Healthcare in the Netherlands: An Expatriate’s Perspective

Living in a new country, expatriates often feel vulnerable when trying to navigate and access the Dutch healthcare system. But why is that?

I trained in healthcare in my home country, Ireland, and previously worked abroad in Australia. That experience was different as I was younger and the language barrier was not an issue. But the Dutch system originally left me feeling vulnerable and exposed. There were a number of factors which influenced my vulnerability: cultural differences, language barrier, administrative processes and the often misunderstood eigen risico (an insurance coverage term that literally translates as “own risk,” which in English mostly defines “deductible”), expectation (Irish healthcare approach) vs reality (the Dutch way), adaptation period (when do you get used to the system) and the perception of entitlement (why can’t I get an antibiotic?).

The aim of this article is to assist newcomers in understanding the healthcare system and, more importantly, how to manage their expectations. No healthcare system is perfect, but the Dutch system works well when you know how to use it.

How does the system work?

The Dutch healthcare system is based on three levels of care: Primary (huisarts or general practitioner), Secondary (ziekenhuis, hospital) and Tertiary (teaching hospital); this article will focus on the first two.

Primary care can be notoriously difficult to navigate, so let’s delve a little deeper. From the outset, it should be noted, that although not mandatory, it is recommended you are registered with a GP. The rationale for this is because the GP manages all your medical complaints, prescriptions, and referrals. In other words, the GP is the gatekeeper of your care. When you contact the practice to make an appointment, a specially trained assistant will triage your care, needs and make the appropriate appointment. During that appointment, the doctor only has ten minutes, meaning they can only assess one complaint per visit. For this reason, you need to be your own health advocate.

In the Netherlands, a common approach to treating minor illnesses or common colds is the “wait and see approach” or “take a paracetamol and call me in the morning”. The GP often performs a pin prick blood test known as a CRP to monitor infection levels. This helps them decide if an antibiotic or a more comprehensive blood test is required. It pays to note that GPs do not regularly prescribe antibiotics, so again, you must be your own advocate by ensuring the blood sample is collected and ring the practice for the results, as often the practice may be too busy to ring you with the results. It should be noted that in some practices the assistant is trained to provide the results but if there is anything unusual, the doctor will discuss it with the patient directly.

The GP aims to treat the patient in the community and only when they can no longer provide the necessary care, they will refer you to the hospital. This is why it is not typical to have a referral letter made to the -hospital, and with a population of almost 18 million people, access to hospitals is well controlled. As expatriates, we find this tricky to comprehend. However, when a referral letter is necessary, the system works quite efficiently. Recently an acquaintance visited her GP, had an issue and was referred for a consultation with the specialist. Within a week, she had her doctor and specialist appointments and a surgical procedure completed. Depending on the issue, the typical waiting time for hospital appointments is 12 weeks or more.

It pays to note that not every fever or pain occurs from 9-5, Monday to Friday, so if you are sick after office hours or at weekends or holidays, every region in the Netherlands has an out-of-hours service or huisartsenpost. After 5 p.m., you can contact the regional number for help.

The secondary line of care is the hospital (ziekenhuis) and access to hospitals is tightly controlled by the general practicioner. If you have an accident, you can contact the emergency number 112. But it is not common practice for someone to visit the emergency room (ER) without a referral letter (verwijs brief) or being brought to the hospital by ambulance. In some countries it is normal to go directly to the ER, but in the Netherlands, the huisartsenpost is the preferred first step.

“In the Netherlands, a common approach to treating minor illnesses or common colds, is the “wait and see approach.”

When new to a hospital, patients need to complete an intake appointment, allowing the hospital to gather previous medical information. Sometimes this appointment is completed by the specific department you are referred to. You are then provided with a patient number and access to a patient portal, where your file is kept.

The hospital specialists (doctors) send reports to the GP as soon as your care is complete. The letter includes history, reason for treatment, type of treatment and any other information that is deemed necessary. More notably at hospitals, as in many countries, there are specialists for many different areas, for example, gynaecologist, internist, endocrinologist, etc.

Finally, it should be mentioned that all health centres and hospitals abide by the EU regulations for privacy. But if you are moving from one country to another, it is wise to always bring your medical records abroad. If you deregister from a Dutch practice, they can make a medical file for you to bring to another country, which includes the notes from the hospital. If, however, you are changing your primary care provider, then the practice can send your medical notes directly to your new practice.

About the author

Bridget Kelleher was trained as a nurse in Ireland. After moving to the Netherlands, she studied for a Master’s in Health Economics, Policy and Law at Erasmus University, having previously attaining a Masters in Law in Ireland. While living in Leiden, Bridget volunteered with ACCESS and returned to nursing at an international clinic. Along with entrepreneur Robert Weij, she recently established Healthy Expats with a primary focus on women’s health. In her free time, Bridget enjoys sports, music, reading, and yoga.

As originally published in the ACCESS Magazine.

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