This article was originally published in The XPat Journal Summer 2018 Issue
By Pim Bouwmeester
When you move to the Netherlands, you are coming to live in a country that is widely-recognized for its excellent healthcare system. Over the past decade or so, the Netherlands has scored near the top in almost every ranking that compares European healthcare systems. High-quality healthcare, but at a price – those same rankings show that healthcare is relatively expensive in the Netherlands. Since it’s a topic that expatriates are naturally concerned about and the international press is full of stories about health scares, we thought we would give you some background on, and the simple version (!) of, how it works.
One reason why the Dutch healthcare system is rated so high for quality is because it is widely and easily accessible. With over 150 acute care facilities that are open 24/7, of which over 90 are hospitals, there is always a medical facility within reach when needed. And since it is mandatory for all Dutch residents to take out at least a basic health insurance policy, the cost of healthcare is seldom part of the decision-making process when medical assistance is required. “Can I afford to go to the urgent care facility?” or “How will I pay this medical bill?” should never be a question here. Having said that, not everything is available on demand; many non-acute medical treatments require a referral (called verwijsbrief) from what the Dutch call a huisarts (translation: ‘house doctor’), similar to a general practitioner or primary care doctor.
Every hospital houses a wide variety of medical specialties, and the number of medical practitioners operating outside hospitals is even greater; all in all, there are thousands of locations where you can receive either physical attention or mental care from certified professionals. There are far more than we can evaluate, so to make sure that everybody finds the treatment best suited to their needs, there are a couple of avenues you can take when looking for medical care.
The first and easiest route – and probably the most important one – is through your huisarts, a primary care doctor who has you as a regular patient. You choose your own huisarts, preferably one near where you live. Registering with this primary care practice is free, and once you have registered, your visits to this doctor are free too. That is the Dutch way of making sure that everybody has access to medical help when necessary. So, when you move to the Netherlands, we advise you to start by finding a primary care practice near your house and registering with them. You can ask your neighbors for a recommendation to get the ball rolling.
Is a visit to the huisarts actually free? Well, no – as we mentioned earlier, healthcare is relatively expensive in the Netherlands – but that does not mean one party pays for everything. In most situations, the patient isn’t billed directly; when you go to your doctor, the bill goes straight to your insurance company. And even though every health insurance policy has a deductible (eigen risico in Dutch – own risk), your insurance company always pays the full cost of a visit to your huisarts.
Your doctor diagnoses your medical issue, after which he or she can either decide to help you directly or refer you to a more specialized medical practitioner. If you’re referred to a specialist, your doctor can often give you one or two suggestions of practices to contact. If you need further help with selecting the best specialists available, consult your insurance company. They know where you can get the required treatment and can advise you.
The Cost of Healthcare
Not only can a health insurer help you find the treatment you need, it is actually in their interest that you find the best possible treatment. That is because, contrary to what most people think, your insurance company doesn’t pay for your entire treatment itself and they don’t pay a higher amount for you to get the best. The overall cost of healthcare in the Netherlands is split three ways, which means that your health insurer only pays a portion of the cost of your treatment. There is also a part that is paid for through general taxes, and your employer contributes an annual amount that is related to your salary. These last two ‘contributors’ have no choice but to pay, but which health insurance company has to cover the bills, and what exactly they pay for, depends on a number of decisions you get to make.
The first decision you need to make is which insurance company you want to buy your mandatory basic insurance policy from. It is an important choice because, even though terms and conditions are for a large part set by the government, the quality of coverage varies a lot. And the treacherous thing here is that the premium you pay for your insurance policy hardly ever reflects its quality.
When selecting insurance coverage over and above your mandatory basic insurance, you can decide, for instance, to buy additional coverage for physical therapy, homeopathic medicine and alternative treatments, and different kinds of dental coverage, to name just a few. When it comes to extra insurance, most Dutch people feel that there are actually too many options available. To help people avoid misinformed decisions, the Dutch government provides several websites to inform residents about the way the Dutch healthcare system works. And to make sure nobody gets caught in a choice that may not be the best for them, everybody is allowed to change policies at least once a year if they want to. There are also several commercial websites that provide comparisons, using smart software to help you compare insurance policies. But that can be bewildering too; so maybe the best place to start is with your employer. In the Netherlands it is customary for companies to negotiate healthcare plans for their employees directly with the insurance companies. They will have done the work of sorting and comparing for you, and you can probably get the best deal through them.
You may, on occasion, hear Dutch people grumble about their premiums or something that is not covered completely by their policy, but they are proud of their medical insurance system because they know that everyone in society has the opportunity to lead a healthy life.