SERVING THE NEEDS OF THE INTERNATIONAL COMMUNITY Guide BASED ON FREQUENTLY ASKED QUESTIONS Health Care in the Netherlands Zeestraat 100 2 nd Floor 2518 AD The Hague Tel: 0900 2 ACCESS (0900 2 222377) 10:00 16:00, Monday Friday helpdesk@access-nl.org www.access-nl.org
Contents Introduction... 3 Frequently asked questions... 5 Emergencies... 7 GP (huisarts)... 8 Medical specialists and hospitalisation... 8 Medicine... 9 Having a baby... 9 Vaccinations... 10 Mental health... 11 Author :Genoveva Geppaart Last update by :Genoveva Geppaart, May 2012 This ACCESS Guide has been compiled with the generous assistance from International Health Centre The Hague 2 ACCESS
Introduction Moving to another country means that you need to get familiar with many practical things that seem so self-evident in your home country. One of these things is the way a country provides health care for its residents. Health insurance The Dutch health insurance is probably arranged in another way as you are used to, as there s just one health insurance system in the Netherlands, called the Zorgverzekeringswet (ZVW). It is a legal obligation for everyone who is registered as resident in the Netherlands to be insured for healthcare by a Dutch health insurer, except for expat workers of certain international organisations and embassies. If you have an international health insurance, please be aware that this might not be accepted, as it isn t recognised as a valid Dutch health insurance. Health insurance companies have an obligation to accept everyone for the standard package, irrespective of gender, age and health. You may be used to a situation where the insurance company decides what is covered by the insurance. However, in the Netherlands the coverage of the standard package (basisverzekering) is determined by the government and is subject to ongoing review and change. Huisarts The most important difference between medical practice in the Netherlands and that of other countries is the predominant role of the huisarts (GP). Your huisarts is the gatekeeper to the Dutch world of medicine. The huisarts treats patients for basic problems and can answer most of your general health questions. He/she will also perform, for example, standard gynaecological or paediatric examinations. Your huisarts will also give you a referral when you need other medical services, such as hospitalisation, maternity care and specialists. If you want to see a specialist, you need a referral from your huisarts. Without that referral, the health insurance will not reimburse the costs. Some specialists are even not willing to make an appointment if you don t have a referral. Non-interventionist approach Another difference you will experience is the non-interventionist approach to medical and maternity care in the Netherlands. This is reflected in the reluctance of doctors (and some dentists) to prescribe drugs unless absolutely necessary, the general practice of giving birth without any pain relief and the high proportion of home births. Doctor-patient relationship In some countries patients are hesitant to question medical opinions. In the Netherlands, it is common for patients to make their voices heard. One of the most important things for you to remember is to be your own advocate. If you have any questions about the 3 ACCESS
diagnosis or treatment, feel free to ask your doctor for an explanation. You may also ask for a second opinion. ACCESS is proudly supported by several healthcare providers and trainers. Please refer to our website for the most current list outlining who they are and what they offer. 4 ACCESS
Frequently asked questions ACCESS has many years of experience serving members of the international community. We know that newcomers have many questions. The questions outlined below are frequently asked by members of the international community. Please note that some of the websites mentioned are in Dutch only, but you can read it in English by using Google Translate (www.google.com/translate). It will not always give a perfect translation, but it will give you an idea of what the text is about. Health insurance Q. What is a basic package in the Dutch health insurance? Health insurance companies have an obligation to accept everyone for the standard package, irrespective of gender, age and health. It is compulsory to take this package but you can choose your own insurance company. The coverage of this standard package (basisverzekering) is determined by the government and is subject to on-going review and change. This standard package (basisverzekering) generally covers (but not always 100%) hospital care medication rehabilitation medical care by specialists, GPs and midwives dental help for persons younger than18 therapists, such as speech therapists and dieticians mental health care maternity care necessary medical help during a holiday or business trip abroad, worldwide You can choose between two types of insurance policies: policy in kind: the insurance company concludes sufficient contracts with health care suppliers in order to deliver health care. The insurance company pays the bill directly to the health care supplier. You must see a health care supplier contracted by the insurance company. restitution policy: you choose the health care supplier yourself and pay the bills yourself, after which the health insurance company reimburses you. Q. What is a supplementary package in the Dutch health insurance? It is possible to take out supplementary health insurance but, unlike the basic insurance policy, the insurance companies are not obliged to accept you for this. The supplementary package can cover physiotherapy, spectacles, dental help for persons of 18 years and older and alternative medicine such as homeopathy and acupuncture. The contents and premium differ per insurance company. 5 ACCESS
Q. How will my children be insured? Children under the age of 18 must also be insured, but are covered under their parents premium, as long as they do not have their own income. Q. I have an international health insurance. Will this be valid in the Netherlands? If you have an international health insurance, please check if this insurance is accepted in the Netherlands, by calling the College for Health Insurances (College voor Zorgverzekeringen): tel. (020) 7978555. Q. I don t have a Dutch health insurance yet, is there a way to get my medical costs reimbursed? You need a Dutch health insurance within 4 months of entering the Netherlands. Within these 4 months, your international health insurance or the health insurance from the country you lived before may be used, if it covers medical costs in the Netherlands. You will have to pay the bill yourself and then arrange reimbursement with the insurance company. Q. I just took out a Dutch health insurance but now the insurance company wants me to pay premium for a few months, retroactively. Is this correct? If you take out a Dutch health insurance, it might start at the day your residence permit was issued. Therefore you may have to pay premiums to the insurance company retroactively. Q. My residence permit has expired and my application to renew it has been rejected. Can I still get medical help here? If you are illegal in the Netherlands, you can get urgent medical help without getting a bill. The doctor decides which help is urgent for an individual person. Q. What is excess? Excess is the amount you have to pay yourself before you receive a reimbursement from your insurance company. Everyone over 18 years of age is required to pay mandatory excess on the basic insurance. For 2012, this has been set at 220.00. If you have also opted to pay voluntary excess, this is payable over and above the mandatory excess. The higher your voluntary excess, the lower the premium you will be charged. 6 ACCESS
Q. Does the excess apply to all types of care? No, the excess does not apply to the following: treatment by your GP (with the exception of contracted-out laboratory tests); maternity care and assistance at delivery; loans of medical equipment; health care for children under the age of 18 Q. Is dental health covered by the insurance? Dental help is covered in the basic package for children under the age of 18. If you are 18 years or older, dental help can be covered by a supplementary insurance. The contents and premium differ per insurance company. Q. What is health care allowance? The Dutch government provides a health care allowance for people with a low income. If you have a Dutch public health care insurance you can apply for this allowance. You must be over 18 and earn a maximum of 36,022.00 a year for a single person or single parent or 54,264.00 for couples (figures for 2012). Emergencies Q. Can I go to the Accident and Emergency in a hospital without referral? Yes, it is possible to visit the Accident and Emergency in a hospital without referral but it is best to contact your GP first. Many problems can be treated by your GP as well. Q. What should I do in case of emergency? For life threatening situations, there is a special telephone number 112. This works throughout Europe. Q. How can I call an ambulance? In the Netherlands you can t call an ambulance yourself. Only your GP or the emergency services can call an ambulance. If you don t follow this procedure you may receive a substantial bill that will not be reimbursed by your insurance. 7 ACCESS
GP (huisarts) Q. How can I find an English speaking GP? Most GP s in the Netherlands are native Dutch but have a good command of English. However, in areas with many expats, there are also health centres specialised in helping expats. Q. How can I contact my GP outside normal opening hours? Outside the normal opening hours (office hours), a recorded telephone message will usually provide contact details for an on-duty doctor or the medical advice service (doktersdienst). Q. I am dissatisfied with my GP. Can I change to another GP? If your GP is working in a group practice and you prefer one of the other GP s in the practice, you can schedule your appointments during his/her office hours. If you want to change to a new GP, it is best to check if he/she is willing to accept you as a patient. Some GP s don t accept new patients because their practice is full. Once you are sure that you can go to the GP of your choice, ask your former GP to send your medical file to the new GP. Medical specialists and hospitalisation Q. I want to go to a medical specialist but my GP does not want to give me a referral. Can I visit a medical specialist without a referral? If you want to visit a medical specialist without referral, the health insurance will not cover this, so you have to pay for it yourself. There is a chance that you will not be able to make an appointment, even if you are willing to pay the costs yourself, because of the complex administration involved. Q. I want to see a medical specialist. How can I arrange that? The first thing you need to do is ask a referral from your GP A referral is necessary to be able to visit a medical specialist. Once you have a referral, you can make an appointment. Depending on the specialism and the facilities of the hospital, there may be waiting times from a few weeks to a few months. An alternative to seeing a medical specialist in the hospital, is visiting one in a policlinic (polikliniek) where ambulatory and acute care are provided, but without major surgical or pre- and post-operative care facilities. When you first visit the medical specialist, you will be required to complete a questionnaire about your medical history and various lifestyle factors. This will be registered in the hospital s patient database. 8 ACCESS
Q. What kind of accommodation and facilities can I expect when I need hospitalisation? Most hospital accommodation is in shared rooms or wards up to six patients and may be mixed gender. Private television and phone lines are often possible but you will be charged for the use. Single-occupancy rooms are available in some hospitals, but they are mainly available for patients who need this for medical reasons. You need to bring your own nightwear, toiletries and other personal requirements. You are advised to leave valuable items and bank-cards at home. All food, medication, bedding and towels are provided by the hospital. Medicine Q. In my home country, my doctor prescribed me some medicine. How can I get this medicine in the Netherlands? Medicines in the Netherlands are not always the same as medicines prescribed in other countries. If you are taking medication prescribed to you in another country, it is best to show these to your doctor and/or pharmacist. In particular, most well-known brand names and packaging from your own country may not be the same in Dutch although the content might be identical. Having a baby Q. Which are the most common options for delivering a baby in the Netherlands? The three most common choices for pregnancy care and delivery are: Midwife care with home birth (thuisbevalling) Midwife care with hospital birth (poliklinische bevalling) Midwife care with a gynaecologist (ziekenhuisbevalling). Q. I am pregnant and will be giving birth in the Netherlands. Can you please tell me what services I can expect from a midwife? Midwives in the Netherlands are the lead professionals providing care to women with 'normal' or uncomplicated pregnancies. They are independent practitioners, like GP s and work in single-handed, duo-, or group practices. In case of complications or an increased risk of complications during pregnancy, during labour or in the postpartum period, the midwife will refer her client to a gynaecologist who will take over responsibility. As an independent practitioner, a midwife can legally practice obstetrics without supervision of a medical doctor. She is the sole health care provider during pregnancy, labour, delivery and the initial postpartum period. In short, she will help you make sure that you and your baby are safe from pregnancy to delivery. 9 ACCESS
Among other things, she will take you and your partner s medical history, as well as that of your family; monitor your weight and blood pressure, the foetal growth, position and heart beat; check your blood iron levels; discuss with you plans about delivery, whether home birth or in a hospital; supervise you during labour, delivery and the initial postpartum period. You can phone the midwife yourself to make the appointment. You will find midwives listed in the yellow pages under verloskundigenpraktijk. Q. What is the role of a maternity nurse (kraamverzorgster)? After the baby is born, most women are cared for at home by a maternity nurse (kraamverzorgster), who may visit you every day during the first week. A programme of postnatal care (kraamzorg) follows the birth. A postnatal welfare practitioner will come to your home for the first week after the birth or your return home with the baby. He/she will come for several hours a day and help with everything to help you adjust: cooking, cleaning, feeding, changing, child minding, etc. Be sure to register for kraamzorg as soon as possible, preferably at the beginning of your pregnancy. Sometimes your insurance company will tell you which organisations you may register with in your area. Some insurers leave the choice to you. Your GP (huisarts) or midwife (verloskundige) can probably recommend several agencies that provide nursing care. They will also help you decide what type and length of care is right for you. Vaccinations Q. Which vaccinations are common in the Netherlands and how can I arrange them for my children? The Dutch national immunisation programme includes vaccinations for the following diseases: DKTP: D = Diphteria, K = Whooping Cough, T = Tetanus, P = Polio-myelitis HIB = Haemophilus influenzae type B - only for children born after 01-04-1993 BMR = Mumps, Measles, Rubella (German Measles) Men C = Meningitis C - only for children born after 01-06-2001 Pneu = Pneumococcal vaccination only for children born after 01-04-2006 Hep B = Hepatitis B vaccination - only for children born after 01-01-2003 HPV = Human Papilloma Virus only for girls All vaccinations are given at the Consultation Bureau (Consultatiebureau, ). Q. I would like my child to have additional shots that are not standard in the Netherlands. How can I arrange this? You will have to contact your GP or visit a specialised vaccination centre. Please bear in mind that you will probably have to pay for additional shots yourself. 10 ACCESS
Mental health Q. Where can I find help for mental health problems? If you have any mental health problems, you need to discuss this with your GP. He can provide you with a referral to a psychologist. You need the referral in order to get the costs paid by your health insurance. You can go to a RIAGG (in The Hague called Parnassia), an organisation specialised in mental health care. Most psychologists are native Dutch speakers, but usually they also have a good command of English. You can also contact the Counselling Service of ACCESS, which is set up to meet the needs of the international English speaking community in the Netherlands. This ACCESS guide is intended to provide general information. If you need more specific information about this subject please contact the ACCESS Helpdesk on 0900 2 222377( 0.20/c per min) 10:00 16:00, Monday to Friday, or send us an email at helpdesk@access-nl.org. We also work closely with our network of partners, associates and trainers. You can find their contact details on our website http://www.accessnl.org/about-access/how-we-do-it/helping-access.aspx ACCESS guides available for downloading, free of charge, from the ACCESS website*: Banking, Taxes and Insurances Having a Baby in the Netherlands Health Care in the Netherlands Housing in the Netherlands Learning the Dutch Language What to do when Leaving the Netherlands Legal Matters regarding Key Life Events Partner Support Studying in the Netherlands Your Child Your First Three Months * The titles mentioned above will be published gradually during 2012. In this period the actual titles available on the website may be different from the ones mentioned here. 11 ACCESS
COPYRIGHT ACCESS May 2012 Disclaimer This ACCESS guide is intended to provide comprehensive and general information. ACCESS did everything possible to ensure correct and up-todate information. ACCESS cannot accept responsibility for any information that may have changed. 12 ACCESS