Table 1 Changes in primary health care in The Netherlands after 2006

A market-oriented health care system was introduced in 2006 together with a new system of basic health insurance replacing the previous distinction between private and public insurance. Adult citizens are obliged to choose a health insurance, for which they pay around € 1100,- per year (with only slight differences between insurers) plus additional taxation guaranteeing basic health care coverage and free access to the GP, but excluding € 350,- co-payment for specialist care (children’s healthcare is free). It amounts to an average family spending € 11.000,- or around 23 % of its income on healthcare.

Insurers got purchasing power and the government withdrew from healthcare, but set strict regulations for insurers and providers. Regulated competition between healthcare providers and between health insurers was introduced for specialist care, but General Practice was exempted from this competition.

General Practice income has increased since 2006 and GPs invested in premises, staff and infrastructure, including ICT and communication equipment. Their personal income increased as well. Along with the change to market-oriented financing the total budget for GP-care rose from € 1.922 in 2006 to 2.372 million in 2010, an increase of 14 %. In 2011 all insurers invested another 10 %. Before 2006 the macro budget for GP care had been constant.

Until 2006 GPs received capitation payments for their public patients (2/3), and fees per consultation for their private patients (1/3). From January 2006, GPs are being paid according to a uniform, mixed payment scheme. GPs receive a partial capitation for each patient per year plus fees per consultation for basic day care. They receive ancillary payments (mainly on a fee-for-service basis) for additional or special therapeutic and diagnostic services and for the care for chronic diseases. They are compensated on an hourly basis for care during out-of-office-hours (evening, night and weekend care). The income of self-employed Dutch GPs was ± € 96.000 in 2005 and of GPs employed by other GPs € ± 73.000.