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Spending on Health Care in the Netherlands: Not going so Dutch

Author

Listed:
  • Pieter Bakx

    (Institute of Health Policy & Management (iBMG), Erasmus University Rotterdam, the Netherlands)

  • Owen O’Donnell

    (Erasmus University Rotterdam, the Netherlands, University of Thessaloniki, Greece)

  • Eddy van Doorslaer

    (Erasmus University Rotterdam, the Netherlands)

Abstract
The Netherlands is among the top spenders on health in the OECD. We document the life-cycle profile, concentration and persistence of this expenditure using claims data covering both curative and long-term care expenses for the full Dutch population. Spending on health care is strongly concentrated: the one per cent of individuals with the highest levels of expenditure account for one quarter of the aggregate in any one year. Averaged over three years, the top one per cent still accounts for more than a fifth of the total, indicating a very high degree of persistence in the largest expenses. Spending on long-term care, which amounts to one third of all expenditure on health care, is even more concentrated: the top one per cent accounts for more than half of total spending on this type of care. Average expenditure rises steeply with age and even more so with proximity to death. Spending on individuals in their last year of life absorbs one tenth of aggregate health care expenditure. In a given year, spending on health care is highly skewed toward individuals with lower incomes. Average expenditure on the poorest fifth is more than three times that on the richest fifth. Spending on long-term care is five times more concentrated on the poor.

Suggested Citation

  • Pieter Bakx & Owen O’Donnell & Eddy van Doorslaer, 2016. "Spending on Health Care in the Netherlands: Not going so Dutch," Tinbergen Institute Discussion Papers 16-024/V, Tinbergen Institute.
    • Handle: RePEc:tin:wpaper:20160024
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    References listed on IDEAS

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    1. Pieter Bakx & Claudine de Meijer & Frederik Schut & Eddy van Doorslaer, 2015. "Going Formal or Informal, Who Cares? The Influence of Public Long‐Term Care Insurance," Health Economics, John Wiley & Sons, Ltd., vol. 24(6), pages 631-643, June.
    2. van Kippersluis, Hans & O'Donnell, Owen & van Doorslaer, Eddy & Van Ourti, Tom, 2010. "Socioeconomic differences in health over the life cycle in an Egalitarian country," Social Science & Medicine, Elsevier, vol. 70(3), pages 428-438, February.
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    5. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & De Graeve, Diana & Duchesne, Inge & Gerdtham, Ulf-G & Gerfin, Michael & Geurts, Jose & Gross, Lorna, 2000. "Equity in the delivery of health care in Europe and the US," Journal of Health Economics, Elsevier, vol. 19(5), pages 553-583, September.
    6. de Meijer, Claudine & Koopmanschap, Marc & d' Uva, Teresa Bago & van Doorslaer, Eddy, 2011. "Determinants of long-term care spending: Age, time to death or disability?," Journal of Health Economics, Elsevier, vol. 30(2), pages 425-438, March.
    7. de Meijer, Claudine & O’Donnell, Owen & Koopmanschap, Marc & van Doorslaer, Eddy, 2013. "Health expenditure growth: Looking beyond the average through decomposition of the full distribution," Journal of Health Economics, Elsevier, vol. 32(1), pages 88-105.
    8. Pilar García-Gómez & Hans van Kippersluis & Owen O’Donnell & Eddy van Doorslaer, 2013. "Long-Term and Spillover Effects of Health Shocks on Employment and Income," Journal of Human Resources, University of Wisconsin Press, vol. 48(4), pages 873-909.
    9. Adam Wagstaff & Eddy van Doorslaer, 2000. "Measuring and Testing for Inequity in the Delivery of Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 35(4), pages 716-733.
    10. Schut, Frederik T. & Varkevisser, Marco, 2013. "Tackling hospital waiting times: The impact of past and current policies in the Netherlands," Health Policy, Elsevier, vol. 113(1), pages 127-133.
    11. J. Oostenbrink & F. Rutten, 2006. "Cost assessment and price setting of inpatient care in the Netherlands. The DBC case-mix system," Health Care Management Science, Springer, vol. 9(3), pages 287-294, August.
    12. Tsiachristas, Apostolos & Dikkers, Carolien & Boland, Melinde R.S. & Rutten-van Mölken, Maureen P.M.H., 2013. "Exploring payment schemes used to promote integrated chronic care in Europe," Health Policy, Elsevier, vol. 113(3), pages 296-304.
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    Cited by:

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    2. Bakx, Pieter & Wouterse, Bram & van Doorslaer, Eddy & Wong, Albert, 2020. "Better off at home? Effects of nursing home eligibility on costs, hospitalizations and survival," Journal of Health Economics, Elsevier, vol. 73(C).
    3. Wouterse, B.; & Hussem, A.; & Wong, A.;, 2018. "The effect of co-payments in Long Term Care on the distribution of payments,consumption, and risk," Health, Econometrics and Data Group (HEDG) Working Papers 18/24, HEDG, c/o Department of Economics, University of York.
    4. Friedrich Breyer & Normann Lorenz, 2021. "The “red herring” after 20 years: ageing and health care expenditures," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(5), pages 661-667, July.
    5. Kárpáti, Daniel, 2023. "Essays in finance & health," Other publications TiSEM 5505e140-1f4d-4f61-a5a5-e, Tilburg University, School of Economics and Management.
    6. Bonekamp, Johan & Wouterse, Bram, 2023. "Do different shocks in health matter for wealth?," Journal of Health Economics, Elsevier, vol. 87(C).
    7. Miszczyńska Katarzyna M. & Miszczyński Piotr M., 2020. "Inpatient Costs in the Perspective of Polish Health Policy: Scenario Analysis," South East European Journal of Economics and Business, Sciendo, vol. 15(2), pages 43-56, December.
    8. Pieter Bakx & Bram Wouterse & Eddy (E.K.A.) van Doorslaer & Albert Wong, 2018. "Better off at home? Effects of a nursing home admission on costs, hospitalizations and survival," Tinbergen Institute Discussion Papers 18-060/V, Tinbergen Institute.
    9. Cäzilia Loibl & Wändi Bruine de Bruin & Barbara Summers & Simon McNair & Pieter Verhallen, 2022. "Which financial stressors are linked to food insecurity among older adults in the United Kingdom, Germany, and the Netherlands? An exploratory study," Food Security: The Science, Sociology and Economics of Food Production and Access to Food, Springer;The International Society for Plant Pathology, vol. 14(2), pages 533-556, April.
    10. Krabbe-Alkemade, Yvonne & Makai, Peter & Shestalova, Victoria & Voesenek, Tessa, 2020. "Containing or shifting? Health expenditure decomposition for the aging Dutch population after a major reform," Health Policy, Elsevier, vol. 124(3), pages 268-274.
    11. Thomas G. McGuire & Sonja Schillo & Richard C. Kleef, 2021. "Very high and low residual spenders in private health insurance markets: Germany, The Netherlands and the U.S. Marketplaces," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(1), pages 35-50, February.
    12. Julio López Laborda & Carmen Marín González & Jorge Onrubia, 2020. "Observatorio sobre el reparto de los impuestos y las prestaciones entre los hogares españoles. Quinto informe – Sanidad y educación, 2013 - 2017," Studies on the Spanish Economy eee2020-28, FEDEA.

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    More about this item

    Keywords

    Health expenditure; Long-term care; Social insurance; the Netherlands;
    All these keywords.

    JEL classification:

    • D12 - Microeconomics - - Household Behavior - - - Consumer Economics: Empirical Analysis
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality

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