BEFORE GOING INTO THE SPECIFIC AREAS OF PEDIATRIC cardiology and pediatric cardiac cardiology and pediatric cardiac surgery, an overview of the general health care organization in the Netherlands might be helpful. The Netherlands, a country with about 15 million inhabitants, spent 47 billion Dutch guilders (US$22 billion) for general health care in 1991. This is about 8.5% of the gross domestic product. Of this, 61% was spent on in-hospital costs, 39% on extramural costs, including the financing of organizations that deal with preventive (primary) medicine, such as clinics for infants and school children which were visited regularly. Almost all inhabitants, 99.6%, are covered for the expenses of health care, 60% through the “Sick Fund,” a state-insurance that is obliged for everyone with a yearly income of less than US$30,000. Employers of these people have to deduct an amount of money from the monthly salary to be paid to the “Sick Fund.” In case of unemployment this money is deducted from the amount paid by the social security office. The remaining 40% has some form of private insurance, that covers health care. Both diagnostic and therapeutic approaches as the timing of these are completely similar and independent from the type of insurance that applies for the individual patient.