Health and health systems compared internationally

Internationally, the Netherlands has relatively low smoking rates and few foreign-trained medical doctors, while relatively little is spent on non-reimbursed medicines. This is evident from the newly released OECD publication Health at a Glance 2019, which contains indicators on health and health care in a large number of - mainly western - countries.

The percentage share of daily smokers aged 15 years and over in the Netherlands dropped from 23 percent in 2007 to 17 percent in 2017. This was a slightly stronger decline than the average across OECD countries. The share of smokers in the Netherlands is just below the OECD average. Average smoking rates across the OECD countries stood at 18 percent in 2017, down from 23 percent in 2007.

There are wide disparities between the various countries. In Greece, the smoking rate decreased from 40 percent in 2006 to 27 percent in 2014. Several countries have seen an increase in the number of smokers, such as Slovakia and Austria. However, the large majority of countries have fewer smokers than previously.

Daily smokers (% of population aged 15 yrs and over)
Land2017*2007*
Greece*/***2740
Turkey*2733
Hungary***2627
Chile2530
Austria*/***2423
Slovakia***2320
OECD-361823
Netherlands1723
Norway**1222
Canada1218
United States1115
Sweden1014
Iceland919
Mexico*813
Source: CBS, OECD
* 2006, ** 2018, *** 2014

Relatively few doctors are trained abroad

At 2 percent, the Netherlands has a relatively small share of doctors with a foreign medical qualification (2017). Many other countries have a larger share of foreign-trained doctors. In Israel, this share amounts to 58 percent. In a number of countries, such as Norway and Sweden, doctors have had training in a neighbouring country. In the Netherlands, there are Dutch doctors who hold a Belgian diploma. There is more exchange in English-speaking countries due to the language. Of the European countries, Ireland has the largest share of foreign-trained doctors: 42 percent. One out of five doctors in Ireland with a foreign medical qualification are from Pakistan.

Foreign-trained doctors (%)
 20172012
Israel57.859.6
New Zealand42.443.5
Ireland42.332.6
Norway39.736.1
Sweden*34.825.1
Switzerland34.127.0
Australia32.133.1
United Kingdom28.729.0
United States*25.024.9
Canada24.623.8
OECD-29**17.716.0
Slovenia17.314.0
Belgium12.310.1
Germany11.98.2
France11.28.7
Denmark*9.28.7
Hungary8.07.4
Czech Republic7.15.1
Latvia6.07.1
Austria5.84.4
Estonia3.52.0
Netherlands*2.22.1
Poland1.91.8
Italy0.80.8
Source: CBS, OECD
*2016; ** including countries with different reporting years

Low level of out-of-pocket payments on medicines

In the Netherlands, out-of-pocket payments on medicines and bandaging aids amounted to 2 percent of total health care expenditure, around the same level as in France and Germany. The percentage share of these payments was smaller than in Belgium (4 percent), and much smaller than in Greece (13 percent) and the United States (12 percent).

The share in the Netherlands was not much higher than ten years previously. Between 2008 and 2013, it went up mainly as a result of a raised deductible excess. In recent years, the proportion of out-of-pocket payments has nearly doubled in Spain and more than doubled in Greece.

Out-of-pocket payments on medicines (% of total health care expenditure)
JaarBelgiumFranceGermanyGreeceNetherlandsSpainUnited StatesOECD-28
20085.92.62.72.04.812.98.0
20095.42.42.55.92.04.412.98.0
20105.12.32.66.51.94.512.48.1
20115.02.32.57.62.05.212.38.0
20124.62.12.68.52.16.211.88.2
20134.72.02.511.22.37.311.88.2
20144.41.92.312.82.37.012.38.2
20154.41.92.312.82.47.412.68.2
20164.31.82.412.62.48.212.37.9
20174.21.72.212.62.37.712.07.7
Source: CBS, OECD

The percentage of daily smokers is an OECD indicator. For the sake of international comparison, the percentage of smokers includes occasional smokers in the Staat van Volksgezondheid en Zorg (State of Public Health and Care).