NETHERLANDS HEALTHCARE SYSTEM

The Netherlands has operated a dual-level healthcare system since 2006.

On the one hand, inhabitants of the Netherlands are legally obliged to take out a basic health insurance with private insurers to get cover for all primary and curative care expenses - i.e. general practitioner services and hospitals care. You can choose to get better cover if you wish to, but the basic package is compulsory.

On the other hand, the government takes care of long term care for the elderly, the dying, the long term mentally ill and certain low-income groups (e.g. with chronic illnesses) through a Social Insurance Scheme funded from taxation.

The aim is to socialise cost, while offering a choice to individuals who wish to be better covered than the basic level. But how does it work exactly?

THE DUTCH HEALTHCARE

Principles
All Netherlands residents are required to purchase a basic health insurance from a private insurer. You can choose among the available insurers, but more often than not, you operate your insurance through group plans administered by your employer. This solution is usually cheaper thanks to economies of scale. Children under 18 are covered for free, and low income residents receive a tax credit to help them purchase insurance. The basic plan does have an excess of 150 Euros per year for all adults so as to control health care costs.

Insurers are tightly regulated by the federal government, and are required to accept every resident who applies for a basic package regardless of medical history. To compensate insurers who could end up with higher-risk policyholders on their book (elders, sick or residents with pre-existing condition), they receive compensation from an equalization pool which is managed by the government.

The government also manage a separate universal national social insurance program for long-term care, known as the Exceptional Medical Expenses Act. It provides long term care for the elderly, the dying, the long term mentally ill and other high-cost categories. Essentially this forms a safety-net for all those who can't afford the normal system.

Scope of Coverage
The basic package standard benefits for insurance in the Netherlands include general practitioners, hospitals, maternity care, lab tests and medicines. Some insurers have negotiated contracts with larger health providers so patients need to go to these pre-chosen partners to be treated; while more costly plans allow patients to choose their health provider freely. One note though, if you need specialist treatment or tests, you will need a referral note from a general practitioner first.

The following reimbursements do kick in once the 150 Euros per year excess is reached:

1. In-hospital treatment – Hospitals stay and treatments are covered. Pregnancy is not fully covered as it is not considered an illness and does not merit medical insurance benefits - unless complications arise.
2. Out-of-hospital treatment – General practitioners and specialist are reimbursed, physiotherapy is not.
3. Medicine – Curative prescription medicine is covered.
4. Appliances, ophthalmic and dentistry – Necessary appliances are covered for everyone and dentistry is covered for children up to 18.

Funding
The private system element is financed at 50% from payroll taxes paid by employers to a fund controlled by the Health regulator. If you are self-employed or unemployed, you should contribute directly. Lower-income groups receive a healthcare allowance from the government to help them pay their contribution. On top of these contributions, the government contributes an additional 5% to the fund. The remaining 45% is from premiums paid by the individuals directly through their insurance premium or direct settlement.

Private Insurance
Private insurances are at the centre of the Dutch Healthcare system. Though they cannot refuse you cover for the basic package, Insurers can refuse to cover for additional packages on top of the basic one. These packages enable you to customize your level of cover as per your expectations, can remove the 150 Euros per year excess, or enable you get a private room in a private hospital; in addition to many other options.

The standard monthly premium for healthcare paid by individual adults is about €100 per month. Of course, this can be higher depending on the level of additional coverage you choose.

Healthcare Abroad
As the Dutch healthcare system is residency-based, healthcare benefits are not available for treatment received overseas. The only exception to this rule is if you move to a European Economic Area country and apply for a European Health Insurance Card (EHIC). This card enables you to access healthcare while travelling in Europe. For all other travel / relocation, you will need to get a private insurance covering you abroad.

YOUR INSURANCE OPTIONS

As the Netherlands has always been a country open to the world, they have a lot of expatriates. Dutch Insurers can provide expatriates with good international options through a wide choice of coverage and premiums. The advantage of such solution is that they offer a good bridge between national and international insurance provisions. The disadvantage is that they are based on the cost of healthcare in the Netherlands, which is one of the highest in the world.

As a result, many Dutch expatriates opt for a dedicated international insurance. The benefit is that their premiums are usually cheaper as they match the place where they are living and not those practised in the Netherlands. Furthermore, they know that Dutch insurer have to accept them when they to go back home in the future, so they can enjoy the best of both worlds.

If you wish to explore your options further, have questions, or need some guidance, give us a buzz.