In this chapter the authors compare the health care systems of England and the Netherlands with respect to contracting, accountability frameworks and the duty to provide care and access to health care. The objectives of contracting are different in these two countries. While in the Netherlands contracting is envisaged to promote efficiency and quality, contracting in England appears to set a minimum requirement. Under the Dutch system, the insurer must fulfill its duty to provide care. In England it is difficult to hold any party accountable for ensuring that patients receive necessary care. Various types of co-payments and out-of-pocket charges occur in both England and the Netherlands. In both countries personal care budgets exist to put patients in charge of their own budgets.
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