Quality Development in Health Care in the Netherlands

The Dutch health care system's recent experiences with reform hold lessons for U.S. legislators and policymakers. In 2003, the Netherlands 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 United States. 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 of these initiatives, including the central focus on primary care; 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.