Parenting in Holland

The standard of medical care in the Netherlands is very high. The Euro Health Consumer Index is an annual ranking of national European healthcare systems across five areas that are key to the consumer: Patients rights and information, waiting times for common treatments, care outcomes, the generosity of the system and access to medication.  The good news for us, is that Dutch healthcare has been in the top three for 4 years in a row. And, the most recent result of 2008, The Netherlands has first place of 31 countries in Europe! (Info just released from Brussels, Aug 2009)

It is important to know, in general, there is a natural, non-interventionist approach to medical and maternity care. For example, many doctors are reluctant to prescribe  drugs unless absolutely necessary and the general practice of many Dutch women giving birth without pain relief. Doctors here are also known to volunteer much less information to patients about their patients’ conditions than in other countries. And, there is far less preventatitive screening: for example, no standard glucose challenge for pregnant women, and women do not have annual pap smears.

The General Practitioner

Here in the Netherlands, the GP (huisarts) is your first point of contact for all medical matters. The family doctor treats patients for basic, non-surgical problems and provides answers for most your general health questions. The GP is your link to other services such as hospitalisation, specialists, midwifery, physiotherapy etc.

You should register with a GP as part of your “settling in” in The Netherlands. You never know when you’ll need one. The International Health Centre of The Hague (www.ihch.nl) has a multi-lingual staff. Your GP is important for all health matters, including re-ordering your acute or chronic prescription drugs (even if you have a prescription from your previous / home country) or medical certificates for sick days off work. With the H1N1 ‘flu epidemic threatening, it’s best to get registered as soon as possible.

Making appointments is always necessary. Your phone call will be answered by a trained medical assistant who will ask you what the reason is for the appointment. Many people feel uncomfortable with this, however, your complaints will be noted and an appointment will be scheduled. Appointments are only 10 minutes, so if you think you’ll need more time, or if you have more than one complaint, ask for a double appointment.

Doctors work out of their surgeries (offices), but will come to your home if deemed necessary.  The doctors in the Netherlands are very accessible. You can even phone them with health questions during their consultation hours. They answer their own phone calls and usually speak English. Bring your medical insurance card with you to your appointments. Changing GPs is discouraged and rarely done.

For after hours medical help (17:00 – 08:00): SMASH is an institution of GPs who are on call at night or over weekends. The number to call is  (070) 346-9669. There are various locations but also one at the end of Bronovo’s parking lot.
Also, read about Emergencies below.

Insurance

Major changes have taken place in the Dutch Health Care System. A new single healthcare insurance system was introduced in early 2006. The Dutch government is no longer in charge of the healthcare system. Instead, it remains responsible for the quality and accessibility of the system and its services.  The new Health Insurance Act (Zorgverzekeringswet), requires all residents of the Netherlands to take out their own health insurance with a Dutch insurance company. If you live in The Netherlands, or pay income tax to the Netherlands, then you are obliged to purchase a basic health insurance plan. You are free to choose your own plan and insurer.

If you are on a temporary stay of less than one year, then you are not required to buy Dutch health insurance.  However, anyone on a temporary stay is required to have international insurance or insurance from his or her country of residence. Once you become an official resident then you will need to apply for Dutch health insurance within four months. Occasionally, people who stay between one and three years may also be classified a temporary stay, but normally anyone who lives in the Netherlands over a one year stay is deemed to be on a long-term stay and is required to have Dutch insurance.

Lower income earners may be eligible for a healthcare allowance. You may request a form for the healthcare allowance (zortoeslag) from the tax office.

The Basic Plan

You are required to buy a basic insurance package and the insurance companies cannot reject anyone who applies. The following items are usually covered under the basic plan:
•    Medical care
•    Hospital stay
•    Prescribed medicines
•    Some medical appliances
•    Prenatal Care
•    Ambulance

Note: Dental Care
Children under 18 are included in their parents insurance, and are covered for both dental and medical care. Some basic plans may cover an annual dental check-up for adults.  Usually you will be required to pay all of your own dental fees or purchase additional dental coverage.

Additional Information

When looking to buy basic insurance coverage, it is important to note that you cannot be refused coverage due to your current medical history (like being pregnant), but be warned that the insurance companies can refuse to sell you supplemental insurance coverage. The basic package that the insurance companies offer does not vary much in coverage or price, and you may choose to switch your plan once a year to a new provider. You also may decide to add additional supplementary insurance (if you meet the criteria) to cover treatments not covered by the basic plan, such as elective treatments, as well as dentistry, physiotherapy, and private hospital care.

There are many different supplemental insurance packages, depending upon the number of extra treatments one might select. These can vary widely in price and coverage. Again, you should check with colleagues or employers to see which policies they might suggest. It is also important to remember that insurance companies are only required to reimburse you for what they consider to be “reasonable costs”. You should always check in advance to see what services will be covered under your basic or supplemental insurance before going ahead with any treatment.

In an emergency

The emergency phone number for the fire, police and ambulance is 112 (also from your mobile phone)
The accident and emergency department in hospitals is called “Spoedeisende Hulp” or Accident and Emergency. You can go to the A & E department at your nearest hospital to receive immediate attention following a serious accident without making an appointment. Take your insurance card for the hospital records. They will charge you after the treatment and you can claim this from your insurance company.
For First Aid (open wounds, burns, bruising) during office hours, first call your doctor. If he expects your arrival, your GP can be prepared and help immediately. For emergencies outside of office hours, phone SMASH (Stichting Mobiele Artsen Service Haaglanden) on (070) 346-9669. You will meet the doctor on call at another location.
Your emergency call to SMASH will be answered by a specially trained medical assistant, who works under the responsibility of the doctor on duty. You will be expected to explain the medical emergency to this person. They could offer you advice independently. These medical assistants work according to clear, safe and stipulated guidelines and procedures. All medical advice offered by the assistant is checked by the GP on duty. If needed, the medical assistant will consult with one of the doctors on duty to see whether a phone consultation, prescription, consultation at the unit or a house call is necessary. As always, the assistant will ask you for: Date of birth, name, address and telephone number.

Hospitals

If you need to go to the hospital, your doctor will arrange a hospital admission. If you are going to the hospital for a non-emergency treatment, check your insurance policy and options with your insurer in advance. Your health insurers will need a referral letter from your doctor. You can get a complete list of hospitals and medical centres in the Netherlands @www.kiesbeter.nl. (use the translator).

Pharmacies

In the Netherlands, prescription drugs are dispensed only at pharmacies (apotheeks). Drugstores (drogists) sell non-prescription and over the counter medicines. You may be surprised to find that some items are only available by prescription here, even though they were “over the counter” in another country.  Most pharmacies are open weekdays, and a few hours on a Saturday. There is usually one pharmacy in each neighbourhood open at nights and weekends. There is an after hours emergency pharmacy at the end of Bronovo’s parking lot, same location as SMASH’s unit. Its open from 17:30 – 08:00 hrs during the week and 24hrs over the weekend. Telephone number: (070) 324-6085

Dentists

Your insurance company will also provide you with a list of dentists to choose from, or you can choose a dentist at: www.tandarts.nl. Again you will need supplemental insurance for all dental visits. Colleagues and friends may be able to help you with choosing a good doctor or dentist in your postal code.

Useful Contacts and Resources

English Websites:

• www.minvsw.nl - The Dutch Ministry of Health’s officially website
• www.expatica.com/nl - Expat website offering news, features, and essential resources to help you live abroad. See Netherlands/Health Insurance
• www.justlanded.com - Information, products and services to make survival easier for expats. See Netherlands/Health Care
• www.access-nl.org - Can provide a list of doctors and dentists available in your area

Dutch Websites:

• www.huisartsen.nl - Provides list of doctors by region
• www.tandarts.nl - Provides list of dentists by region
• www.kiesbeter.nl - Click on translator/discusses insurers, policy coverage, how you can switch policies, etc.
• www.denieuwezorgverzerkering.nl - Rates insurers/check out the health information in the A-Z dossiers
• www.belastingdienst.nl - The Tax Authorities: Information on tax refunds from health insurers, etc