Hospital Financing in Seven Countries (Part 8 of 11)

s in other industrialized countries, the health care sector is an important element of the Netherlands’ economy. As a share of gross domestic product (GDP), national health expenditures in the Netherlands rose from 6 percent in 1970 to 8.2 percent in 1980 (23). The growth rate slowed in the 1980s; by 1991, national health expenditures accounted for only a slightly higher share of GDP at 8.3 percent.1 Health care expenditures grew by a cumulative increase of 185 percent from 1970 to 1981 but by a cumulative increase of only 51 percent from 1981 to 1991 (2). The importance of health care to the Dutch economy is also illustrated by the fact that health care employment accounted for over one-tenth of total employment in 1991, and investments in the health care sector amounted to 8.4 percent of total investments in the economy (18). Despite the relatively constant ratio of national health expenditures to GDP over the past few years, major reforms of the Dutch health care system initiated in the late 1980s arguably belong to the most radical planned so far for the 1990s in any OECD country (4,22,24). The main objective of the reforms (which are based on a report of the so-called Dekker Committee, Willingness to Change) (4) was to combine a national health insurance system with managed competition to improve efficiency and achieve more effective cost containment. Currently, however, there is substantial uncertainty about the future of the Netherlands’ re-