| Verified against primary record | |
| Data reported to the Commission (2023) | None supplied; insurers apply their own procedures[1] |
|---|---|
| Cross-border care as a share of the national care budget | About 1 per cent[2] |
| EHIC claims received by Dutch insurers (2013) | About 47,000, worth over EUR 85 million[2] |
| EHIC claims received (2012) | 57,500, worth almost EUR 95 million[2] |
| Dutch residents among non-resident hospital stays in Belgium (2014) | 61.2 per cent[3] |
| Independently reported | |
| EU patients using the Directive each year | About 200,000, under 0.05 per cent of EU citizens[4] |
| Bands apply only to the rows beneath them. The European Health Insurance Card claim counts cover unplanned care during temporary stays abroad, which is not medical travel for treatment, and the responsible minister noted the figures were still subject to change. The Belgian percentage is a share of stays recorded in Belgium, not a Dutch figure, and is included because no Dutch source counts the same flow. No typical cost range is given because no official Dutch source publishes prices paid by foreign patients. | |
Medical tourism in the Netherlands is characterised by an asymmetry: Dutch residents are the single largest group of foreign patients recorded in neighbouring Belgium, while the Netherlands itself attracts comparatively few foreign patients and, by its own government’s assessment, cannot measure cross-border care well. The Netherlands supplied no figures at all to the European Commission for reference year 2023.
What the Netherlands does not report
Member states report annually to the European Commission on care obtained abroad under Directive 2011/24/EU. The Netherlands provided no data for reference year 2023, and the Commission records the reason: Dutch insurers operate their own procedures, so no generic national figures could be supplied. The Netherlands is therefore absent from both the prior authorisation and the reimbursement tables.[1]
This is a structural feature rather than an oversight. In the Dutch system, statutory health insurance is delivered by competing private insurers, and reimbursement of care abroad is handled within each insurer’s own processes rather than through a central authorisation body.[1]
The government’s own review
The most substantial official Dutch assessment of cross-border care is the interdepartmental policy review on the subject, with the cabinet response setting out both the findings and the measures adopted. It put cross-border care at about 1 per cent of the national care budget, a small share of total health spending. Spending on care abroad by people insured under the Health Insurance Act rose by about 30 per cent between 2008 and 2012, against a little over 21 per cent for the care budget as a whole, and the review concluded that this increase was smaller than had previously been assumed.[2]
On volumes, Dutch insurers received about 47,000 European Health Insurance Card claims worth over 85 million euro in 2013, compared with 57,500 claims worth almost 95 million euro in 2012, with the caveat that the figures might still change. These claims arise from unplanned care needed during temporary stays abroad and are not a measure of travel undertaken in order to obtain treatment.[2]
On the inbound side the review found that the Netherlands attracts relatively few foreign patients, and the cabinet response gives no figure for them. It also records that the costs the Dutch state bears for people insured under European rules or treaties who live outside the Netherlands exceed the contributions it receives for them, again without stating amounts.[2]
The cabinet’s stated conclusion on measurement is unusually direct. It accepted that the Netherlands cannot measure cross-border care well, that weak information had distorted the picture of spending growth, and that breakdowns by country, by planned or unplanned care, by contracted status and by type of care do not fit the structure of the national care budget. It also accepted that insurers find it hard to detect misuse of the European Health Insurance Card, so the extent of any unlawful use is unknown.[2]
Among the measures adopted were asking the care institute to report spending by date of treatment rather than date of payment, improving patient information about the two parallel reimbursement routes, asking the healthcare authority to pay closer attention to insurers’ checks on care abroad, and holding open the option of a prior authorisation system for planned care should cost control prove inadequate. The response also committed the government to supporting Dutch providers that wish to attract foreign patients, and dropped a proposal to take account of provider capacity abroad when granting licences for specialised medical procedures.[2]
Dutch patients abroad, counted elsewhere
Because no Dutch series counts it, the clearest measure of Dutch outbound hospital care comes from the country receiving it. Belgium’s statutory patient mobility observatory, working from compulsory hospital discharge records for 2014, found that the Netherlands accounted for 61.2 per cent of hospital stays by patients not domiciled in Belgium, far ahead of France at 9.6 per cent and Germany at 3.8 per cent. In the observatory’s earlier work covering 2008 to 2011 the Dutch share was about 57.4 per cent.[3]
Those are shares of a Belgian total, not Dutch patient counts, and the Belgian figures count stays rather than individuals. They establish the direction and dominance of the flow rather than its absolute size.
Eurostat maintains a collection of hospital discharges of non-residents, with tables for in-patients, day cases, bed days and average length of stay, and its metadata, last updated on 15 December 2025, states that country of residence is reported for non-resident patients where member states can supply it. Individual cell values for the Netherlands were not retrievable for this article.[5]
Legal framework
Under Directive 2011/24/EU, the member state of affiliation must reimburse cross-border care where the treatment is among the benefits it covers domestically, capped at the level of costs that state would have assumed and not exceeding the actual cost of the care received, with a discretion to pay more. Prior authorisation may be required only for care subject to planning requirements that involves an overnight hospital stay or highly specialised and cost-intensive infrastructure, for treatments carrying a particular risk, and for care from providers raising serious concerns about quality or safety.[6]
The Netherlands has not introduced a prior authorisation regime of the kind the Directive permits, and the cabinet response treats such a regime as a reserve option rather than a current instrument.[2]
Limits of the evidence
Every quantity in this entry carries a caveat. The Dutch figures are a decade old, were described as provisional when published, and cover a category, unplanned care during temporary stays, that is not medical travel for treatment. The Dutch government has itself stated that it cannot measure cross-border care well. The one recent and specific figure, the 61.2 per cent Dutch share, is a Belgian measurement of Belgian hospital activity. No official Dutch source identified here counts foreign patients treated in the Netherlands, or Dutch residents who travel abroad to obtain treatment, as distinct populations.
See also
- Medical tourism in Belgium, the destination whose records count the Dutch outflow
- Cross-border healthcare, the framework the Netherlands reports nothing under
- Outbound medical tourism, the direction that dominates the Dutch picture
- Emergency healthcare abroad, what the European Health Insurance Card claims actually represent
- Administrative data in medical tourism research, why insurer-held records resist national aggregation
References
- European Commission, Directorate-General for Health and Food Safety. Data on cross-border patient healthcare following Directive 2011/24/EU, reference year 2023. 15 May 2025. Verified against primary record: the report was opened and the absence of Dutch data, together with the stated reason that insurers use their own procedures, was read directly from the country entries. Retrieved 23 October 2026.
- Government of the Netherlands. Kabinetsreactie IBO Grensoverschrijdende zorg. 2013-2014. Verified against primary record: the cabinet response was opened and the share of the care budget, the growth comparison, the 2012 and 2013 European Health Insurance Card claim counts and amounts, the finding that the Netherlands attracts relatively few foreign patients, the statement that cross-border care cannot be measured well, and the list of adopted measures were read directly. Retrieved 23 October 2026.
- Observatoire de la mobilite des patients. Rapport annuel 2015-2016. Institut national d’assurance maladie-invalidite. Verified against primary record: the report was opened and the country-of-residence breakdown of non-resident hospital stays, including the Dutch share for 2014 and the earlier share for 2008 to 2011, was read directly. Retrieved 23 October 2026.
- European Court of Auditors. Special Report 07/2019: EU actions for cross-border healthcare. 2019. Verified against primary record: the report was opened and the Union-wide annual patient estimate and share of citizens were read. Retrieved 23 October 2026.
- Eurostat. Hospital discharges and length of stay for inpatient and curative care (hlth_hosd), reference metadata. Last updated 15 December 2025. Verified against primary record: the metadata page was opened and the non-resident definition, the statement that country of residence is reported, and the list of non-resident tables were read. Retrieved 23 October 2026.
- European Parliament and Council. Directive 2011/24/EU, Chapter III, Articles 7 and 8. 9 March 2011. Verified against primary record: the chapter text was opened and the reimbursement rule in Article 7 and the three permitted grounds for prior authorisation in Article 8(2) were read. Retrieved 23 October 2026.
Sourcing note: this entry uses only official sources. Because no Dutch series counts medical travel in either direction, the sharpest available figure is a Belgian one, and it is labelled as such rather than presented as a Dutch statistic. The European Health Insurance Card claim figures are included because they are the only official Dutch volume data located, and are explicitly distinguished from travel undertaken to obtain treatment. No figure has been estimated for foreign patients treated in the Netherlands. The Eurostat non-resident collection is cited for its definitions and structure only; its individual cell values could not be retrieved.