Healthcare in the Netherlands can be divided in several ways: firstly in three different echelons; secondly in somatic versus mental healthcare; and thirdly in "cure" (short term) versus "care" (long term). Home doctors (huisartsen, comparable to general practitioners) form the largest part of the first echelon. Being referred by a first echelon professional is frequently required for access to treatment by the second and third echelons, or at least to qualify for insurance coverage for that treatment. From 2012 to 2020, health care spending declined from 10.9 percent to 10.5 percent of GDP. Further costs savings could be realized by reducing the over-use of in-patient care, institutionalised psychiatric care and elderly care.