Table 1 Emergency care in the Netherlands [23,24,25]

Emergency care in the Netherlands is mainly provided by emergency departments (ED) and general practitioners (GP). During out-of-hours care, GPs mostly collaborate in out-of-hours services: large on-call rotations in which they take care of each other’s patients. In order to have access to hospital care, including EDs, patients are obliged to have a referral from an ambulant emergency service or GP, who functions as a gatekeeper. However, in practice, many patients attend the ED directly.

Out-of-hours GP services and ED contacts are covered by obligatory health insurance. For hospital services (i.e. ED visits), there is a compulsory fee of at least €170 (at the moment of data collection). Prices of care pathways are determined by the national DTC system (DTC means the registered diagnosis and treatment combination). Out-of-hours GP services operate with one fixed budget, based on the catchment population, which is converted to a price per medical service (advice, consultation at care center, consultation at home). Since the 2006 Health Insurance Act, the Dutch healthcare system is based on a market of regulated competition. The prices for medical services are determined after negotiations between health insurance companies and care providers. As all citizens of the Netherlands are required to have health insurance coverage, every citizen pays for annual healthcare expenditures.