currencies, given the prices of goods and services in the countries concerned.
a2002 data.
Source: Organization for Economic Cooperation and Development (OECD) Health Statistics 2005.
Features of the Dutch Health Care System

  • Complete coverage of all residents
  • Strong primary care focus: gatekeeping, all patients related to one specific practice
  • Primary care by trained family medicine specialists
  • All other medical specialists work in hospitals (private or salaried)
  • Increasing role for nurses

Publication Details



R. Grol, Quality Development in Health Care in the Netherlands, The Commonwealth Fund, March 2006.