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Open Access Research article

Towards a comprehensive estimate of national spending on prevention

Esther W de Bekker-Grob1*, Johan J Polder23, Johan P Mackenbach1 and Willem Jan Meerding1

Author Affiliations

1 Department of Public Health, Erasmus MC, Rotterdam, the Netherlands

2 National Institute for Public Health and the Environment, Bilthoven, the Netherlands

3 Department Tranzo, Tilburg University, Tilburg, the Netherlands

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BMC Public Health 2007, 7:252  doi:10.1186/1471-2458-7-252

Published: 20 September 2007



Comprehensive 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.


National 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.


Total 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.


Total 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.