Sustained high growth health care expenditure

• Restricted growth expenditure on GP practices and medicines
• Above-average increase expenditure on mental health care and care for disabled
• Robust increase health-care-to-GDP ratio

Last year, Dutch expenditure on health care and welfare amounted to 83.8 billion euro, an increase by 5.8 percent relative to 2008. Over the period 2004-2008, the growth pace of care expenditure has increased continually. The expenditure increase over 2009 is marginally below the level of one year previously, but the exceptional increase recorded in 2008 was partly caused by an increase in expenditure on medical aid appliances (spectacles). More jobs and wage increases in the health care and welfare sector caused the total wage bill of care-providing institutions to grow by approximately 5.5 percent in 2009.

Expenditure on hospital care and medical specialist practices rose by 7.3 percent last year, as against nearly 9 percent in 2008. This type of expenditure accounts for more than a quarter of total spending in the health care and welfare sector.

Expenditure on dental and paramedical care grew by 8.1 and 7.6 percent respectively in 2009. The costs of dental care, more specifically implants and dentures in adult patients rose. Expenditure on GP practices showed a 2.7 percent growth. 

Expenditure on prescribed medicines bought at dispensing chemist’s shops rose by 1.7 percent. Continuation of the so-called preference policy advocated by health insurers has resulted in lower prices for medicines no longer protected by patent law. The preference policy implies that health insurers select a medicine – in most cases the cheapest – from a group of similar medicines.

Expenditure on care for disabled and elderly people increased by 9.0 and 4.7 percent respectively in 2009. Care for disabled persons increased predominantly as a result of extension of the admission capacity, whereas a relatively restricted growth in elderly care was caused by cutting back on professional counselling services. 

In this first estimate, expenditure on mental health care showed a considerable growth in 2009. Over the past two years, expenditure on mental health care has risen by approximately 8.5 percent annually. The transition in 2008 of a large part of mental health care from the Exceptional Medical Expenses Act (AWBZ) to the Health Care Act and the introduction of a new financing scheme have resulted in less reliable mental health care figures.

The health-care-to-GDP ratio rose from 13.3 percent in 2008 to 14.7 percent in 2009. The increase is the result of the dramatic decline by 4 percent of the GDP on account of the economic recession in combination with a sustained growth of health care expenditure.

In the period 2002-2003, when the Dutch economy stagnated, the health-care-to-GDP ratio also rose dramatically. In the following period, the share of health care expenditure did not drop.

In 2009, per capita health care expenditure was 5,069 euro versus 4,818 euro in 2008 (+5.2 percent).

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