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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.

Shopping Survival Tips in Amsterdam (and beyond*)

This article was originally written in 2018 by past president Rhonda Jimenez and was focused on Amsterdam shopping. It has been updated for 2020 by Marcie Asplin. 

*Most of the stores mentioned have branches across the Netherlands and you can order articles from several of the others. For shopping tips beyond Amsterdam, please watch for a  more extensive article which includes information for Haarlem, Utrecht and ‘t Gooi.

So, you’ve just arrived in Amsterdam and you have no idea where to shop for what you need. If only there was a Target! Here are some basics to help you survive without that Target or Walmart down the road, and a few go-to’s and tips to help you find what you need — fast.

Groceries: You have probably already found Albert Heijn (AH), but did you know that they deliver? It’s so much easier than balancing your bike with a full load of groceries and then carrying it up two flights of stairs. Other grocery stores are Jumbo, Aldi and Lidl. For organic groceries, try Marqt (similar to Whole Foods, although not everything is organic but rather local, ethically-sourced or sustainable) or Ekoplaza. TIP: Many items you can’t find are usually shelved in strange locations and or have unique packaging. American peanut butter can sometimes be found in the wereldkeuken (world cuisine) aisle with Indonesian foods, not with the Dutch nut butters. Sweetened condensed milk is in the Asian food section. Evaporated milk is called koffiemelk and is found near the coffee, as is sugar (rather than the baking aisle). Bleach is called bleek (or dikbleek) and looks like toilet cleaner. Ask for help if you need it. You will slowly find everything you need.

American Stuff: If you still can’t find what you need in the grocery chains, try Tjin’s Toko in De Pijp or Eichholtz on Leidsestraat. Both international stores charge a big premium but offer things like canned pumpkin puree, Betty Crocker cake mixes and frostings, Pop Tarts, Lucky Charms, and many other American treasures. Newer to the expat food store scene are Kelly’s Expat Shopping (also with locations in The Hague and Wassenaar) and The Junior’s, both located on Ferdinand Bolstraat in De Pijp. Make a trip to one; it’s worthwhile! There are also small international grocery stores called tokos dotted around the city. They are great for pan-Asian ingredients and may also have some American ingredients (looking at you, Arm & Hammer baking soda). If your local searches don’t unearth what you are looking for, you can try ordering online from My American Market

Health and Beauty: Etos, Kruidvat and Da (drugstore is drogisterij in Dutch) are like CVS or Walgreens, except you can’t get prescriptions filled. TIP: Solid deodorants are hard to find, hydrogen peroxide (waterstofperoxide) is only sold in tiny bottles and Visine isn’t sold here, so if you use any of these regularly, you should probably stock up in the US before arriving or pick them up on a trip home. To fill prescriptions, you need to go to an apotheek (pharmacy), which you can usually spot by the neon green cross hanging outside. You will also need to register at a pharmacy so your doctor can (digitally) send your prescriptions there to be filled. You can’t just have a prescription filled at a pharmacy that happens to be closest to your location at that particular time. Holland & Barrett is classified as a drogisterij but focuses on vitamins and natural soaps/shampoos, and it has an extensive range of teas and alternative (baking) ingredients (including superfoods, vegan and gluten-free items). If you’re looking for a store like Sephora, Douglas and ICI Paris XL sell higher-end makeup, beauty supplies and perfumes/colognes.

Home goods: Blokker has most items that you would find in a Target: supplies for cleaning, kitchen and bathroom items, small appliances (personal care and household), and some home decor. HEMA also has home and office items as well as food and clothing basics. Action, Wibra and Zeeman are similar to Kmart, selling inexpensive clothing and some home/kitchen goods. Big Bazar is like the Dollar Store, as is Xenos, which also has a Pier1 feel to it.

Appliances: MediaMarkt, BCC and Expert sell all things electronic — from irons to video games to TVs and refrigerators — much like Best Buy back home. They have physical stores in many locations. Coolblue (which also has 10 stores across the Netherlands), bol.com and Amazon.de are good online sources for electric appliances as well. Recently, Amazon.nl came online but their offering is still limited in comparison to Amazon.de.

DIY stores / Garden centers: Praxis, Gamma and Karwei are the Home Depot equivalents; most sell garden supplies, and larger ones will have plants and flowers, too. You can search for a bouwmarkt + (the name of your city) to find the DIY store closest to you. There are also places to rent tools and equipment for building projects; Boels and Bo-Rent are two of them. There are also large garden centers around the country if you are really into plants and gardening. Search for tuincentrum + (city) for the garden center nearest you. Intratuin has several locations in Noord Holland and Tuincentrum Osdorp is one of the larger garden centers near Amsterdam. DIY stores and garden centers also sell holiday decorations as well as live and fake trees if you celebrate Christmas.

Fashion: The trendy Nine Streets and busy Kalverstraat are always fun shopping destinations. But when it’s wet or cold, try the Stadshart mall in Amstelveen. There is a large De Bijenkorf department store in the mall. Closer to Amsterdam you’ll find the Gelderlandplein shopping center in Buitenveldert. They have free underground parking for the first 1.5 hours. 

Furniture: Ikea is a mainstay, but stop by Loods 5 and the outlet behind it — together, they take up a full block — for a huge selection of furniture. There is also a woonmall (home furnishings mall) called Villa ArenA located near the Amsterdam ArenA — you’ll experience long waits, but also good quality custom furniture. In the Bovenkerk area of Amstelveen, there are several furniture stores to be found, including De Troubadour, Leen Baker, Kwantum, and more. Online, try Woonexpress and Wehkamp

Outlet Shopping: Not an outlet per se, but the T.K. Maxx discount store has arrived in the Netherlands. There are a few locations, including Osdorpplein in Amsterdam. There is also a huge outlet mall about 1.5 hours away in Lelystad, called Batavia Stad. The outlets will remind you of home, with many of the same outlets you know and love — from Nike to Michael Kors. There are other similar outlet malls in Roermond and Roosendaal, as well as Maasmechelen Village in Belgium. 

School Supplies: HEMA and Gebroeders Winter have stores all over the Netherlands. Big stores like Office Depot do exist (OfficeCentre is one) but you need to have your own business to become a customer. 

Sporting Goods: If you’ve got kids, or are a sporty person yourself, chances are you’ll need sporting goods of some kind. You can find shoes, clothing and equipment for various sports at places like Decathlon, Intersport, Sport2000 and Bristol. Hockey District in Amsterdam and Special Sports in Amstelveen specialize in field hockey equipment and also carry clothing for some clubs. Voetbalshop.nl is a great place to find football basics online, and your (child’s) club may get their uniforms from there as well. If you are a runner, Runnersworld has stores in Amstelveen, Bussum and Utrecht (among others), and Run2day has stores in Amsterdam, Haarlem, Hilversum and Utrecht. Bever, with stores across the Netherlands, is the place to look for your hiking and camping needs. You can also shop for those things online at Trekkinn or A.S. Adventure.

Second-hand Shopping: If reducing, reusing and recycling is more your style, there are lots of places to find second-hand goods. A thrift store is a kringloopwinkel in Dutch. A second-hand (children’s) clothing store is a tweedehands (kinder)kledingwinkel, some of which are consignment shops. There is a list of stores in central Amsterdam and, to find a second-hand store near you, check Alle Kringloopwinkels. There are also consignment shops in Amsterdam Zuid that offer designer clothing, like Mooi and Freddy’s. For children’s clothes and toys, you can try Lino & Moos, JunJun and Kids & Queens (which also has some women’s clothes). Boomerang in Amstelveen has clothing and accessories at one location, and another location a few blocks away sells furniture and home goods. Rataplan is a large thrift shop which has household goods, appliances, clothing and furniture. They have three locations around Amsterdam. If you are moving and have things to donate, they will come and pick it up by appointment (there is often a wait for pick-ups, so book your appointment in advance!). Online, Marktplaats is a cross between Craigslist and eBay; you can find almost anything you need or want there (also from businesses)! While plenty of items are offered by genuine, individual sellers, there are also some dishonest people selling items there, so it is better to (agree to) buy something you can collect in person so you can check that it’s legitimate (certainly for big-ticket items like secondhand phones). There is also Facebook marketplace, where you can set your location and then search based on a certain distance to find items you want in your area.

Good luck on your next shopping adventure: you will survive! Remember, look carefully — and you can probably find it!

 

Preparing Kids for a Move

Moving is not easy on anyone — adults or kids. John is a 14-year-old boy who recently moved from the US to the Netherlands. According to his parents, he is moody and angry, and he is having a hard time making friends and engaging in schoolwork at his new school. His parents are not sure if he is depressed or just being a teenager.

Research shows that young people who have moved house may experience unresolved grief from the loss of their home, school and friends, and this may manifest itself as denial, anger, depression, withdrawal or rebellion. Like John, kids who have recently moved may exhibit difficulties with their identity formation because previously stable factors at home and school are missing during an important time in their life.

Parents and caregivers have an essential role in supporting kids during a move. They can help children and teens create a sense of identity, belonging and rootedness. The following are some strategies to help improve self-confidence and minimize cultural homelessness: 

  1. Realize that every child is unique when it comes to change

One of my kids had a much harder time with a recent move than the other. He missed his friends, his old school and his routine, and he grieved this loss. Know your child and take time to explore how they may be addressing change. Remember that moving during the teen years is significantly harder because this is a formative period. Having said that, many young people are extremely resilient and handle change well. 

  1. Create belonging in the local community

Kids that feel connected to the local community will feel more self-confident. Ensure yours have a good understanding of the culture by encouraging them to be involved with community service, be part of a local sports team, or engage in other activities. For my son, who was struggling with our recent move, activities like walking the neighbor’s dog every day, joining a local soccer club, and speaking with his grandparents regularly were very helpful. Don’t be afraid to reach out for help and support, whether it is from a family member, counselor, coach or teacher. 

  1. Use social communities to build language

Multilingualism can be hard to maintain, especially if there are more than two or three languages at play. As Mariam Ottimofiore, who is the author of This Messy Mobile Life and who has lived in nine countries with her husband and two children, suggests, “Get support from others to encourage using the local language, to make it fun and exciting for kids. Think about joining clubs or camps where the additional language will be used or enrolling in a study-abroad experience for immersion. At the same time, realize that it is OK if your child is unable to maintain all the languages they have been exposed to. You and your teen will need to prioritize which languages are important and how to continue learning them.”

  1. Use virtual tools to maintain contact

For some kids, having connections with their old community and friends is a meaningful way to handle loss. As we have learned from Covid-19, using virtual tools such as Skype or Zoom are good ways for kids to stay in touch with family or community far away.

  1. Demonstrate healthy ways to grieve, and get help if needed

Encourage healthy ways to address loss, such as journaling, connecting via a phone or video call, exercising, meditating, and listening to music (even crying can be cathartic). If needed, look for a counselor or mentor to help your teen identify and deal with loss directly.

  1. Be aware that adults can struggle, too

Adults who have moved may not have a clear sense of identity in their new location or may struggle to belong, which can add to their child’s or teen's challenges. On the other hand, cross-cultural adults may also impart skills and values honed from their own experiences. As an adult expatriate, I realized that each time I moved, it took me two to three years to settle into my new environment. I now know that finding a community and creating a sense of identity and belonging have been crucial to my happiness and sense of well-being in each country that we have lived in. Having friends who have gone through similar experiences, visiting online forums, and being involved with cross-cultural organizations such as Families in Global Transition (FIGT) have also helped me immensely. Being aware of these issues may be important for families as they navigate change and uncertainty  — both now and in the future.

Dr. Anisha Abraham is a pediatrician and a teen health expert who is on the faculty of the University of Amsterdam and Georgetown University Hospital. Anisha works with cross-cultural teens on issues such as stress, substance use, body image, and self-esteem. This piece was adapted from her recently released book, Raising Global Teens. For more information or to order the book, see dranishaabraham.com.

Have any questions or comments, or want to share more ideas? In the American Women’s Club member-only Facebook group, you can join the lively conversation! Not yet a member? We’d love to have you!