Health insurance for low-income households varies widely by municipality
A study estimates that 160,000 people miss out on municipal health insurance because their municipality does not offer it or contributes too little.
Access to extra financial protection against healthcare costs depends heavily on where people on low incomes live. The Institute for Public Economics is therefore calling for a national scheme instead of the current municipal health insurance policy.
Municipal health insurance is supplementary cover that municipalities offer together with insurers to people on low incomes. The policy often covers dental care, physiotherapy and out-of-pocket payments. According to the Institute for Public Economics, about 580,000 people used such a scheme in 2026.
The researchers estimate that around 160,000 people on low incomes do not use the policy because their municipality has no scheme or contributes too little towards the premium. This is an estimate from the study, not a national register of individual households. The IPE says that 34 municipalities did not offer municipal health insurance in 2026.
There are also differences between municipalities that do offer a policy. According to the study, 83 municipalities contribute at least €40 a month towards the premium, while 53 contribute less than €20. In the remaining municipalities, the contribution falls somewhere in between. As a result, the net premium can vary widely for comparable households.
Zorginstituut Nederland previously concluded that municipal health insurance can help people cope with high healthcare costs and reduce socio-economic health inequalities. At the same time, the institute sees room for improvement. It mentions, among other things, better cooperation between municipalities, insurers and the national government.
The IPE wants to replace municipal health insurance with a national approach. Under the proposal, people on low incomes would automatically be exempt from out-of-pocket payments within the basic package. In addition, the central government should contribute to supplementary insurance covering at least dental care, physiotherapy and glasses or contact lenses.
That proposal is not a government decision. The debate concerns which responsibilities should lie with municipalities and which with the national government. A national scheme could reduce disparities and limit non-use, but would also require national funding and new implementation arrangements. For individual residents, the study does not automatically establish whether they are entitled to a particular policy.
One story, several perspectives
What is established
- Municipalities offer different forms of supplementary healthcare cover to people on low incomes.
- The financial contribution and availability vary by municipality.
- The IPE recommends a national scheme.
- Zorginstituut Nederland sees both benefits and areas for improvement in municipal health insurance.
Left
Arguments Essential healthcare should not depend on one's postcode. A national scheme would prevent people with the same income and healthcare needs from being treated differently.
Values Equal access, solidarity and protection against avoiding healthcare.
Consequences National coverage could reduce disparities and debt, but would require more public funding.
Centre
Arguments Municipal health insurance works for many people, but should be made simpler and better coordinated. National minimum standards could be combined with scope for local tailoring.
Values Practical implementation, efficiency and a balance between national direction and local knowledge.
Consequences A hybrid system could deliver improvements without abolishing all existing provisions at once.
Right
Arguments Municipalities and insurers should retain room to tailor schemes to local circumstances. A national policy could become more expensive and remove responsibility from municipalities.
Values Decentralisation, freedom of choice and control of public spending.
Consequences Local freedom can provide tailored support, but leaves differences between residents in place.
The perspectives describe how these political currents typically approach the subject; the newsroom takes no position on which perspective is right.
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The key figures and the proposal can be found directly in the IPE report and an independent summary. The text makes clear that 160,000 is an estimate and that there is no government decision.
- confirmed About 580,000 people used municipal health insurance in 2026. — This figure appears in the IPE report. source
- confirmed The IPE estimates that 160,000 people on low incomes miss out on municipal health insurance. — The report gives this estimate and the reason for it. source
- confirmed In 2026, 34 municipalities did not have municipal health insurance. — The figure is mentioned in the public summary of the study. source
- confirmed Zorginstituut Nederland sees municipal health insurance as a tool for helping people cope with high healthcare costs. — This appears in the summary of the report De gemeentepolis gewogen. source
- confirmed The IPE recommends a national scheme with exemption from out-of-pocket payments and supplementary insurance. — The proposal appears in the IPE report. source
Editor's note
The figures come from an IPE study and should be read as estimates. The national scheme is a recommendation by the researchers, not established government policy.Sources
- Gelijke toegang tot zorg voor minima — Instituut voor Publieke Economie
- Rapport De gemeentepolis gewogen — Zorginstituut Nederland
- IPE: toegang tot zorg voor minima mag niet afhangen van postcode — Gemeente.nu
More on this in Dutch media
- NRC — „gemeentepolis zorgkosten”
- NU.nl — „gemeentepolis zorgkosten”
- De Telegraaf — „gemeentepolis zorgkosten”