The Netherlands has a social insurance system similar to Germany's. About two-thirds of workers are covered by the social insurance program; the remainder are covered by private insurance. Under the Health Insurance Act, everyone with earned income of less than 50,900 guilders per year pays a monthly contribution in return for which they receive medical, pharmaceutical, and dental treatment and hospitalization. People who earn more than this have to take out private medical insurance. The state also pays for preventive medicine including vaccinations for children, school dental services, medical research, and the training of health workers. Preventive care emphasizes education, a clean environment, and regular exams and screenings. As of 1999, there were an estimated 3.1 physicians and 11.3 hospital beds per 1,000 people.
The general health situation has been excellent over a long period, as is shown by an estimated general mortality rate of 8.7 per 1,000 as of 2002 and an infant mortality of only 5 per 1,000 live births in 2000, down markedly from the 12.7 rate in 1970. The maternal mortality rate was 7 per 100,000 live births. These low rates are attributed to a rise in the standard of living; improvements in nutrition, hygiene, housing, and working conditions; and the expansion of public health measures. In 2000, average life expectancy was 78 years.
Most doctors and hospitals operate privately. A system of hospital budgeting, which was introduced in 1983, has helped contain costs. In 1990, a proposal to increase competition among insurers, eliminating the distinction between public and private insurers, was developed. A reference price system—to control pharmaceuticals especially—was introduced in 1991. As of 1999, total health care expenditure was estimated at 8.7% of GDP.
The Ministry of Public Health and Environment is entrusted with matters relating to health care, but health services are not centrally organized. There are numerous local and regional health centers and hospitals, many of which are maintained by religious groups.
In 2002, the estimated birth rate was 11.6 per 1,000 people; 75% of married women (ages 15 to 49) used contraception in 2000. In the same year the total fertility rate was 1.7 children for each woman living throughout childbearing years.
Major causes of death in 1992 were categorized as follows, per 100,000 inhabitants: communicable diseases and maternal/perinatal causes (40), noncommunicable diseases (416), and injuries (36). There were 339 deaths per 100,000 attributed to cardiovascular problems and 235 per 100,000 attributed to cancer. There were 302 reported cases of measles in 1994. In 1999 there were 10 cases of tuberculosis per 100,000 people.
Immunization rates for children up to one year old in 1997 were as follows: diphtheria, pertussis, and tetanus, 95%; polio, 97%; and measles, 96%.
As of 1999, the number of people living with HIV/AIDS was estimated at 15,000 and deaths from AIDS that year were estimated at 100. HIV prevalence was 0.2 per 100 adults.