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Encounters with Dutch Medicine

I’ve been in the Netherlands for a few months now and for various reasons I’ve had the need to interact with the medical entities here quite a bit.

Like everything new, it can be a bit confusing to start with and getting your head around what’s happening and what is expected can be a bit daunting.

It starts with getting health insurance. Health insurance in the Netherlands is compulsory, everyone in the country has to be insured. Insurers are not allowed to refuse you cover, nor are they allowed to require special conditions; questions someone from the UK might never have considered, but Americans are probably very used to. Most hospitals and medical establishments appear to be private, not-for-profit organisations. Wikipedia (as usual) as has more details for those interested.

A “basic” package includes essentially everything needed to keep one alive and functioning, this is covered in part by employer contributions from payroll and in part by your own contributions to insurance. Some things, like GP (Huisarts, lit. house doctor) visits are fully covered and you’ll never pay towards them. I’m sure there are others but I’ve not yet encountered them.

Prescriptions are covered by a form of co-pay scheme where you pay up to an annual amount that’s mandated by the government, this year it’s €218. That means you’ll pay the first €218 of your covered costs in a year and after that your insurance pays everything else. My insurer gives me a nice little summary bar chart of what’s left for me to pay.

You can decrease your monthly insurance costs by increasing your “eigen risico” (lit. own risk) but I was recommended not to by my employer.

In addition to the basic package the insurers will tend to then offer cover for additional services, mine for example (and I tried my best to get it removed) is cover for “alternative” medicine, like homoeopathy, but it’s in the standard package offered because people seem to like paying over the odds for water. More sensible things are mental health, dietary advice, elective surgeries, even health spas and similar things. Generally the difference between the different levels of cover is how much you have to pay before/after the insurance kicks in.

Dental is usually not covered, except it seems for children under eighteen. I know I need to visit the dentist twice a year, so I had dental insurance added. I’ve always paid a fair bit on the NHS when I went to the dentist, and the hygienist was never covered by the NHS, whereas it is covered by my insurance here. I’ve had an hygienist visit, a check-up and two fillings repaired and I’d say I’ve probably ended up paying a third or half more than I would have on the NHS (including my insurance cost). Looking at private dental costs charts in the UK I’d say prices are comparable, if possibly slightly cheaper in the Netherlands, although I’ve not done an in-depth analysis.

Once you have insurance things are actually fairly simple. I haven’t handed cash or debit-card over to anyone at all since I was here. Even in the UK you are expected to pay for prescription charges up front (unless exempted); not so in the Netherlands. Once they have my insurance details everything goes via the insurer, so I pay nothing at the counter, not at the doctor, pharmacy (for prescriptions) nor at the dentist; which makes a nice change from the UK where I had to hand over cash/card all the time, even for NHS stuff.

Finding a doctor was fairly simple as well. There’s a nice website where you just type in your postcode and all the doctors, dentists, etc. in your area listed with contact details and ratings (there don’t seem to be too many of those yet, so probably not that reliable).

I found my doctor by looking them up there, then going to their website and signing up as a new patient. As it happened my health took a turn for the worse shortly after and I then phoned them up. The answer machine had an option for English, which is nice, and I was able to make an urgent appointment for the next morning (none of this” phone before 0900h for a same day appointment” I had at my UK doctor). My first appointment actually lasted 45 minutes, much longer than usual, but I never felt rushed, which is also a nice change from my UK GP experiences. I consider both my UK and Dutch surgeries comparable as they are both GP collectives (can’t think of a better term right now) where you have multiple GPs working out of a single surgery and sharing the load. Unlike my UK surgery though, the Dutch one assigned me a doctor and will do everything they can to make sure I always get “my” doctor. In the UK this was merely a formality and they gave me whatever doctor they felt like for the appointment, unless I specifically asked for one by name.

The doctors all speak excellent English so I had no problems talking to them, the doctors’ assistants (I might be doing them a disservice, but they seem more like receptionists to me) are a different matter, none of them seem to speak English, so that can be a bit interesting at times as I try out my slowly improving Dutch on them.

Things were sorted out for me pretty quickly. Blood tests done the next day, results and medication to deal with what was found. Interestingly doctors here won’t sign you off work, not even recommend if you should go in or not; that’s up to you and your company’s doctor (who I have yet to speak to, not sure my company even has one).

Medication I got from the in-house pharmacy and again I had to hand over no money, it all goes direct to my insurer. If the medication isn’t covered, then it’s added to my “own risk” and/or I get a bill. The only time I was required to pay for medication was for something that’s commonly abused and the insurance just flatly refuses to pay for; an understandable attitude.

Unlike the UK, every prescription you get from your doctor is, seemingly, a repeat prescription. That is, once you’ve been given medication once by your doctor, you can keep going back to the pharmacist for more; at least that’s how my doctor explained it to me; I’ve yet try it out. This might explain why the insurer refused to pay even for a prescription medication.

Talking of medication, one thing that’s different is the level of restrictions on medication. Things I used to buy in the supermarket in the UK are prescription only over here. Cocodamol (paracetamol and codeine) for example. Even things like the cetrizine antihistamine is only available in packs of seven from the pharmacy, whereas I could buy it in packs of thirty from the pharmacy in the UK. Getting the prescriptions is not difficult, just need to ask the doctor. Dosages are also slightly different, my painkiller here in Netherlands is stronger now; 500mg/10mg (paracetamol/codeine) instead of 500mg/8mg that I used to get in the UK. One thing this means is that, once my “own risk” is used up, I won’t be paying for these medications any more for the remainder of the year; whereas the NHS would never have paid for these.

Keeping track of my insurance is easy as well. My insurer provides a nice website, which I log into using the government required “DigiD“, which is also used for things like my taxes (a federated security model, for those that are interested). Once in I can see everything that has gone through the insurer (see left, vergoed = reimbursed), how much is covered, what isn’t, what’s left of my “own risk” (see above) and an itemised breakdown, (see below).

Dentist, GP and pharmacy.

All in all, my experience with Dutch healthcare as been pretty favourable. As I’m required to pay for it now I’m actually pretty pleased with the way things are organised and presented to me, in many ways it’s actually more convenient than what I was used to under the NHS. In some ways I’m actually much happier here than I was in the UK, but I’m not sure if that’s a systemic difference, or because of the doctors’ offices I happened to have chosen in each country.