DUTCH HEALTHCARE & INSURANCE

The Dutch heathcare system may be different to what you are used to.

Below you will find information on the following:

• The role of General Practitioners
  
• Your legal obligations for health insurance whilst living in The Netherlands
• Types of Dutch health insurance policies
• Changing your insurance provider or level of cover
• Mandatory yearly deductible (Eigen risico)
• Registering with a GP or Family Practice
• Seeing a specialist doctor at the Polyclinic or in Hospital

The role of General Practitioners

General practitioners (GP)/family doctors make up the central part of the health system. If you have any (non-life threatening) health or medical related concerns, you are expected to visit your GP (called a ‘Huisarts’ in Dutch). For life threatening emergencies, always call 112. Should you require specialist care, the GP will refer you to the appropiate specialist or the hospital where necessary. Your Dutch insurance will not cover your medical expenses for (non-emergency) care if you have not received a referral from your GP. Therefore the first thing you should do when you come to the Netherlands is to register with a general practitioner or family practice and take out Dutch healthcare insurance. You can register with the IHCH Family practice should you so wish to.

Your legal obligations for health insurance whilst living in The Netherlands

If you are employed under a Dutch contract,  you are obliged to take a policy with a Dutch insurance provider.  If you have insurance with a foreign provider only, it will not satisfy your legal obligation under the terms of your residency or employment status

Types of Dutch health insurance policies

There are two different types of insurance policies that Dutch health insurance companies offer:

• • “Restitutie polis”, which means that you can choose to select your own healthcare provider, or
  • “Natura polis” where the insurance company directs you to their contracted providers (doctors, pharmacies, etc). 

Should you visit a provider that is not contracted to your chosen insurance company, you will not be reimbursed (in full) for the costs. Therefore, we strongly advise you to select the slightly more expensive “restitutie” policy, which allows you to select the healthcare provider of your choice.

Basic and/or supplementary insurance

In addition to the legal minimum “basis”, or basic insurance, you may also choose aanvullende  or supplementary insurance, which offers different levels of extra coverage at an additional cost. All companies are obliged to accept everyone for the “basis” insurance, but they are not required to accept everyone for the aanvullende insurance.

Check out this page for more information regarding the different Dutch health insurance packages and policies.

Changing your insurance provider or level of cover

Ensure you are satisfied with your provider and are properly informed about your level of cover as it is only possible to change your level of cover and/or insurance provider at the end of each calendar year.  It is not possible to make any changes throughout the year. If you would like to make any changes, you need to notify your insurance by December or else you risk having to wait a full year to make changes to your policy. For more information about the Dutch health insurance system, visit this page.

Eigen risico- Your yearly deductible

All Dutch insurance companies impose a mandatory yearly deductible, called your eigen risico. Insurances cover basic and essential medical care, though a minimum excess applies, and varies according to your chosen policy. The minimum deductible is regulated by the Dutch Government and it applies every year to everyone with Dutch insurance. Your eigen risico is deducted from any reimbursements you may receive from your insurance company. Items such as prescription medication and laboratory investigations also form part of the eigen risico. GP consultations are exempt from the eigen risico. You can also purchase a supplementary package to cover dental fees, physiotherapy or some cosmetic treatments.

Registering with a GP (Huisarts) Family Practice

Since the Dutch healthcare system revolves around your general practitioner (GP), the first thing you need to do is find a local GP practice (called Huisarts in Dutch) and contact them to register. Some practices may already be full and not be able to take on new patients. This is to ensure they maintain reasonable waiting times and quality of care. Be aware that your GP practice needs to be relatively local, since GPs sometimes perform home visits for certain cases, and therefore require that you live within the local area.

If you are currently registered with another GP in The Netherlands, be aware that you will need to officially de-register at your previous medical practice.  Under Dutch law, patients with Dutch health insurance can only be registered with one GP practice.

Seeing a specialist doctor at the Polyclinic or in Hospital

If you require specialist medical care and you have Dutch insurance, your GP will be the one to refer you to get such care. The billing system for Polyclinic or Hospital care works differently to that of GP’s, and is based on a DBC system.

A diagnosis-treatment combination (DBC)- is a nine-digit code describes the total hospital activities (diagnostics, treatment and checks). The DBC provides information about the entire treatment process.

DBC are used within specialist care as well as mental health care (GGZ). The doctor or practitioner determines which DBC will be issued. All performances that can be declared are expressed in so-called DBC (or DOT) care products. There are approximately 4,400 DBC care products.

Why are there DBCs? The government wants to stimulate market forces in healthcare to a certain extent. The current DBC system offers possibilities for this, because:

•     Hospitals and health insurers can negotiate with each other about the price and quality of care and treatments. The consumer can ultimately benefit from this.
•     There will be more transparency in the costs of certain treatments, so that hospitals can optimize their business operations and continue to provide affordable and effective care.

How does a DBC care product work? If someone needs specialist care, not every action, such as an injection or X-ray, will be charged separately. Payment for hospital or specialist care takes place on the basis of DBC care products. You could see these products as a package of care forms that are used in a specific treatment, for example for a hip fracture. The price of the healthcare product is the average of all healthcare costs associated with such a break. The DBC is opened on the first day that the patient is with the specialist. This can be done before an intake interview, check-up or directly before treatment.

What does the health insurance company reimburse? How much the patient or health insurance policy ultimately has to pay to the hospital depends on the following factors: How much the average treatment costs when diagnosed and the severity of the treatment. For example, is it necessary to have the patient stay overnight in hospital or can he go home quickly after treatment? Whether or not surgery is required? How many visits the patient made to the specialist?. All the above information is recorded and the rate is determined on the basis of this. Afterwards, the hospital will charge the rate of the care process to the health insurer. The patient may then receive a bill for the deductible.

What information does a DBC care product contain? A DBC contains all the activities of a hospital and a medical specialist that are the result of a specific care demand. This includes:   

• The diagnosis of a specialist   
• Treatments   
• Follow-up (if applicable)
  

Getting billed for your specialist treatment
A DBC remains open for a maximum of 120 days. For outpatient non-operative treatments, the duration is 90 days. However, this only applies to the first process for a new care demand. All follow-up programs (outpatient and non-surgical) have a duration of 120 days. A DBC can even be open for 365 days for the GGZ. Important: Hospitals will send the bill to the health insurer, no more than 120 days after opening the subproject. In some cases, the bill is sent to the patient. For certain expensive medicines and treatments it sometimes happens that the costs are declared immediately after treatment, but more often you will be charged once the DBC is closed. Therefore keep in mind that it can take months before you receive the bill for specialist or hospital care.

Your deductible (eigen risico) and DBCs

Non-emergency specialist treatment is first charged to your deductible. Once your deductible is used up, you will be reimbursed according to your policy cover.