The Dutch healthcare system has been in decline for decades under market pressure. The new government is continuing the neoliberal policies of its predecessors. We need to seriously rethink how basic services are organised to get out of the chokehold of the current system.

The new Dutch government coalition consisting of D66, CDA, and VVD has presented its plan for the next four years. While many parts of the plan, such as increased military spending and keeping the mortgage interest deduction, have generated mixed reactions, the proposed healthcare changes have stolen most of the headlines. Key changes include a higher healthcare deductible (rising from €385 to €460 in 2027), stricter assessment of medicines covered in the basic package, cuts in elderly care and district nursing, and investments in prevention and welfare. Some measures, including municipal compensation schemes for chronically ill patients, attempt to soften the impact, but these changes largely come at the expense of patients and the most vulnerable.

Patients vs consumers

In 2006, the Dutch Health Insurance Act (Zorgverzekeringswet) came into force, marking the start of marketisation of healthcare. Inspired by the 1987 Dekker report, the Act introduced “regulated competition,” replacing the traditionally strong, state-planned universal coverage with a market-oriented model. All residents received a single mandatory insurance package, but insurers competed on price, service, and contracts with providers.

The promise of this model was greater efficiency and choice: patients would become “healthcare consumers,” selecting services and insurers in a competitive market. In practice, however, this shift has mostly benefited insurers and the system’s administrators rather than patients. Studies comparing pre- and post-reform periods find no clear structural reduction in overall healthcare spending growth attributable to competition alone. At the same time, transaction and contracting costs increased due to complex negotiations, reporting requirements, and billing systems.

What was once a relatively straightforward universal service has been reorganised into a quasi-market, where healthcare is treated as a commodity, patients are reframed as consumers, and healthcare professionals increasingly function within administrative and contractual constraints.

Deductibles as a punitive measure

The mandatory deductible (“eigen risico”) is a central feature of the marketised Dutch healthcare system. By requiring patients to pay a fixed portion of medical costs out of pocket, it shifts financial responsibility from the system to individuals, framing healthcare as a personal expense rather than a universal right.

Economic theory justifies deductibles as a way to reduce “moral hazard”, arguing that people overuse healthcare when it is free. In theory, deductibles are meant to encourage more careful and efficient use of medical services. However, evidence from the Netherlands shows that higher out-of-pocket payments reduce not only unnecessary care but also necessary care.

Low-income households and patients with chronic illnesses are disproportionately affected, often paying the full deductible every year. The deductible functions as a flat financial threshold: those who are sick pay more simply because they are sick. The proposed increase to €460 in 2027 will further intensify this burden, effectively penalising those who rely most on care.

While income compensation exists through healthcare allowances (zorgtoeslag), this does not remove the upfront financial barrier or the psychological deterrent of potential costs, which can lead patients to delay or avoid care.

Healthcare is a collective duty

The neoliberal logic underlying the market model encourages what scholars call “responsibilisation”: social services are framed as tools for individual risk management rather than collective protection. Patients are expected to make rational financial decisions, manage their own healthcare risks, and accept the consequences of those choices. In this framework, freedom is equated with choice. Citizens are considered autonomous if they can select insurers, compare premiums, and respond to price signals.

In reality, this framing masks structural inequality. Those with fewer resources, less knowledge, or chronic health conditions are set up to fail, while insurers and private actors profit from the system. Rising costs, longer waiting times, and unequal access are not random outcomes but predictable consequences of treating healthcare like a market commodity.

At MERA25, we reject this logic. Healthcare is not a product to be purchased but a public good and universal right. True freedom comes from guaranteed access to care, irrespective of income or status. The market model has failed to deliver on its promises, and its continuation threatens the affordability, equality, and quality of Dutch healthcare.

MERA25 proposes the following:

1. De-marketisation of healthcare. Since the 2006 Health Insurance Act introduced competition among private insurers, administrative costs have risen sharply—now surpassing those in fully public systems. This fragmentation creates inefficiencies, unnecessary bureaucracy, and longer waiting times. Healthcare funding should go directly to care, not to shareholders or private insurers.
2. Abolish the “eigen risico”. We call for the complete abolition of the eigen risico, ensuring that access to care depends on need, not financial means.
3. Reject any freeze of the basic healthcare insurance package. Some political parties advocate freezing the basic healthcare package, which would restrict access to essential care and shift more costs onto patients. We oppose this policy. The basic insurance package should expand to include all necessary physical and mental healthcare, without hidden fees or exclusions.

MERA25 is clear that strengthening public healthcare is not a question of scarcity, but of political priorities. In the coming years, billions more will be allocated to military expansion and increased defence spending. At the same time, healthcare, elderly care, and social services are presented as financially constrained. This is a political choice. We reject a model in which militarisation expands while social protection is restricted. Public resources should first secure access to care, mental health support, and dignified ageing before financing further arms spending.

At the same time, the Netherlands continues to provide substantial fossil fuel subsidies and tax advantages to large corporations and polluting industries. Redirecting these funds and ensuring that multinational corporations contribute fairly would create fiscal space for social investment.

Funding healthcare reform is not only about revenue but about restructuring the system itself. Moving toward a more unified, single-payer model would reduce administrative overhead by eliminating the fragmentation of competing insurers. Stronger public bargaining power would enable more effective negotiation of drug prices. These structural savings could be reinvested directly into patient care.

Rather than framing healthcare as a cost problem, MERA25 sees it as a matter of redistribution and democratic choice: public resources should serve public needs.

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