Every country has its own healthcare system, some maybe have no system at all. When I speak with people all over the world, they think the Dutch healthcare system is one of the best. At least, that's what they have heard. I have to admit, it once was. In 2006 the government decided to change the system. Privatization as a method for competition and ‘market-oriented’ health care quality. Did it work? I will give my personal view and share some experiences.
When I was young, this was the RAVE-box. Now the box is back...
When I was young
In the 90's I left the house, 18 years old and responsible for my own life now. Paying rent, insurance and loads of other bills. Healthcare was one of them. I was studying and had a parttime job. Earning around 730 euro's a month and the rent for my apartment was around 120 euro's. The cost for health insurance those days: 11 euro's. And with this 'Ziekenfonds' (Health Insurance Fund) everything was covered, including all dental treatments, fysio therapy, mental healthcare (although not many people got mental healthcare those days), medicines, etc. When you went to a doctor, your could go without an appointment, but sometimes you were in a waiting room for 2 hours. The doctor only had a paper archive and nothing was digitalized. The doctor knew who you were and took the time to explain. When you had to go to a hospital, it did not take that long to make an appointment. And The Netherlands had 15,650,000 inhabitants.
The hype of privatization
In the new Millennium the government started to privatize more and more. Railway, Telecom, Post, Energy and Healthcare. All with the same reason: more competition, better quality, lower prices. I guess most of us know by now that privatization did not bring any of this at all. I can start ranting about all of them, but today I will focus on Healthcare. Nowadays we have 36 different health insurances, owned by 10 main insurance companies. In 1998 I paid 11 euro's a month and everything was covered. In 2024 I have to pay 130 euro's a month, plus 32 euro's a month extra for 'Own Risk'. This is only the fee for the mandatory Basic Insurance. The other big differences in 2024; for example dental costs are not covered, fysio is not covered, a large number of medication is partly or not covered, glasses and contact lenses are not covered and I can go on with more things. In 25 years the insurance got almost 15 times more expensive. And besides that I still need to pay a lot of stuff myself (the last few years this was more than 2,000 euro's per year). Healthcare has changed from a necessity of life into a big profitable economy.
Of course, in 25 years there was inflation. But if I compare my salary in 1998 with my latest salary in 2023, bit is not multiplied by 15...by far.
Let's focus on privatization in healthcare. If you are a resident in the Netherlands, you are obliged to have basic insurance. The fee I mentioned earlier is the minimum. Every year this fee increases. And every year thing they come up with another extra. Like the 'Own Risk' they came up with year ago. They increased this almost every year and now this is 3885 euro's per year. Until 1 year ago you could get a proper discount on you health insurance if you arranged this by for example your employer. This was called 'collective insurance' and an average discount of 15% was normal. The government stopped this, because this it would be more fair now. Like all the other bullshit reasons the came up with with privatization industries, prices increased more. It didn't reduce costs, it increased insurance premiums.
I will sum up the changes after Privatization in 2006. In 2005 the premium for Healthcare Insurance was around 30 euro's a month.
- Insurance premium went from 30 euro's to at least 130 euro's per month
- Introduction of an additional Own Risk, currently 385 euro's per year
- From 21 to 36 different health insurance brands
- Dental costs are not covered anymore
- Fysio is not covered anymore
- All kind of supportive tools (like glasses) are not covered anymore
- The waiting lists increasing big-time, 6 months isn't strange at all
- Every insurance needs to make a year contract with every specialist individually
- It's all about profit now, declared costs are insane
Improvement in healthcare isn't Rocket Science...or are we just fucked (by rockets)
Out of Service
It's not only Healthcare were service and expertise is hard to find these days. And I guess that some people are less lucky. My karma is also not that lucky... I've had a history in healthcare and received several wrong diagnoses, with serious consequences. Since I am traveling a lot and living a nomad live, things are not getting easier. Especially when you need healthcare. I will give a few examples:
THE HOUSE DOCTOR, alias GP
Maybe it's because I don't have a house anymore. Making an appointment with the house doctor (GP) is a huge challenge these days. For any health related complaint, you must first visit your GP to arrange a referral letter. You can only sign up at a general practice in your town of residence. And you can not change GP when you are already signed up at a GP in you own residence. If you have bad experiences with one, you can not change. Every month your insurance pays a fee, for you being able to visit the GP. Every 3 months your insurance pays a signup fee for the GP. Weird right, you signup once and not every 3 months. For every time the assistant picks up the phone, the GP declares a certain amount of money at your insurance. This is already where it goes wrong with healthcare costs. The waiting area at my GP looks like a hipster place (colorful useless decoration, chairs so stylish that nobody can sit on it, golden colored lamps and other ithems, travel movies on a huge tv screen etc.). You are only allowed to call and make an appointment for the same day. With 1 assistant, an oldschool telephone and answering machine and 2,095 patients, this is a very inefficient process. A waiting time of 30 minutes on the phone is 'normal'...if you get through anyway. When you finally reach the assistant, the answer is often...
Sorry, we are fully booked for today. You can try it another day.
Can you imagine? This practice has 4 doctors. The walk-in consultation hours have been abolished since 2020. They don't use e-mail for patients, but they have an online portal. You have to login with a Ducht Digital ID (DigiD). But this portal hardly works. I tried laptops, smartphones, VPN, no VPN. It's just a shitty portal. And guess what, you are not allowed to make online appointments with this portal.
Since last summer I am experiencing more health issues. For example from the entrance to both exits it feels fucked. Not that I am fucked in the ass, but you'll understand. I tried many times to make an appointment, it just didn't work. At the end of the year they even closed the practice for 2 weeks! And no replacement for the 4 doctors. There is always an option to visit at GP at the hospital, but they only take patients with life-threatening issues. Even at the emergency post of the hospital you will not be helped without an appointment. No joke, I burned my fingers a few years back at night and went to the hospital. I was standing at the reception of the First Aid area;
Sir, do you have an appointment?
Uhm, no...I am at the emergency post right?
Yes, but you need to have an appointment
Why? It's an emergency. I just burned my hands. How can I get help?
You have to call the emergency post first
Seriously? Didn't you listen and had a look at my fingers?
How can I use the screen of my smartphone when my fingers are burned?!
Sorry, but you need to make a call first
This was so ridiculous. I told them that they have to call me then and shared my number. They did from behind the glass and I picked up the call by tapping my nose on the screen of my smartphone. And we made an appointment. It would have been a lot easier if they put my details in without the phone-call, I was standing in. front of them with wounded hands. The waiting area at night was full of man, all wounded after stupid accidents. It was actually quite fun in there. The doctor took care of the wound. She told me that a Tetanus injected was needed. The hospital had it there, but they wanted me to do it at my GP. And guess what, my former GP didn't want to do it, because it was a waste of time for him.
Anyway, back to last week. I was so done with my GP and their way of planning. I just went there early in the morning and didn't leave without an appointment. They booked a double time-slot for me, because I mentioned quite a number of issues. I ad to wait an hour for my appointment. I started answering the doctor's questions friendly and with a smile. After the 2nd issue he already started to change the look on his face. He was asking me questions, that should be in my history in the system. As I also found out myself, the history in the portal went back to 2023 and a lot of stuff wasn't there anymore. He wanted to send me to a rheumatologist and I mentioned I already visited one a few years back. He could not find my history anymore... Wow, digitalization works well here. While we were at issue for, I asked a friendly question about blood sample and his reaction...
You really need to calm down and stop talking now!
Uhm sorry, I just asked a normal question on a normal tone of voice...
I am done with it, you are costing me too much time!
WTF?! Because there is a maximum of time of 20 minutes (each appointment can only be 10 minutes, no matter what), he lost control of his frustration, when he realized it was already 35 minutes. I had to leave his room. For more questions I should make another appointment, but not with him anymore...seriously? During this appointment of 35 minutes, he did not touch any part of the body to check and feel. I went to the assistant and she asked me with a rude voice;
What do you want?!
Uhm, I have to pick up some thing for the testlab downstairs?
Why?
Because the doctor told me to?
THE QUEST FOR BLOOD
I received the items and went to the blood sampling area. I took a number and waited for my turn. I showed the lade the letter that the doctor gave me. And she said;
What is this?
The letter from my GP for taking blood samples.
I haven't seen this before. Don't you have another letter?
This is what the doctor upstairs gave me. Maybe I can search for a referral letter in my e-mail? I asked here if they couldn't not see what they should do in her system, because the doctor upstairs put everything in the system. the answer was NO.
She started to discuss the letter with her older colleague. Her colleague recognized this type of form and grabbed her notebook with handwritten notes. It took ages, before she found it in het notebook. I was already reading all the referral letters in the portal to search for another letter, but there was nothing there.
And then she clicked on her screen and said;
Ah, I already found it!
You know what samples you have to take now? So it is in the system?
Yes, it is
Incredible. First they say it is never shared in the system by the doctor upstairs and all of a sudden it is there. Just to be clear. We all spoke the same language: Dutch
THE OSTEOPATH
I've had a few discussions with GP's about osteopathy, they seem to have a different view on your health. In the Netherlands it's quite hard to find a good osteopath without a patient-stop. Some Dutch friends in Portugal introduced me to a good one. First appointment was on the bill of my friends, so nice of them. A visit to a osteopath is twice as much as a similar visit in Portugal, it cost around 95 euro's (of course, not covered by the system). I visited the osteopath the same day as my GP and wow...what a difference. This guy listened to my complaints, explained everything in details, felt at several parts of the body, dived into my (medical) history. and even shared some Biology lessons...this al in 45 minutes. My main issue is food consumption and digestion, although I didn't knew some other issues were connected to that. I already started eating and drinking differently a few weeks ago. But also this 'Put-it-in-your-mouth-and-Swallow'-technique, is not made for food. I've been watching the wrong kind of movies when I was young...
Germans and their sense of humor
BESUCH BEIM DOKTOR
As I am spending quite some time in Germany these days, I am also trying to fix myself through the German healthcare system. Insurance-wise it's not all covered, because my healthcare insurance only makes contracts with Dutch specialists and hospitals (although it's an European Health Insurance). The big differences here in Germany? They listen and take their time. Digitalization is far behind here, it can take up to 20 minutes of paperwork, before you can walk in. Waiting lists are very short, within a week you can visit a clinic.
The German dentist is also an experience. I went there with my girlfriend, that I introduced as 'my translator'. The female dentist had this typical German name and I was not sure about the game here. Looking at me with this sparkle in her dark eyes, constantly touching me when she was talking. Was she trying to punch a hole in my shoulder? Was she trying to make my girlfriend jealous? Or was this just the way of telling me to stop talking? After this 20 minute annual check-up I received the bill. The place looked a bit luxury, but asking 12 euro's for this flirty inspection? I like this :) I left without holes in my teeth, maybe one in my shoulder.
I did rant a lot in this post right? I will try to end it with a smile. I always thought Germans were not funny. But in healthcare they are way more funny than most Dutch. One of the last specialists prescribed me some creams and tablets. When I received the pills from the pharmacy I had to laugh out loud... 'RETARD TABLETS'?! They are calling me a retard?! It took a few minutes to figure out that retard tablets are not made for retards.
Even my German girlfriend seems to be funny. While I am experiencing serious darm issues, she took me on a weekend to visit some friends. First stop: DARMSTADT Let's see if I have the GUTS to make friends... (The Dutch and German word 'darm', means 'intestine', 'bowel' or 'gut').
Health care is not that at all. It is sick care and it’s a really broken model. We have the unhealthiest people in charge of a lot of this and their only idea is to make money. The patient means absolutely nothing but they virtue signal to make it seem like they care. It’s a load of shit in a lot of ways and I hope that we can turn it around and back to where the patient is the important piece - not turning it into a factory conveyor belt if in and out.
Holy heaven! And I thought the Romanian healthcare system is a mess. I'm not saying it's better, but they don't treat people like that for sure. I don't envy you as most likely your blood pressure is to the roof, when you have to go to the doctor. It's sad though, that the more technology advances, the worse the healthcare system gets and with that, doctors too.
Just after posting it, the Dutch news also picked up the mess, Thousands of people can not even get a doctor, because the practices can not handle the amount of patients anymore, The system itself needs a good doctor now...it's totally sick.
It's sad honestly. You think in more developed countries the system is better, yet it looks like a badly managed business.
If this was the healthcare system, I would downvote this a 100% but as it's a post by you, I will instead make that a 100% upvote ;<)
Thanks, you should be happy to be quite healthy these days ;)
I am but being healthy and staying healthy is hard work too. I like to think that escapimg the (healthcare) system and The Netherlands have played a big part in this.
I really hope you find a way to make your way out of it sooner rather than later, too. It will sure improve your blood pressure, for starters ;^)
Glad you made me smile with the retard tablets and the visit to darmstadt.
Humor is the best medicine and it's free ;<)
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WEEHOO, that is some rant on 'our' healthcare system.
Close friends and family tell me their stories and experiences with the healthcare systems in countries like Switzerland, Germany and France. And when I hear those - and even without taking all that into account - I have my doubts regarding the healthcare system we have today.
Not sure if I ever experienced what you all experienced. That said, am not a frequent visitor of the system, hence don't have much experience. Although, the two times the doctors had to operate on me, the way I was treated from start to finish of the whole process, was top-notch, all the way through. Perhaps I was lucky, I dont know. Doors opened for me when they needed to be opened. The best surgeons took on my case. The best aftercare was provided.
But still, I hear you.
Regarding some of the statements you made, the cheap healthcare costs in the 90s versus what it is now. Please realise that in the 90s de 'ziekenfonds' was subsidised by all those peeps in the Netherlands who had to go for private insurance. For instance, my parents - for themselves as well as for their children, including myself - had to pay BIG ASS for the insurance since they were not allowed ziekenfonds, just because they were self-employed instead of being an employee. Not a very fair system. When all citizens are under the same regime, those who did have 'ziekenfonds' before the system changed, pay more in the new system, obviously.
The current system allows for paying less for an increase of our own contribution in case we use the healthcare system. I don't have numbers/stats ar hand, but I predict most of the youngsters to middle-aged peeps take that option, maximising their contributions in favour of a lower insurance fee.
These days up to 40% of the time is spent in administration. Partially such admin is required for the insurrances and whatnot. However part of such administration is also to try and prevent errors, as well as to have records whenever patients are pointing fingers at healthcare professionals. Again I dont have stats, but I feel too often patients are trying to blame healthcare professionals when something didn't work out as planned. Less admin means we shall stop blaming others.
Sure, I do think our healthcare system is far from optimal. Perhaps we need to go back to the 'ziekenfonds'. BUT BUT BUT when we do that, this system shall be for everyone, not just the average employee. But also for the not-so-average employee, as well for the self-employed citizens. Essentially, same system for all of us.
Of course it's understandable that the old 'Ziekenfonds' was too cheap. Although nowadays a large group of people can not afford the current healthcare costs. There are for certain expertises (like 'MDL') waiting lists in hospitals of around 6 months. I am in the middle of this now. If you followed the Dutch l news this week, you might have heard that in several cities people can not even get a GP anymore. The administration time in healthcare is ridiculous, but this is in more businesses these days. We should focus on helping eachother. It's insane that with tge current digital world, we spend more time on admin than before...at least, it feels like it.
I am volunteering as a caregiver and here I see one of the current issues with elderly care. Since the government stopped with the former type of retirement homes, a lot of old people live in a house. And tge are notvable to take care of the house andcthemselves. Most of them need care on all levels. But it was becoming too expensive for the healthcare costs to keep the former retirement homes open. What do you think it cost to send all kinds of care to every seperate home now? And not to forget all the planning and transport. If all this care was given in a retirement home (centralized for a large group on 1 location), it would save so much time. It would save a lot of people. It would decrease the amount of traffic on the road. It would make the the shortage of staff a little bit smaller. And not to forget, there would be more houses available. I see it daily that people can't live on their own anymore. But no, we let them live in a house (mostly) too big, send 5 different healthcare providers to them. And don't think the planning of this is efficient. The ready-to-eat dishes are even delivered by different companies, all with their own car on the road. Where is this paid from? Correct, health insurance...
This is just an example of the cause of increasing healthcare costs. And the other consequences that created more problems in tjis busy country. Money is wasted on profits for investors, profits in big pharma, ghost companies that declare for care that is never given and so on...I notice that my ranting mood comes back again. I will stop. It's nice to see that there are more Dutchies here.
I am happy that you are in good health at the moment and I also know people who had good experiences. I will share good news as soon as I experience it :)
You touched on a few topics that I agree with you.
Health at home: It would be much better when a single person can do all the things needed. The consequence is that most caretakers need more training/education I suppose. Not all are allowed to inject medicine for instance. But I believe it would be better for a caretaker who does e.g. injections, to also be allowed to do other things.
An organisation that is much more about self-management (less central planning, lower number of managers) in the eastern part of the country are doing much better than all the other organisations, efficiency-wise. Don't know the details though, and I do not even know the name of that organisation. Heard them on BNR a few months ago in a long interview.
Elderly homes: I do believe they must come back into our system indeed. Added to the reasons you gave, I do believe for many elderly who are living by themselves, an elderly home will bring more joy in life as well. Always peeps around. Much less chance of feeling lonely. Also less pressure on the family.
So cool you are volunteering to help out! Respect!
ps Not that I didn't use the health system, I did and I do. I guess I was fortunate no waiting lists for me. I felt it went way too quickly when after a diagnosis they wanted to keep me in the hospital for almost immediate surgery. I was able to push this for a few days so I could get things arranged at home and office, before landing on the surgery table.
Wish yo all the luck you can get ;)
Maybe I should stop in the East of NL more often. Which part do you recommend?
The only time I experienced no waiting lists at all, was during the years 2020 - 2022...when te world looked totally different. Traveling (by van and car) around Europe was also a lot more relaxed.
But I will look more forward and try to handle the current world :)
Not too experienced with the East. Lived for 15 weeks or so in Hengelo, back in the late 80s when working in Enschede as part of my uni education. Owww lived in Nijmegen and Arnhem as well, but that was 70s and part of 80s. Nijmegen has a great club, Doornroosje (a pop podium), so if I go back the the 'East' I perhaps would select Nijmegen just because of that club 🙃
Best one can do is accept the world as it is, and pick our fights and leave frustrations as much as possible. I know, easier said than done.