In Europe, an ageing population and technological innovation are the most significant drivers behind public health care expenditure increases. Several reforms are needed in order to limit these increases. International research has shown that market mechanisms and better public management have the most effective impact on limiting expenditures. Budget caps can also be important in lowering costs, though they may have some drawbacks. Other instruments, such as supply-side constraints and demand-side reforms, are less effective. Since the 2006 Dutch health care reform, patient orientation within the curative system has improved. However, in order to be able to limit increases in Dutch expenditure, further modifications to the market-orientated health insurance system are needed. For long-term care the recommendation is put forward that ultimately a reform stage should be implemented which would boost the responsibility of individuals and the family and limit the role of the government.