Healthcare in the Netherlands

After 6 years of navigating the system of healthcare in the Netherlands, I can say that, although better than that in the US, it still leaves a lot to be desired. It is relatively expensive, compared with its European neighbors, and the quality of primary care is marginal, at best. It excels at treating serious and catastrophic illness. However, as far as regular, preventive health care, it’s got a lot of catching up to do.

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Healthcare in the Netherlands supposedly among the best in the world — but according to whom?

Amazingly, the Dutch rate their health care very highly. They must have low expectations. The Netherlands was number one on the Euro Health Consumer Index in 2015 for its health care system. It has also been listed in the top 3 European countries since 2005. It may be the best system in terms of economics. However, I’m not so certain it works well for everyday patients.

Dutch huisartsen (general practitioners) are notorious for sending you home from an office visit with advice to rest and take a paracetamol. Come back in 2 weeks if you’re not feeling better. This goes for everything from a sore throat to an amputated limb (ok, that may be a slight exaggeration). You have to have one foot in the grave for your huisarts to either prescribe an antibiotic or to send you to see a specialist. Now, I am not someone who believes in prescribing antibiotics for every minor illness, but for bacterial infections they are sometimes necessary. The same goes for pain meds and anesthetics. The Dutch seem to believe one needs to suffer for a while before doing anything proactive.

Take a couple of these and come back in 2 weeks if you're not dead.
Healthcare in the Netherlands: Take a couple of these and come back in 2 weeks if you’re not dead.

Huisarts

Your huisarts is expected to handle most non-catastrophic health issues him- or herself. I personally don’t see how a huisarts could conceivably know about every aspect of medicine enough to treat it personally. They do everything from minor gynecological procedures to the surgical removal of moles right there in their office — which all needs to be accomplished in a typical 10-minute office visit (gesprek). If you think you will need more than this amount of time, you need to request a double-gesprek in advance. In my experiences with doctors in both France and Spain, the typical visit lasted at least 20 minutes.

Preventive care is rare here, certainly in terms of women’s health. For example, in the US and in France and Spain, it was typical to get a test for cervical cancer at least every 2 to 3 years. Here, insurance will only pay for one every 5 years. Hormone replacement therapy is also rare here, as most GPs are still following outdated guidelines, based on a flawed study from 2002.

No huisarts I have encountered has been up-to-date on more recent medical knowledge, which I suppose is not surprising, given they must wear any number of medical hats at once. Which of them has any time to read the most recent research? Nevertheless, they are extremely reluctant to send you to a specialist who might be more current with specific medical issues.

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The ins and outs of  the Dutch insurance companies (for healthcare in the Netherlands)

Unlike countries such as France and Spain, where a percentage of people’s income taxes pays for universal health care, every Dutch resident is required to buy their own health insurance (zorgverzekering) on top of the taxes they pay to the government. Most standard insurance packages cost around €100 a month, which covers basic health care (trips to the GP, hospital, referred specialists and many prescription drugs). Like in most countries, you can add on additional coverage (aanvullende pakket) for things like dental care, chiropractic, physical therapy, etc. Fortunately, premiums in the Netherlands are not related to age, sex, or health status. Everyone is responsible for a minimum annual deductible (eigen risico) of €385, and the Dutch insurance companies pay for everything in excess of that amount.

For those with a low income, the zorgtoeslag is a program that helps pay for health insurance; in 2016 it was available to those who earned no more than €27,012. The benefit ranges from €2 to €83 a month, depending on your income. You can apply for the zorgtoeslag by visiting the Belastingdienst webpage (in Dutch only) and entering your DigiD. An English translation of the form is here as a guide, but you need to complete the official form in Dutch.

Once you’ve sorted you insurance…

Once you have your insurance, you are required to register with a huisarts, through whom you must go if you want to visit any type of specialist, including a gynecologist, dermatologist, etc. If you choose to visit a specialist without the prior approval of your huisarts, you must pay for the visit yourself and try to get reimbursed from your insurance company.

healthcare in the Netherlands
One way to shop for Dutch insurance companies

Although you can freely choose your insurer, you are only allowed to change that company once a year. This is during a short window between mid-November and 31st December. One day later, and you’re stuck with the same company you had until the following year. There is a mad rush at the end of each year for people to switch companies so as to find the most affordable policy, given they almost always go up in cost.

One useful site to use to find health insurance, particularly for expats, is Independer. It’s great for comparing various insurance packages as well as easily switching to a new one at the end of the year, should you so choose. You only have to enter your birthdate, sex, and postcode and they will present you with a range of insurance packages from which to choose. They take care of the legwork in canceling your old insurance policy and in getting you subscribed to a new one. The website is only in Dutch, but you can either use Google translate or you can call and speak to one of their English-speaking representatives.

If you are someone who rarely visits the doctor, insurance is relatively costly. If, however, you need significant medical care, you’ll be glad you live here instead of in America.

 

Where healthcare in the Netherlands excels

Healthcare here is certainly better than in the US, where a typical uneventful non-Caesarean birth costs upwards of $10,000. An unexpected trip to the emergency room or a diagnosis of cancer can bankrupt people. Literally to the point where they lose everything they own.

A case highlighting the benefits of the Dutch health care system is the experience friends of mine had when their son was born. Baby Q was born at full-term via C-section, but was “small for gestational age”. They found his blood sugar to be dangerously low, so they put him on a glucose drip. When he still did not improve, he was transferred to a teaching hospital for special care. He remained for a month, with two weeks of that in the high-dependency neonatal ward. During that time, they discovered a heart murmur in the course of some routine tests and ran some visual scans. It turned out he had a hole in his heart that was going to need surgery.

Ongoing care

After a month in the hospital, baby Q had finally gained enough weight to go home. Two weeks later, he was readmitted to the hospital for his heart surgery, which went flawlessly. He is now a happy, bouncy, rosy-cheeked toddler.

His mother said, “During all this we had support from their child developmental staff, pastoral workers, a nutritionist, a pre-speech therapist, a world class surgeon, pediatric home nurse when needed, and incredible nurses, consultants and trainee consultants. The child developmental worker held my hand when I was in the OR holding my baby’s hand as he was given his first bit of anesthetic before his big operation.”

She added, “Bar a few communications issues, we had stellar support and amazing care. Our insurance even paid for special formula and all the stuff that came with the food pump we had to have in the house to feed our son for a month or so.”

The cost?

What was billed to them for all this care? (I can imagine Americans cringing at the thought). Nada. Zip. Zero. The only things they had to pay for were the few meals baby Q’s dad ate when in the hospital. These were only €30 for 3 meals per day. All children under age 18 are automatically insured by the government.

The total cost to their insurer was about €60,000. This included the birth, the hospital stay for both mother and baby, tests, treatments, and follow-up checkups. They did not have to pay a penny of this over their premium and the annual €385 deductible.

So that’s healthcare in the Netherlands in a nutshell. There are far worse countries in which to be ill, but don’t expect your doctor to be sympathetic to pain.

 

Looking for an alternative view? Check out another of our articles defending Dutch healthcare. 😉

20 COMMENTS

  1. “Amazingly, the Dutch rate their health care very highly”. We don’t. A commercial company (called ‘The Health Consumer Powerhouse Ltd’) collects fairly random data and omits the opinion of actual users of healthcare in their Index.

  2. I totally agree with you. I have been living in the Netherlands while studying medicine and healthcare system is a joke. The teaching values here and the experience of doctors are the lowest I’ve ever seen. Dutch people believe the system is by public funding and when I explain them that is not true, they just end with ” Well, still is not as bad as the US”.

    • I’m not sure where you come from but having lived here for fifteen years I have had a significant number of procedures and major surgeries in different hospitals
      I cannot agree from my experience that healthcare is ‘a joke’. Far from it, the care received has-been simply outstanding.

  3. Hi s ,if you want to chose the best health insurance company services then you must get a suggestions of some senior persons and also get information of different health insurance companies in Ireland because these are helpful for a save of your life in the case of emergency when you have enough money to complete the medical expenses of your treatment otherwise you may have face some kind of financial problems during the process of medical treatment ,So you must be take care of your self and chose a best authentic service of health care for a comfort of your life .
    Thanks.

  4. Thanks for this article – it is very informative… I’m still on the fence as to whether I’d feel safe health-wise in the Netherlands… My hubby is Dutch but we’ve lived for the last 24 years in France…so have gotten used to the French system… From what I’ve seen of Dutch in-laws health care issues, it seems that basic female preventative medicine doesn’t exist or is frowned upon… Does anyone know if there’s a network of more doctors with a broader spectrum of healthcare in the Hague? Our French gp is a homeopath and does acupuncture too…. thanks for any advice…we’ve got a few years to make our final decision…. but for me the big issue is the cultural attitude in the Netherlands to healthcare… thanks!

  5. I don’t know where these people get their informations from but I must tell you Dutch health care is very expensive a d yet the worse you can think of, doctors only attend to you here in the netherlands when you are at the point of death, for kids is even worse, the insurance system here is so corrupt that people pay Dutch insurance and yet get to good medical care, alot of people leave for Belgium or France when they ‘re sick and get better treatment, I have read alot of comment here and I ask myself where do these people get their information? I will not advice anyone looking for a better health care to come to the netherlands when other Europeans countries are avaliable, the health insurance here ‘re criminals and everyone is afraid of talking about is for one reason or the other, people lost thier love once because the doctors refuse to admijister treatment for been afraid that the insurance companies will not pay. I will like people to go to the streets of the netherlands and ask or better still go to belgium hospitals and see how many % of Dutch people there receiving treatment and ask them why they didn’t come to the netherlands and u will be shock to hear their response.

  6. I am originally from the UK, have lived here for 28 years and am now in my early 50s. I have followed many forums over the last 20 years and have seen the many horror stories left by expats about their experiences with the Dutch health care system. Now, I have experienced it for myself:

    In the middle of 2017, I finally went to my doctor (General Practitioner) here complaining that I could not get off the floor/out of the bath anymore. This had been getting gradually worse over a long time (I am not overweight). He told me that I just needed to do some sports. I made the mistake of listening to him and just went and did fitness for six months.

    During 2018, I started becoming immensely tired, would often go to a room and forget why I went there. I developed IBS/stomach problems, started to lose my balance often and felt like my arms and legs were being crushed.

    I pleaded with him to send me to a specialist, specifically a neurologist. He finally relented although he said that he thought it a waste of time, ‘because I don’t think that they will find anything’, he said. There was a 3 month wait to see the neurologist. When I finally saw the specialist, it took almost a month for the results of the blood test to come back. It was negative.

    The specialist said that I had to go back to my doctor to plan any further diagnosis, and advised seeing a rheumatologist.

    I then called my doctor and asked to be referred, as the specialist has advised. He refers me, but it will be another 3 months’ wait to see the second specialist.

    I say that I also want to be checked out for Hemochromatosis (‘The Celtic Curse’) and wanted to see a hematologist as well. His answer was that I should just ask the rheumatologist in 3 months’ time about that. He also advised that to see a hematologist would take even longer, another 3-4 months at least.

    By this time I am feeling much worse, and am so tired some days that I just can’t function. I am having to try and diagnose myself, because no one seems to have any idea what I have, how to proceed, or what to do!

    I know that I can go to my health insurance provider and ask them to try and get me a faster appointment with a specialist at another hospital but I have now lost all faith in the Dutch health care system. I have now been trying to get myself diagnosed over a period of EIGHTEEN MONTHS. If I hadn’t been really assertive I wouldn’t have got even this far.

    I have the feeling that no one really cares here. Preventive medicine? You must be joking. You could die here before they find out what’s wrong with you and treat you.

    I will now fly to London in order to get diagnosed privately (I have no idea what the bill will be, but I have no other choice).

    From my experience with Dutch doctors (the General Practioners) they are all the same. It seems all to be a question of saving the insurers money by not sending you for expensive investigation/treatment. But it is MY health that they are playing with!

    The Dutch system is private, but as everyone is using it, don’t confuse it with other countries’ private health care systems! I am absolutely appalled that now that I finally need care that the system has completely failed me. And most Dutch people just seem to accept it all because they have nothing to compare it to, and don’t know any better.

    Please…don’t trust this system. If you have the feeling that you are really ill, head for Schiphol before it’s too late!

  7. Medical System is worst in the Netherlands, untill you are not dying you have to wait 1 month minimum fir a consultation (specialist) and if they prescribe any tests, results will be discussed with you in the next appointment which is again after 1 month and then again test again appointment. If you are lucky they will see you and your results whole cycle in 6 months. Otherwise once you are dead file is closed. But 6-12 month cycle just to treat kidney stones is very normal here and yes don’t forget their paracetamol rule. According to Dutch doctors paracetamol can heal almost anything.so they will tell you doesn’t matter what probkem you have to take paracetamol

  8. Completely anecdotal and speculative without a single citation in sight, and the few actual comments are similarly irrational hogwash. Come enjoy less for more in America, where the above story is actually a more accurate description.

  9. I need to say about my experience at this moment. I live in a special house that they call it Fokuswoning in Netherlands. The idea of these houses are great that you can live alone with 24h help of care. When you need help you can call than you call a person will come to help you. But in reallity it has problems. For example, I call at 5 o’click because I needed to go to toilet and I had to be washed than a person helped. Somebody came to help me but she left me to help another one and said that she will come to help me fast. I waited waited no one came. I was wet and cold just sit on toilet. I called again and she did not answered and another one replied. And she said I am busy with another one. I waited and call again and she said you need to wait. I waited more than an hour naked, cold. That is just one experience. Of cource, there are good things, too but it had still so much problems.

  10. It’s true, Dutch healthcare is a joke and way too expensive; and I’m saying this as a Dutchman. I’ll let you in on a secret: the yearly price I pay to insure myself for health is the same price that my father paid into the healthcare system 30 years ago to cover himself, my mother, plus 3 kids. Ever since our government decided to liberalize our healthcare system the costs have become prohibitive, while the quality of care of especially the huisartsen has tumbled down the drain. 30 years ago, the huisartsen were actually still providing healthcare, but these days they act more like the gatekeepers hell-bent on preventing you from getting real treatments.

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