Key points
- The Netherlands runs the Bismarck model: mandatory private insurance, with managed competition between insurers.
- Basic insurance is mandatory for every resident, and 99.9% of the population is covered (OECD Health at a Glance 2025).
- Care is delivered by private non-profit providers, with the GP as gatekeeper and a referral needed for specialists.
- GP visits, maternity care and care for under-18s are exempt from the deductible; other care carries a mandatory deductible of €385 a year (2025 and 2026).
- Life expectancy at birth was 81.9 years in 2023, and health spending was 10.0% of GDP in 2024 (OECD Health at a Glance 2025).
Direct answer: The Netherlands runs the Bismarck model: mandatory private insurance, with managed competition between insurers under the Health Insurance Act of 2006. Basic insurance is mandatory for every resident, and 99.9% of the population is covered (OECD Health at a Glance 2025). Care is delivered by private non-profit providers, with the GP as gatekeeper and a referral needed for specialists. GP visits, maternity care and care for under-18s are exempt from the deductible; other care carries a mandatory deductible of €385 a year (2025 and 2026). Life expectancy at birth was 81.9 years in 2023, and health spending was 10.0% of GDP in 2024 (OECD Health at a Glance 2025).
At a glance
| Item | Detail |
|---|---|
| Model | Bismarck — mandatory private insurance |
| Who pays | Mandatory basic insurance from private insurers: flat premiums plus an income-related contribution; healthcare allowance for low incomes |
| Who delivers | Private non-profit providers; GP gatekeeper, referral needed for specialists |
| What is free at the point of use | GP visits, maternity care and care for under-18s exempt from the deductible; other care subject to a €385 annual deductible (2025 and 2026) |
| Life expectancy at birth | 81.9 years (2023, OECD Health at a Glance 2025) |
| Health spending | 10.0% of GDP (2024, OECD Health at a Glance 2025) |
| Source for the model and coverage | Commonwealth Fund — Netherlands country profile |
Figures are a snapshot checked 7 November 2026, not a live feed. No country is ranked as best.
How the system works
The Health Insurance Act of 2006 replaced the old split between public and private sickness funds with a single mandatory market. Every resident must buy basic insurance (basisverzekering) from a private insurer within four months of registering an address. The government defines the basic package — GP care, hospital care, most specialist care, prescription medicines, mental health care within set limits and maternity care — and every insurer must offer it. Insurers must accept all applicants at the same price regardless of age or health, and they compete on service and on the premium, not on who they cover.
Funding comes from two streams: a flat monthly premium paid to the insurer, and an income-related contribution collected through the tax system. People on low incomes receive a healthcare allowance (zorgtoeslag) towards the premium. Long-term care sits outside the basic package, under the separate Long-Term Care Act. Around four-fifths of the population also buy voluntary supplementary insurance for care the basic package does not cover, such as adult dental care.
Who pays, and what people pay
The patient pays the monthly premium and the income-related contribution, and then the mandatory deductible (eigen risico) on most care: the first €385 each year, unchanged since 2016 and confirmed for 2025 and 2026 (European Observatory on Health Systems and Policies). GP visits, maternity care and care for children under 18 do not count towards the deductible. Above-reference-price medicines carry a further personal contribution, capped at €250 a year. People can voluntarily raise the deductible to €885 in exchange for a lower premium. Anyone who does not buy insurance is traced and fined, and can be enrolled by the Central Administration Office (CAK).
What is free, and what is not
GP visits are free at the point of use and never count towards the deductible, as are maternity care and all care for children under 18. What is not free is the margin: the €385 deductible on hospital, specialist and prescription costs, the capped contribution on above-reference-price medicines, and care outside the basic package — most adult dental care, some physiotherapy and optical care — which is paid for directly or through supplementary insurance. The boundary is set annually by the government when it defines the basic package.
How it compares
The Netherlands spends 10.0% of GDP on health — above the OECD average of 9.3% — and $8,436 per person, more than the OECD average of $5,967 (USD PPP, 2024). Its life expectancy of 81.9 years is 0.8 years above the OECD average of 81.1 years (OECD Health at a Glance 2025). Its distinguishing feature is managed competition: private insurers and private providers inside a mandatory, tightly regulated market, with the GP as gatekeeper — the model that, with Australia and the United Kingdom, ranked in the top three of the Commonwealth Fund’s Mirror, Mirror 2024 comparison. Compare countries side by side in the Health System Comparison tool, or read the other profiles in the country index.
Frequently asked questions
Is Dutch health insurance private or public?
Private, but mandatory and tightly regulated. Every resident must buy basic insurance from a private insurer, and insurers must accept all applicants at the same price regardless of age or health. The government defines the basic package and pays a healthcare allowance to people on low incomes.
What is the eigen risico?
The mandatory deductible: the first €385 of most care each year comes out of your own pocket. It was €385 in 2025 and stays €385 in 2026. GP visits, maternity care and care for children under 18 are exempt from it.
Do Dutch patients need a referral to see a specialist?
Yes. The GP is the gatekeeper: a referral from the GP is normally needed to see a hospital specialist.