Expat Chronicles: Dutch Healthcare
We’ve lived in The Netherlands for about six months now. Time flies! In our time here we’ve used a fair amount of health services, even one visit to the emergency room. Here’s the low down on our experiences accessing and paying for healthcare in The Netherlands.
The law mandates that all Dutch residents purchase basic health insurance. Brandon was the first to get his residency permit, back in June, so he tried to buy health insurance. The insurance company said we needed to wait until all of us were officially granted residency. I became official in August and we received word soon after that the kids would also be approved; however, they didn’t get their residency cards until early October. That means we went quite a few months without health insurance, not a good feeling. We’re so grateful to be in this country, that we really, really want to follow all the rules. Also, health insurance = good idea.
A Home Visit
In August, we received a letter from the Consultatiebureau explaining that a nurse would come to visit us in our home to meet the children and generally assess their health. What’s the Consultatiebureau? A government-funded entity which provide healthcare to all children, regardless of any factors. If you live legally in The Netherlands with children, they will contact you. It starts with an initial home visit and then follow-up appointments with the youth doctor (pediatrician) for regular developmental check ups and vaccinations. No need to remember to schedule those regular check ups. They’re mailing you invitations!
I was a little nervous when the nurse came, since we didn’t yet have health insurance, but she wasn’t irritated with us. She met all the children, took notes on our home language and any health concerns and provided Elora with a special status document that entitles her to extra preschool services, since her home language is not Dutch. It was friendly and efficient. Not a bad start.
One August afternoon Elora was playing on our bed. We were living in an apartment at the time with concrete floors. She took a bad fall, landing on her head, her cries long and intense. There wasn’t a bump, but she didn’t have an appetite for dinner and fell asleep suddenly in the midst of family time. When it was hard to wake her and then she fell right back to sleep, all the alarm bells went off. We know all too well that head injuries are life changing.
What to do? We had no health insurance and weren’t really sure if she needed medical care. After some stressful deliberation we decided to be safe rather than sorry, regardless of the cost or effect on our resident status. To the hospital we went, by bike.
Enschede hospital, photo by Johan Janson
The emergency room was empty and quiet.
The receptionist asked if our family doctor had called to let the hospital know we were coming. So the story came out - no insurance, no family doctor, no idea what we were doing. We learned that in The Netherlands you don’t have to decide alone about whether to go to emergency. You call your family doctor, who always answers, and helps you decide if it’s a true emergency. If it is, they send an ambulance or call ahead to the hospital to prepare the emergency team. Brilliant! Our experience with Eleni was that no one would give us advice, I believe for liability reasons. We always had to make that big decision alone, and pretty much always chose to go. The system here is so different without that liability pressure.
Anyhoo, there we were at the mercy of the Dutch emergency room. They took the situation in stride and without judgement, helping us entirely in English. Within an hour Elora was seen by a capable nurse, we were given clear instructions on what to look out for and how to call for an ambulance if need be, and on our way home.
The best part was the cost. Can you believe our 1-hour emergency room visit cost just 103€ (or $113)? We were so, so glad that we went and so, so grateful for the kindness offered by the system itself and those who attended us.
By the way, Elora was fine! Thank goodness.
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The Youth Doctor
After settling into our home, each of the children received invitations for appointments at the youth doctor, the Jeugdgezondheidszorg. This is the pediatrician who is employed by the Consultatiebureau. There they received vaccinations, hearing and vision exams and simple developmental tests (for my two-year-old). All services are at no cost and with no reference to health insurance status. Wow.
Vaccines are optional in The Netherlands, but highly encouraged. However, the encouragement doesn’t come off as pressure as it did in the States. For example, they actually said to me, “Your child doesn’t have to have this.” When I requested that Elora receive just one shot at a time, they were happy to oblige and didn’t make me feel foolish. It may seem like a small thing, but it means a lot to me. I feel respected and heard.
I’m a big fan of the efficiency at the Jeugdgezondheidszorg office. The nurse is also the receptionist. She makes sure children are weighed and measured as soon as they arrive. Then they play while they wait for the doctor to see them, about 5 to 10 minutes from the time of arrival. It’s all so quick and convenient, not the least since it’s a 3 minute bike ride from our house. And yet, the time with the doctor doesn’t feel rushed. It seems like they don’t over-schedule, so that they are actually able to provide attention at the time of your appointment. Very nice!
This is the health center down the road from us. It houses the youth doctor, as well as the pharmacy, which I was going to need soon.
By October my supply of medication for my thyroid condition was dwindling. We still didn’t have health insurance, but I couldn’t wait any longer. I needed to get a family doctor, who would provide a new prescription. One morning I called about 15 practices, all of whom said they were full. So many rejections! Was I being prejudiced against for speaking English?
Nope, my Dutch friends explained that it’s a problem for everyone. There aren’t enough general practitioners in The Netherlands to meet the needs of their rapidly expanding population. Our city isn’t even big, by Dutch standards, but it too faces a doctor shortage.
The following week I got up the courage to make another bunch of phone calls. Finally someone referred me to a practice that was new and reportedly taking clients. What a relief when they said they could accept me and my family too! In fact, they gave me an appointment to see the doctor just a few days later.
I went alone to my appointment with the family doctor. The wait in the waiting room was more typical of my U.S. experiences - about 20 minutes. She didn’t speak quite fluent English, but much, much better than my Dutch! we were able to communicate, and I got my prescription. What did that visit cost me, without insurance? A mere 29€ ($32). Hooray!
Oh, hey, does this look like a pharmacy to you?
So spacious and with a play corner too!
I had to ask to make sure I was in the right place. Haha. My medication cost a whole 11€ without insurance (that’s $12). I kid you not.
Insurance at Last
With all our paperwork in order, we bought the basic level of health insurance this October. What constitutes “basic” is quite regulated, so shopping for health insurance is simple. All basic plans are similar. You won’t end up paying surprising co-pays or hefty deductibles. Ours costs 208€ (or $230) per month and has a 385€ ($425) annual deductible for Brandon and the same amount for me. This is the basic, minimum deductible. The deductible is paid as you use medical services during the year. After you meet the deductible the insurance covers 100% of typical health care expenses, including doctors, hospitals, medicine, mental health care and physiotherapy.
Our health insurance is really just to cover Brandon and I. So we’re each paying 104€ per person, per month. Once parents insure themselves, all of their kids are automatically covered at no additional cost. Plus, dental is included for kids through age 18! That means children can access the full spectrum of health care at no cost. Isn’t that wonderful?
I’m happy to be paying into a very good system.
Speaking about health services for kids, Elora started speech therapy last week. Elora doesn’t speak very often or very clearly in English, let alone Dutch. I shared my concern at her appointment with the Youth Doctor, who referred us to speech services. Lucky us, there is a speech therapist in the very same health building as our youth doctor and pharmacy. Here is Elora ready to go in to see Miss Marta!
Elora will visit with her therapist, Miss Marta, each week for a half hour session. Since we’ve only been twice, Marta is still evaluating Elora’s abilities in both English and Dutch. They asked me which languages I would like her to have therapy in, and I said both! Marta has already made a connection with Elora, who was chattering about “my teacher” later that day (though I could only make out those two words). I’m very grateful that it was so easy to access language therapy here and that our weekly visit won’t be costly in either time or money. Adding this weekly outing to our schedule isn’t so hard, when therapy is just down the street.
The therapy room is bright and airy, with toys chosen to provide tangible sources of language exposure. Elora enjoyed setting up the doll house with her teacher, who named the furnishings in Dutch. For homework we took home a simple game, which provides an easy way to keep exposing her to that set of vocabulary. Elora is very enthusiastic! We played the game this morning at breakfast before preschool.
It could be that I’m still in the honeymoon phase, but I’m quite impressed overall with the Dutch healthcare system. It’s affordable, efficient and provides a high quality of care. I have yet to meet a health professional who seemed rushed or unfocused. It’s been a pleasure. Many thanks to the Dutch people!