Health care spending in the Netherlands is expected to reach 114.1 billion euros this year, nearly a quarter of the national budget, as experts warn the system faces mounting pressure from an aging population, staff shortages, and expanding demand for care, De Telegraaf reports.

Without reforms, spending is projected to rise to 136 billion euros during the current government term, increasing pressure on public finances and leaving less money for areas such as infrastructure, education, and policing.

Mental health care is a major contributor to rising costs. Nearly half of Dutch residents now report mental health problems, compared with 37 percent in 2014, though severe psychiatric illness has not increased, health economist Wim Groot told De Telegraaf. “That is remarkable,” Groot added. “This is notable because severe psychiatric issues have not increased at all.”

Experts say broader social issues—including debt, stress, and housing conditions—increasingly lead people to seek medical treatment, while mild psychological problems are often medicalized. “Psychiatry is finger-in-the-wind work,” said psychiatry professor Jim van Os, who questioned evidence that such treatments produce measurable health gains.

Costs have also risen in youth care, where the number of providers increased from about 4,000 in 2015 to nearly 13,500 this year after services were decentralized to municipalities.

Long-term elderly care also reportedly drives spending pressures. The Netherlands has one of the highest shares of older people living in nursing homes in the world, which experts say contributes to rising costs.

At the same time, the sector faces severe labor shortages. Projections show the country could face more than 300,000 health care vacancies within a decade if current trends continue.

Experts state that previous attempts to control spending — including market competition between insurers — have often failed to reduce costs, and political resistance has repeatedly blocked deeper reforms.