SUMMARY The Dutch East India Company (‘VOC’) organized a health care service on board its vessels as well as its home bases and in its factories in Asia. This health care service was based initially on the Dutch navy model. This study addresses the problems manifesting in the VOC health care in the 200 years of its activities, framed within the general concept of the transition during that period from individual to mass health care. It is argued that the service proved inadequate because of a number of factors, chiefly including the inability of the organization to cope with large numbers of people already ill before boarding or falling ill during the Asia-bound voyages; the inability to enlist staff on board of a proven quality, in spite of recruitment efforts; the ignorance of the causes of malnutritional and (tropical) infectious diseases; the training of surgeons (focused on injury-caused disease rather than on systemic disorders); the inordinate frugality of the directors as well as the fear of junior officials to displease the managerial board; and the preoccupation of the VOC board with detail rather than with a policy addressing fundamental health problems.