Cost containment and the right to health care

This article addresses the question of how cost containment programmes affect the right to health care in The Netherlands. A distinction is made between three different dimensions of the right to health care: health care entitlements, need assessment and enforceability. The analysis starts with a discussion of entitlements in social and private health insurance and a brief overview of how decisions on entitlements are made. Next, it is shown how the search for cost containment has influenced health care entitlements in Dutch health care (e.g. critical screening of entitlements) and has resulted in a need for more stringent guidelines for need assessment to use health care resources more efficiently. The growing gap between the growth rates in health care demand and the resources for health care points to the creation of enforceability problems in health care (waiting lists). The final section discusses the question of whether Dutch health care is moving towards a two-tier system. Throughout the analysis attention is given to the political dimension of the debate on health care entitlements, need assessment and the enforceability of entitlements.