Health insurance funds – Combined Lifestyle Interventions in the Netherlands
Case study
Netherlands
Insurance funds
The Netherlands integrated Combined Lifestyle Interventions (CLIs) into its basic health insurance system to address overweight and obesity through preventive care. Fully reimbursed and delivered by certified professionals, these two-year programmes provide structured lifestyle support, improving health outcomes and access to prevention, particularly for lower-income groups, while demonstrating cost-effectiveness at a national scale.
Context and problems addressed
The inclusion of preventive services in the Dutch healthcare system was a gradual process, taking over a decade (2006-2018). Early evidence from the National Institute for Public Health and the Environment (RIVM) and the Dutch Healthcare Institute demonstrated that Combined Lifestyle Interventions (CLIs) are cost-effective in addressing overweight and obesity. Following pilot projects and policy development, CLIs were officially included in the basic health insurance package in 2018. RIVM evaluates and monitors implementation, while insurers are responsible for offering the programmes.
Intervention and financing model
CLIs aim to support individuals in adopting and maintaining healthier lifestyles through structured guidance on nutrition, physical activity, and behavioural factors such as stress and sleep. The programmes last two years, consisting of a one-year treatment phase followed by a one-year maintenance phase.
Eligibility is based on weight-related health risks, in line with national clinical guidelines. CLIs are fully reimbursed through the compulsory basic health insurance package, ensuring nationwide coverage. RIVM evaluates candidate programmes based on quality, effectiveness, and feasibility, and advises the Ministry of Health, which makes final decisions on inclusion. Currently, three CLIs are approved, all demonstrating positive outcomes, including weight loss, improved metabolic risk factors, and increased physical activity.
Delivery is carried out by trained and licensed professionals who must complete specific training, register as providers, and contract with health insurers. Referrals are typically made by general practitioners or specialists. Health insurers directly reimburse providers, removing financial barriers for participants.
Health insurers directly reimburse providers, removing financial barriers for participants.
Key outcomes and associated measurements
CLIs are expected to contribute to improved health equity, as participation is free of charge and accessible to all eligible residents under the universal insurance system. This is particularly relevant for lower-income populations, who are at higher risk of obesity but often face barriers to preventive services.
Ongoing monitoring focuses on outcomes such as weight loss, quality of life, and participation rates. Public funding has supported implementation (€6.5 million in 2019, increasing to €9 million annually from 2020). Continued inclusion in the insurance package depends on demonstrating sustained cost-effectiveness and impact.
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