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BMC Public Health

, 7:252

First Online: 20 September 2007Received: 09 January 2007Accepted: 20 September 2007DOI: 10.1186-1471-2458-7-252

Cite this article as: de Bekker-Grob, E.W., Polder, J.J., Mackenbach, J.P. et al. BMC Public Health 2007 7: 252. doi:10.1186-1471-2458-7-252


BackgroundComprehensive information about national spending on prevention is crucial for health policy development and evaluation. This study provides a comprehensive overview of prevention spending in the Netherlands, including those activities beyond the national health accounts.

MethodsNational spending on health-related primary and secondary preventive activities was examined by funding source with the use of national statistics, government reports, sector reports, and data from individual health associations and corporations, public services, occupational health services, and personal prevention. Costs were broken down by diseases, age groups and gender using population-attributable risks and other key variables.

ResultsTotal expenditures on prevention were €12.5 billion or €769 per capita in the Netherlands in 2003, of which 20% was included in the national health accounts. 82% was spent on health protection, 16% on disease prevention, and 2% on health promotion activities. Most of the spending was aimed at the prevention of infectious diseases 34% and acute physical injuries 29%. Per capita spending on prevention increased steeply by age.

ConclusionTotal expenditure on health-related prevention is much higher than normally reported due to the inclusion of health protection activities beyond the national health accounts. The allocative efficiency of prevention spending, particularly the high costs of health protection and the low costs of health promotion activities, should be addressed with information on their relative cost effectiveness.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-7-252 contains supplementary material, which is available to authorized users.

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Autor: Esther W de Bekker-Grob - Johan J Polder - Johan P Mackenbach - Willem Jan Meerding


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