# 16-024/V (2016-04-08)

Pieter Bakx, Institute of Health Policy & Management (iBMG), Erasmus University Rotterdam, the Netherlands; Owen O’Donnell, Erasmus University Rotterdam, the Netherlands, University of Thessaloniki, Greece; Eddy van Doorslaer, Erasmus University Rotterdam, the Netherlands
Health expenditure, Long-term care, Social insurance, the Netherlands
JEL codes:
D12, I13, I14

The Netherlands is among the top spenders on health in the OECD. We document the life-cycle profile, concentration and persistence of this expenditure using claims data covering both curative and long-term care expenses for the full Dutch population. Spending on health care is strongly concentrated: the one per cent of individuals with the highest levels of expenditure account for one quarter of the aggregate in any one year. Averaged over three years, the top one per cent still accounts for more than a fifth of the total, indicating a very high degree of persistence in the largest expenses. Spending on long-term care, which amounts to one third of all expenditure on health care, is even more concentrated: the top one per cent accounts for more than half of total spending on this type of care. Average expenditure rises steeply with age and even more so with proximity to death. Spending on individuals in their last year of life absorbs one tenth of aggregate health care expenditure. In a given year, spending on health care is highly skewed toward individuals with lower incomes. Average expenditure on the poorest fifth is more than three times that on the richest fifth. Spending on long-term care is five times more concentrated on the poor.