Netherlands

In his daily prompt yesterday, Scott Andrew Bailey asks us about the “right to health”. I purposefully put that between quote marks, as obviously no-one has a right to health. We all get sick and die eventually. Okay, that was my autistic brain’s literal thinking acting up again. What Scott means is the right to medical care.

Scott asks whether medical care is something the government should provide for the people or whether it’s best left to the private sector. Are there drawbacks to your choice?

The answer to that last question is, of course, yes. Any system has its drawbacks. My answer to the first question, on the other hand, is: I’d like it to be a little of both. For my Dutch readers, the answer can be short: I like my own system best, despite its drawbacks, such as the mandatory copay and the diagnosis-treatment combinations which dictate that you’ll get care based on a diagnosis, not your needs. Those were a particularly problematic thing in mental health. I believe they’ve been altered to something else this year, but I don’t know whether it’s better or worse.

For my international readers, here is a little explanation of how the Dutch system works and why it has the best of private and public healthcare combined. Basically, what is called basic health insurance is more or less public, even though it is covered through the same insurers that will cover your additional insurance should you get it and the insurance companies are private. The government decides which care is covered under basic insurance and insurers must accept every Dutch resident for this package, regardless of health status. The basic package covers visits to your GP, hospital care, most medications, specialist mental health services (ie. services for people with more severe mental health problems), etc. Things that are not covered include physical therapy, dentistry for adults over 22 I believe, contraception (even though Christian parties have been demanding it gets put into the package to prevent women needing abortions), etc. When I lived with my husband, I had mostly just the basic package (I did have some physio coverage but didn’t use that) and I didn’t have to pay a lot of extra money for things that weren’t covered.

You can decide to get additional coverage for things like dental care, physical therapy, alternative medicine, etc. However, insurers can refuse you for those. They usually don’t for the cheaper packages, but then again getting these hardly outweighs the cost of paying for care out-of-pocket.

Basic health insurance currently costs about €133 a month if you want to have free choice of healthcare providers (I do). You can opt for a cheaper policy where the insurer has contracts with only certain providers and you have to pay 30% of treatment costs if you go to an uncontracted provider. Like I said, there’s a mandatory copay of €385 a year on your healthcare. GP visits do not count towards this.

Like I said, I think our system has the best of both public and private worlds. Before the current system was put in place, low to medium income people were covered under the sick fund, which was similar to the UK’s NHS, including its problems of extreme waiting lists and bureaucracy. People with higher incomes would need to get private insurance, but I don’t think it was much better for them, in the sense that those with private insurance would be treated favorably. That’s a good thing.

A note about those who cannot afford to pay for health insurance at all: as a general rule, basic insurance is mandatory and there are several ways in which the government aids low-income people, but ultimately if a person doesn’t pay at all, insurers have the ability to stop insuring them. In that case, hospitals can refuse care, but not in acutely life-threatening circumstances such as when someone has a heart attack. In that sense, you have a right not to die on the health system, but not an ultimate right to medical care.