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Table 1 General principles of the Dutch Health Insurance Act

From: The relation between trust and the willingness of enrollees to receive healthcare advice from their health insurer

• Citizens aged 18 years and older are obliged to take out health insurance for basic health insurance [12]

• Everyone aged 18 years and older contributes to the cost of healthcare through premiums, contributions and taxes [13]

• Each year citizens are free to choose between the different health insurance policies offered by private health insurers [13]

• The content of the basic health insurance package is determined by the government, and includes many necessary medical care, medicines and aids [12]

• There is a deductible: the first €385 of healthcare costs must be paid by the enrollee, except for GP consultations, maternity care, home nursing and care for children under 18 years. In addition, enrollees can choose for a voluntary deductible up to €500 per person per year in exchange for a lower premium [14]

• An enrollee can take out supplementary insurance for care not included in the basic health insurance package. For example, reimbursement for treatment at the dentist or physiotherapist [12]

Roles of health insurers

• Health insurers are obliged to accept everyone for the basic health insurance, no matter health status or other characteristics [12]. Furthermore, the enrollee’s personal situation does not affect the health insurance premium. This means that the insured's health, age or income make no difference to the amount of the premium [12]. Through a risk equalization model, health insurers are financially compensated for predictable variation in individual medical expenses [15]

• Health insurers have a duty of care, meaning that their enrollees must have access to all care from the basic health insurance package within a reasonable time and travel distance. Health insurers must therefore purchase sufficient care or mediate if someone cannot get to a healthcare provider quickly enough (waiting time mediation) [12]

• Health insurers are expected to provide good information to their enrollees on policies, costs, reimbursements and waiting times for care and support [12]