Dutch Healthcare

by Marcie Asplin

December is an excellent month to talk about healthcare and health insurance in the Netherlands, since it’s the month when you are free to change insurance providers or make changes to your existing policy. If you wish, you can cancel your current policy by December 31, 2020, and you have until January 31, 2021, to pick a new health insurance policy, which will be effective retroactively to January 1, 2021. Dutch law requires all residents to have health insurance, and lots of information already exists on the subject. This video is a great place to start if you need help understanding Dutch health insurance basics. XPAT.NL also has a series of articles on healthcare in the Netherlands, from finding and going to the huisarts (family doctor or GP) to visiting a specialist to what to do if you have other medical issues.

Coverage

All basic health insurance policies (basisverzekering) are more or less the same, the terms being set by the government. Costs vary between insurance companies, but each insurer must charge individuals the same premium. Although insurance companies are obliged to accept any applicant for basic coverage, they do not have to accept your application for supplementary insurance coverage (aanvullende verzekering). Where the insurers really differentiate themselves (in terms of coverage and extra cost) is therefore in the supplemental coverage they offer. Supplemental care includes physiotherapist or chiropractic visits, dental coverage or medical coverage abroad, among others. Alternative therapies such as acupuncture and homeopathy are also covered, although you need to find a licensed provider affiliated with an approved umbrella organization.

You can have different coverage levels for each paying adult in a household, either by the same insurance company or with other providers. The basisverzekering is free for children under 18 (including dental coverage), and children are also included free of charge on the most comprehensive parental aanvullende verzekering policies. For example, we knew our son would need braces, so we added dental coverage to my husband’s policy. My son’s braces were then covered up to a certain amount, which varies by insurer. Timing is also an issue, as sometimes you need to have the coverage for at least one year before you are allowed to submit a claim under it.

It’s a good idea, however, to check the math and see if adding coverage is really worth it. For example, unless you have a complicated eye prescription, it may not make sense to add €5 per month (or more) to your insurance rate for a payout of €200 for new glasses once every three years. 

Compare costs

The Consumentenbond (Consumers Association) reports that healthcare costs will increase an average of about €59 annually in 2021. There are several websites to use to compare the costs of health insurance policies. Zorgwijzer has a comparison tool in English and also guides you through the available choices. Independer lets you compare health and other types of insurance on their website (in Dutch). Zorgkiezer compares not only health insurance but also hospitals, GPs, physiotherapists and dentists as well (in Dutch).

Own contribution

Your personal contribution to the cost of your Dutch health insurance consists of the eigen risico (literally, own risk; otherwise known as your deductible or excess) and your eigen bijdrage (copayment or personal contribution). The eigen risico is fixed each year by the government when it presents its annual budget on Prinsjesdag (held on the third Tuesday in September each year) and is the same for all insurers. This amount was €385 per adult for 2020 and will remain the same for 2021. Care falling under eigen risico includes medicines, ambulance transport, emergency help, and hospital admission but does not include visits to your family doctor or the huisartsenpost at the hospital (pre-approved urgent care), midwife or obstetrician services, care for children under 18 years, and possibly other medical services. You’ll find a good explanation of eigen risico here. To keep the cost of your policy down, you can increase the amount for eigen risico. Your insurer may also give you a discount if you pay annually instead of monthly.

In general, you have three years to claim healthcare costs, although insurers can set different time limits. It’s always a good idea to submit claims before the end of the calendar year, to be on the safe side.

Receiving care

Illnesses don’t always happen at the most convenient times of day, especially where kids are involved. For after-hours care needs between 5 p.m. and 8 a.m. or anytime on weekends/holidays, you should call the huisartsenpost (after-hours general practice center) for help (contact info is here for Amsterdam, Haarlem and Het Gooi). You are advised to contact your huisarts or the huisartsenpost first, even if you think you need to go to the hospital. When possible, you need to provide your insurance policy number, BSN number, name of your huisarts and a medications list when calling the huisartsenpost. For life-threatening emergencies, call 112 for assistance or an ambulance. 

Suppose you want to share your medical information between the GP, pharmacy and any specialists you may see. In that case, you can give permission to the Landelijk Schakelpunt (National Exchange Point) to facilitate this. Without permission, each new specialist you see will need to request your records before they can treat you. 

The GGD (Geneeskundige en Gezondheidsdienst or Public Health Service), which has regional branches, is responsible for public health. They carry out well-baby check-ups for newborns up to age four, including scheduling vaccinations. They do childhood developmental checks at age five and ten. If you need travel vaccinations, you can arrange them at your local GGD for a fee. They are currently also providing coronavirus testing for people with symptoms and will likely play a role if and when there is a large-scale coronavirus vaccine program.

Differences with US system

There are differences between Dutch and American healthcare, which may take some getting used to. You need to register with a huisarts (preferably in your neighborhood) who serves as your first point of contact when you need care. The huisarts will write referrals if you need to see a specialist. Referrals are not required to see physiotherapists or midwives – you can contact those professionals directly. If you have several health issues or concerns, you can and should book a longer appointment with your huisarts. Walk-in appointments (during a GP’s spreekuur, or consulting hour, which may actually be only a half hour) are generally no longer than 10 minutes and are for one issue only. If you are pregnant, you won’t visit your huisarts for regular checks, but you will see a midwife instead. Internations has a good summary of pregnancy and childbirth in the Netherlands. Amsterdam Mamas has a series of articles on pregnancy, childbirth and the unusual concept of the kraamverzorgster (maternity assistant) as well. Each baby born in the Netherlands receives a certain number of days of in-home maternity care (kraamzorg), which provides postnatal care to a new mother and her baby in the eight to 10 days immediately after birth.

Dutch doctors do not provide antibiotics nearly as frequently as American doctors do. It is part of their strategy to reduce antibiotic resistance. They prescribe them when necessary, but in many cases Dutch doctors prefer to let the body try and heal itself first. When it comes to women’s health, exams like pap smears are generally done once every five years from age 30 and mammograms every two years after age 50. If you wish to have an exam more frequently, you will have to pay for it unless you have a medical indication to the contrary. For an independent mammogram, you can visit the Breast Care Center. Your huisarts can do a pap smear for you on request, or you can make an appointment at an independent clinic like the Women’s Healthcare Center in Amsterdam. 

When it comes to your body, you are your own best advocate. Sometimes you will have to be persistent to get the treatment you might need. If you have chronic or complicated health needs, get a copy of your US medical records before you move, if possible. Having evidence that your concerns are real is especially useful and your Dutch doctors will have a more complete picture of your health history. Being clear about your expectations and being able to thoughtfully present reasons why you’d like specific tests will likely create a more harmonious and productive relationship with your huisarts. If you are unhappy with your huisarts, you have the right to find a new one.