Activities

All health insurers in the Netherlands are private entities – some of which are for-profit, others being not-for-profit. A distinction between Dutch private healthcare insurers can be made on the basis of the area of activities:

• Regionally operating healthcare insurers. They are actively striving to obtain a strong position in the field of care in their respective region, from which they can then negotiate directly with the care providers. 
• Nationally operating care insurers with a few strong regional offices. These are the former statutory health insurance funds that wish to expand their "market", or enterprises that have resulted from mergers and take-overs of various public health insurance funds and private medical expenses insurers.   

Another distinctive feature of Dutch private healthcare insurers is their way of organising health care provisions for their insured. In general, there is no blueprint of this organisation, since this is a strategic choice of healthcare insurers. The way of providing services to its insured is a matter of competition between the insurance companies. Three main concepts are to be distinguished:

• In kind services for the insured. The healthcare insurer offers health services in kind by contracting healthcare providers. In contracting, healthcare insurers can control accessibility, quality and costs of health care providions. In this type of insurance, an insured chooses a selected healthcare provider and does not pay directly to the care provider. The insured pays a premium to his insurer, who will pay the contrcated healthcare provider.
• Reimbursement for the insured. The healthcare insurer does not have a selected network of healthcare providers. The insured chooses the care provider of his preference and pays the services himselves. After the direct payment to the care provider, the insured can claim his costs at his healthcare insurers, who will reimburse the costs.
• There are also healthcare insurers who offer a combination of the in kind and reimbursement policies. In this situation, an insured has the option of chosing a care provider outside the providers network of the insurer. If an insured stays within the network, he will get a 100 percent  discount. If he preferes a care provider outside the network, than a lower discount may be charged.  

The six largest care insurers carry the insurance of around 15 million residents of the Netherlands (2005).