stress first of all that health care is part of the total politics of a country. It always involves political choices. What do we spend on our health care, what do we want the citizens to pay for themselves, what kind of care do we make available? As other parts of the society, health care is the result of political choices and cannot be considered without the political context. Of course, in this presentation I will focus on the health care processes, but it is a good thing to always bear in mind that the way in which the health care is organized is the result of a political process.
Looking at the health care in itself, the most important general principle of Dutch health care is that of 'equity and solidarity'. This means that traditionally there is a broad support for sharing the financial burden of health care, while at the same time it is believed that health care should be accessible for every one who is in need of care. This principle is translated into the fact that most health care payments are income related. There are only modest amounts of flat rate premiums. There are separate health insurance schemes with the intention to safeguard access for certain high-risk groups of insured, like handicapped people. In this way virtually everyone in the Netherlands is covered by health insurance. In conclusion, equity and solidary reflect the idea that everyone pays more or less the same, that is, in percentage, not in real money. And everyone has, in principle, the same access to health care.
Another principle of Dutch health care is that decisions are negotiated upon and that these are made on a consensus base. This feature is embedded in a long history of health policy. It means that the decisions are shaped by the interaction between government and organized interest groups. These interest groups are, for instance, hospital organizations, the organization of medical specialists, insurance companies, home health care organizations, the organization of general practitioners, etc. Each one of these groups is represented in advisory
