Netherlands health insurance system under legal and financial pressure

The Netherlands’ universal healthcare policy may have withstood a recent legal challenge over the mandatory requirement to purchase a basic policy but the legal victory comes at a time when the rising cost of healthcare is causing a risk management crisis.

The legal case had been brought by a man, Cedric de Kok, who was fined by the National Healthcare Institute back in 2014 for his refusal to buy health insurance.

Under Dutch law, residents are required to purchase a basic health insurance package at an approximate cost of €110 per month. De Kok had contested the fine, stating that he was only interested in homeopathic medicines and therefore did not want to pay into a system that he would not use.

While the Netherlands does cater for exemptions on religious or conscientious objection grounds, this comes with a higher tax burden, something that De Kok also refused to pay.

The European Court of Human Rights (ECHR) found that the case lacked “seriousness, cohesion and importance” and ruled that the Netherlands had struck an appropriate balance between collective and individual needs.

The court also chastised De Kok’s argument that his case was supported by Article 9 of the Human Rights Convention, which is designed to ensure that European citizens have freedom of thought, consciences and religion.

The judges ruled that his distrust of the medical system did not fall within the scope of the article.

Similar cases objecting to the requirement to pay into national schemes have been brought by companies as well as individuals in the past.

One of these, Geotech Kancev GmbH v Germany, took place in 2016 when the German geothermal company objected to its obligation to pay into a benefits fund for workers that became ill or injured. However, it was established by the court that European companies can be made to pay into social welfare funds.

The EHRC noted in its most recent judgment that EU states “enjoy a wide margin of appreciation when it comes to balancing the general interests of the community and the requirements of the protection of the individual’s fundamental rights”.

But the Netherlands’ legal victory comes at a time when its healthcare sector is under unprecedented pressure.

According to national statistics office CBS, the Netherlands spent €116bn on healthcare in 2020. This has led the government’s healthcare adviser Zorginstituut Nederland (ZN) to call for a rigorous change of approach to avoid the system being overrun.

The adviser has launched a campaign to promote the need for action and ZN chairman Sjaak Wijma warned that “if we do not act now, within 20 years we will be spending one third of our income on care”.

This view was supported by the government’s scientific policy unit WRR, which cautioned that in 40 years’ time, one in three people will work in the care sector unless action is taken.

It also means that as this pressure mounts, more companies are likely to face more obligations to pay into the system and provide healthcare benefits for their employees, which could in turn lead to more lawsuits about opting out of such obligations.

ad been brought by a man, Cedric de Kok, who was fined by the National Healthcare Institute back in 2014 for his refusal to buy health insurance.

Under Dutch law, residents are required to purchase a basic health insurance package at an approximate cost of €110 per month. De Kok had contested the fine, stating that he was only interested in homeopathic medicines and therefore did not want to pay into a system that he would not use.

While the Netherlands does cater for exemptions on religious or conscientious objection grounds, this comes with a higher tax burden, something that De Kok also refused to pay.

The European Court of Human Rights (ECHR) found that the case lacked “seriousness, cohesion and importance” and ruled that the Netherlands had struck an appropriate balance between collective and individual needs.

The court also chastised De Kok’s argument that his case was supported by Article 9 of the Human Rights Convention, which is designed to ensure that European citizens have freedom of thought, consciences and religion.

The judges ruled that his distrust of the medical system did not fall within the scope of the article.

Similar cases objecting to the requirement to pay into national schemes have been brought by companies as well as individuals in the past.

One of these, Geotech Kancev GmbH v Germany, took place in 2016 when the German geothermal company objected to its obligation to pay into a benefits fund for workers that became ill or injured. However, it was established by the court that European companies can be made to pay into social welfare funds.

The EHRC noted in its most recent judgment that EU states “enjoy a wide margin of appreciation when it comes to balancing the general interests of the community and the requirements of the protection of the individual’s fundamental rights”.

But the Netherlands’ legal victory comes at a time when its healthcare sector is under unprecedented pressure.

According to national statistics office CBS, the Netherlands spent €116bn on healthcare in 2020. This has led the government’s healthcare adviser Zorginstituut Nederland (ZN) to call for a rigorous change of approach to avoid the system being overrun.

The adviser has launched a campaign to promote the need for action and ZN chairman Sjaak Wijma warned that “if we do not act now, within 20 years we will be spending one third of our income on care”.

This view was supported by the government’s scientific policy unit WRR, which cautioned that in 40 years’ time, one in three people will work in the care sector unless action is taken.

It also means that as this pressure mounts, more companies are likely to face more obligations to pay into the system and provide healthcare benefits for their employees, which could in turn lead to more lawsuits about opting out of such obligations.