The Dutch healthcare system is not a single overall plan, but has evolved from a constantly changing mix ofinstitutions, regulations, and responsibilities. Theresulting system provides high-quality care with reasonableefficiency and equal distribution over the population. EveryDutch citizen is entitled to health care. Health insuranceis provided by a mix of compulsory national insurance andpublic and private insurance schemes. Hospitals generallyhave a private legal basis but are heavily regulated.Supraregional planning of high-tech medical services is alsoregulated. Hospitals function under fixed, prospectivebudgets with regulation of capital investments. Independentgeneral practitioners serve a gatekeeper role for specialistand hospital services and are paid by capitation or fee forservice. Specialists are paid by fee for service. Allphysicians' fees are controlled by the Ministry ofEconomic Affairs. Coverage of benefits is an importantmethod of controlling the cost of services. There isincreasing concern about health care quality. Healthtechnology assessment (HTA) has become increasingly visibleduring the last 15 years. A special national fund for HTA,set up in 1988, has led to many formal and informal changes.HTA has evolved from a research activity into policyresearch for improving health care on the national level. In1993 the government stated formally that enhancingeffectiveness in health care was one of its prime targetsand that HTA would be a prime tool for this purpose. Themost important current issue is coordination of HTAactivities, which is now undertaken by a new platformrepresenting the important actors in health care andHTA.