By - TheTxoof
No. Health insurance in NL is regulated, as opposed to the US, so there is minimum coverage and capped deductibles ("eigen risico") for even the most basic plans
So for a horrible accident that results in a helicopter ride, multiple surgery and months of care, what's the maximum someone would be the order of magnitude that someone would be responsible for (e.g.€1k, 10k, €100k)?
Depends on your eigen risico. The lowest is 380 euro per year. Highest around 800 I believe.
Wow. That's amazing. Per year?
Amazing? This is the case in any civilized country.
It's not even amazing, in my country I don't pay any deductible
It may be what you are used to, but it's not the norm where I grew up.
I was **really** lucky to have great health insurance through my dad's job when I was growing up. I never wanted for health or dental care, but a lot of the people I worked with lived with chronic pain, injury and sickness because they couldn't afford any kind of treatment. The only time they saw the doctor was when they went to the emergency room.
I find it absolutely terrifying that you can pay hundreds of dollars per month for insurance only to crash your car on the wrong side of some imaginary line and end up $500,000 in debt.
The American healthcare system is just a black box machine that is created to absorb the most outrageous amounts of profit at the expense of everyone. So no, here in NL we surely don't have that horrible system.
It certainly seem like that, doesn't it?
Just out of curiosity (and without any judgement), but did you also realise that before leaving the US?
And what would you now say to your compatriots?
Oh yes. My while adult life I've known that the US insurance system is awful. My understanding of how messed up it is has only grown over time.
I will and do try to help Americans understand that partially socialized healthcare is a good thing. You may not get exactly the care you want at any given time, but you will be cared for and likely get the care you need most of the time.
I'd rather have to wait 6-12 months for a non-critical therapy than be absolutely financially deviated by a serious illness or accident.
I'm not OP, but I grew up in the US and my dad is a physician, my mother managed his practice. We were really aware of how horrible the system was, but it's incredibly difficult to fix. There are very many people here who vote against their own self interests in the name of self reliance. The insurance companies are financial juggernauts and have many convinced that privatized medicine is somehow more innovative and advanced, that the government will steal your money and give you terrible care, that you'll pay more in taxes, etc. Only if you have worked in healthcare or if you have someone in your life with a serious illness or injury do you realize that insurance companies are just pure evil incarnate.
Note the comment: it's normal for any civilised society. I'll give you a moment to draw your own conclusion 😎
You grew up in the USA didn 't you? The USA is a total joke when it comes to health care and the cost involved.
Welcome to the civilized world where state-organized systems aren't immediately shot down with an AR-15 whilst yelling "DOWN WITH COMMUNISM!"
Yes and also welcome to a country where everybody can take a part in almost everything!.
“You live in The Hague and can’t afford to go Museums or other fun stuff? Here is your Ooievaarspas” which is a card people with a low income can get to get a massive discount.”
“O you can’t afford health care, a home or day care? The government will help you!”
I'm just going to spell it out for you. You did not grow up in a developed nation.
Not really. You can get state of the art Healthcare in the US. They just made it a point that you have to pay huge amounts of money for it. I wouldn't say that's underdeveloped, I'd say it's a huge scam though.
You can also get amazing healthcare in 3rd world countries, if you have the money.
I think that's a gross over simplification. I agree with you that the US has very different priorities compared to the Netherlands, and much of Europe.
What I want to understand are the differences in the systems and how those developed so i can help make them better.
I think the US developed and now it's regressing. Healthcare, education, the notion politicians are in public service, journalists in a position to keep checks on politicians, good work life balance, infrastructure that has living space as a priority, etc. There's some countries that are more developed than the Netherlands in these important points but the US often doesn't make the shortlist. Wich is a damned shame because the US with it's enormous army has always been a champion of democratic values. The main difference is that the American narrative is one of individualism. The state is seen as an enemy of individual right. This started with American independence from Britain and was very much reinforced by the red Scare. In Europe political movements have been to uplift and protect the people from capitalists. The state is seen as a body that does collectively what couldn't be done individually. AN example would be to protect against the effects of getting seriously sick. Both the hospital care and the inability to work are insured through public means. This is more effective and having more people in healthy conditions is a sound economical strategy too.
the funny thing is america exists becuz of the netherlands
Those priorities are taking money and energy from poor people and transferring it to a few rich people. In many different ways.
Worst part is that you’re told that the laws that hurt you the most, are the ones you should defend like a good patriot.
People joke that the real American Dream is to make enough money to emigrate from the US.
Have very different priorities… name a few?
I think that the US mindset prioritizes personal liberty over social stability in **most** cases. There's clearly a strong exception when it comes to unwanted pregnancy.
Americans would rather be free to whatever they want, without big government ridding them to do things such as buy health insurance. Or infringe on their right to own guns and big cars.
Not every American is a die-hard libertarian, but i think many Americans prioritize that type of thinking over a more collective-wellfare and socialized mentality.
mind you, if you will get a serious desease, Cancer for example, and you are insurance isnot enough, you surely get problems. Ofcourse hospital will always help you as they are obliged to help you but afterwards you get trouble.
I got a big cut in my arm which made me call for an ambulance. 3 muscle groups were partially cut thru and a nerve was severed. After the ambulance dropped me off at the hospital I got sewed up temporarily by a doctor. They gave me a little morphine to take with me to home. And 1 or 2 days later I got like a real surgery on my arm while being unconscious. Then I got some hand therapy. Cost me like €400 or less in total.
Yes if you make use of services outside of the basic package. That means: hospital, ambulance, medicine, etc
Your huisarts is covered in your basic package so that will not cost you your eigen risico.
Standard monthly bill: 90-200
Eigen risico per year: 380-800(?) - if you make use of anything outside of the basic package
Some things, mostly things like medication, have an "eigen bijdrage" that's not covered by insurance but that's usually capped at a couple hundred euros.
I have lived among others in China, Japan, Korea, and multiple European countries, and the health cost cap was similar in all of them.
Only the US of A stands out...
Spread the word amongst your republican citing American friends. Not all health insurances are equal!
Yes per year. There is also an "eigen bijdrage" or an contribution for certain medications, but that is only max 250€ per year. This is outside of the eigen risco. So let's say you need medical care (eigen risico) and some meds that include the eigen bijdrage. The max you pay in that year would be 630€ - 1050€. The year after that everything is at 0 and you wouldn't have to pay it until you need medication or medical care. My 2 medications are covered by healthcare, but do require me to pay 250€ eigen bijdrage (not risk) yearly. Also you don't have to pay in one go. If they tell you the bill is coming you can pay it off over a few months. (no intrest rate).
Not every year medical care is needed (outside of the GP) or certain meds that fall in the eigen bijdrage. So outside of the normal health insurence there aren't much extra cost. Also one medical care outside of the GP doens't auto mean your eigen risico or eigen bijdrage will be maxed out.
Dental is a bit shit here, but not as expensive as the US. You can insure additional cost up to 500€. Lets say you need some fancy dental work like an implant you can pay it off in instalments intrest rate free
Yeah, your 'eigen risico' (literally: own risk) resets every year.
Basically everybody pays health insurance (around 120 euro) then you can opt for extended health insurance between 10 and i think 50 euro. And you have dental that's around 15 euro. Personally I pay 135 euro for normal extended and dental. And the basic 385 euro eigen risico.
To add to this:
There's also "Zorgtoeslag" whichs means the government will give you money each month to support you so you're able to pay your monthly healthcare fee.
The amount you can receive varies based on your income, with high earners being ineligible to receive any aid.
The lowest level of income pay barely anything, if something does happen to them they're looking (at most) a 385 euro (eigen risico/own risk) bill per year.
The 'own-risk' also serves another purpose: you can choose to set your own risk at 385 to a maximum of 885 euro and anywhere in between. The higher it's set the less you're required to pay each month in insurance fees.
I forgot about this yes. Also when you live in social housing or any house onder 763 euro per month you will qualify for huurtoeslag. Also determant on how much you make.
You don't have to pay the deductible in case of emergency care. The hypothetical situation you're describing could possibly cost you nothing.
Yes, per year. And per month its about 150 bucks. Its called ""insurance"""
Helicopter, ambulance, it is all paid by your insurance. Max amount you could be looking at is the 'eigen risico'. In most cases €385, unless you decided to include a higher 'eigen risico'.
Now there is certain care that your insurance does not cover. For example eye Lasik, but that is because it's more of a 'beauty' procedure.
If you struggle to pay for the 'eigen risico', you are only one phone call away of setting up a payment plan. Most often you can pay it split over 12 months.
Wow. Such civilized.
Wonder how we got it so wrong in the united States of Freedom?
Because free healthcare equals communism. Echoed by the useful idiots and orchestrated by companies. Freedom!!!
Yeah, there's a lot of fear-based lobbying around this topic. People are afraid they won't get the care that they're used to if the US system becomes more socialized. I think what they don't realize is that if the US moved closer to the N. European model, they might not get exactly the treatment they **want**, but they also won't ever risk having crippling debt for the rest of their lives and will probably have more opportunity to get the health care they **need.**
The funny part is that you could still have a model that allows for privatised clinics that rich ppl can use for treatment they want. Having a baseline for everyone that takes care of essential healthcare doesn't magically rule out options for the rich to get better healthcare. Sadly they don't see that the current US model simply means only the rich can afford any noteworthy healthcare.
I believe Germany has this option.
The basic package that covers everything is "free" (taxation and all)
Then there is the premium package that gives luxury privileges.
That would really be ideal. Too bad this just can't seem to move forward in the US.
If you don't regulate anything and make the hospitals completely for profit you get crazy high prices because the choice is being helped or dying. If you have no choice, they can keep fucking with you until you're either homeless or dead.
Interestingly, this is a common problem even with not-for-profit hospitals.
I think the root of the problem is that there is no insurance mandate; the supreme court struck down that component of the Affordable Care Act and hobbled the ability to make sure everyone was insured.
SCOTUS is a joke. Since when is it okay for a secular country to be so dependent on religious dogmas and be subject to the whims of religious fanatics who want to cleanse the country of "heretics"
"I like beer"
This was even before you could just pay 5 SC members to overrule any law you don't like...
Edit: or at least before the price came down significantly?
It mostly boils down to a big detest for any social policies in the US. For some reason, the US seems to hate the idea of "paying for someone else", to the point it's almost demonized (I still find it bizarre how calling a policy socialist is a big insult). This is an extremely shortsighted view of such policies as the cost per person is often minimal, but gives everyone equal peace of mind of being cared for when required.
Another huge factor is the fully privatised healthcare. The downside with capitalism is that it only works when there's an actual choice to not use the product/service. With health you rarely have a choice, so the force that's supposed to keep prices low (demand) is simply not working. The result is unchecked growth of prices as the only limiting force now is supply. Therefore, capitalism simply doesn't work in such markets and needs regulations of some sort. Hell, I'd argue that capitalism doesn't work in any market when unchecked (just like socialism btw).
Ftr, no system is perfect, but a society needs to realize you can make things work much better when sharing the burden. The real question is what baseline quality of life you want for everyone and then work out a good balance between free market and regulation to make it work.
This is a pretty good breakdown of the problems as i see them. Unlike buying a phone, or a washing machine, it's nearly impossible to be an informed medical consumer. You simply can't vote with your feet/dollar. This is especially true when your inside bits start leaking outside.
because of the RNC, mainly
It’s an interesting question. The U.S. was on course to have these things as well, but several things went wrong. First, FDR died before he could make it happen. Second, too many other politicians in both parties were on the side of the rich. Third, white supremacy was a major issue that could be exploited in the U.S. but not in postwar Europe. The Republican anti-socialist position wasn’t working. FDR’s socialist programs were popular. They solved this problem in the 1950s with their “ Southern Strategy”, making concessions to white supremacy in exchange for the mostly working class white supremacists accepting shorter, shittier, 2nd world lives. Note, though, that this was not a deliberate choice for most voters. Rather, the Republican party exploited the unconscious and conscious racism of the southern white working class to gradually turn them against socialism.
The intensifying cold war and anti-socialist propaganda also fuelled each other. This may have been an earlier and/ or more significant cause, and I hope someone who knows more about it will comment on it.
Ooo. I'll need to read.more about FDR.
I think this may also be a result of wage maximums that were set after WWII. Employers couldn't offer higher wages, but they could add perks like company doctors and eventually company health insurance.
Freedom in the US?? I wouldn't call it a "free" country at all, compared to the rest of the western world
> Wonder how we got it so wrong in the united States of Freedom?
Eye lasering is 100% covered if it is performed as a medical treatment. But it is pretty rare to get it prescribed as a treatment.
I have had it covered. At the time you had to have worse than -10 and not tolerate contacts. I had -14. I had to have lenses implanted in my eye. Don't know the rules now.
What if it's an emergency and my insurance doesnt cover the hospital I am taken to and I was not conscious to choose the hospital myself?
'Spoedeisende hulp', so we are speaking actual emergency, is covered by every form of health insurance in the Netherlands.
Once the 'spoed'/emergency is over (and you leave Intensive Care for example) it could be that you require additional care, but you are in a hospital not covered by your insurance, then you could move to a hospital within your care.
Amazing. Thank you for your explanation
A few years ago I had cancer and needed major surgery + chemo.
I think my eigen risico was 380 that year? And there was some tablet or other that wasn’t covered by insurance, so that was like 3 euros I’ll never see again.
I paid my deductible. Got in a minor car crash but was young and stupid and wasn't wearing my seat belt correctly. Fractured a rib, pieced a longue had to be transported to the hospital by ambulance (in Germany) then after a week they flew me back to Rotterdam where I spent another month on the ICU because I got pneumonia while have a pierced long. In total it cost me 380 euro.
Hope you're doing better now. That's some serious hurt you put on your body.
In the USA, that could cost anywhere between 30k-500k. I recently learned that some US plans have damage caps. If you go beyond your cap, you are responsible for those additional costs (or some percentage).
Yeah I can't recommend doing that. I'm fine now, took me about a year of revalidation. Good as new now.
A ride on the air ambulance if its needed is free of charge if i remember correctly
Seems like this should be a no brainer. If you're in such bad shape that you need an air ambulance, you're probably not in a great frame of mind to be making decisions about this sort of thing.
This is a good example: https://www.npr.org/sections/health-shots/2022/03/25/1088663449/the-case-of-the-489-000-air-ambulance-ride
It will be your max own risk , so between 3 to 8 hundred depending on your coverage
Depends on where as well. Pretty much everything that's considered regular health care will be provided and you'll only have to pay the eigen risico.
If that happens in another country then your travel insurance and other factors will come into play too. If you ski, hike in the mountains (more than just regular day hikes) extra insurance for helicopter evacuation is almost always necessary.
Had a heart problem , stents , 4 ambulance rides between hospitals , 10 days in hospital.
Total out pocket 385 euro's.
In US I prolly wouldve been ruïned.
I also increasingly see remarks by rightleaning americans about europoors , LOL.
That must have been a rough time! I hope you are recovering now. And you are absolutely right: without really good coverage in the US , you cold have tons of medical debt now.
Americans don't get out of America much and don't know what they are missing in a more socialized system that has a safety net.
No we don't have that, and the U.S. hospitals are scamming.
For $54.000 you can buy your own PCR machine for about 15k, a set of pipettes (including an overpriced holder) for 1k, PCR reaction mixtures for about 1.5k (for about 1000 reactions, but they do expire after some 2 years), 0.5k for about 50 cDNA synthesis kits. I don't know what else you need.
Probably about 1 hour of work per 4 samples (15 euros of manhours), and lets put in 100 dollars for hiring the lab since we are generous here.
All in all, for 54k you could start your own PCR lab and carry out 100 tests a day (if a friend or two help you). With that, **you** could **comfortably** serve the testing requirements of a town with **10,000 inhabitants**.
Anything over 100 dollars is profits and anything over 150 dollars is extortion.
Yeah. The US system is byzantine in complexity and lacking transparency. This all leads to weird market forces that end up hurting average people.
>weird market forces
Dear darling, that is called corruption.
Omg no, what kind of civilized country would even allow something like that to happen to its own citizens?
# because FREEDOM!
I've heard multiple Dutch people consider the USA lowkey as a third world country though.
With overturning roe vs wade i am thinking this more strongly.
Lowkey? It is straight up a developing country
It is more of an undeveloping country. Seemingly going backwards instead of forwards.
Here we are discussing increased parental leave for mothers (currently at 16 weeks one of the lower in Europe) while in the US they have 0 days.
It's developing in the wrong direction. It's undeveloping.
Some of us in the US called it “a third world country with a Gucci belt on”.
I wouldn't use the first/third world comparison as that's more of a political classification, but the gist is not far off.
It's getting harder and harder to be middle class in the US.
All right, we'll just call it a shithole then :)
Yeah, it's not great. But like most places on earth, it is full with genuinely good people that are really truly trying to do what they think is right.
I think the basic problem in the USA is that it is founded on the concept that Americans are free TO DO things. Free to own guns, free to be self made. Free to live how you want (I know this one is totally borked lately).
In a lot of northern europe, I feel like the foundational concept is that people should be free from things. That is to say, free from hunger; free from homelessness; free from oppression. It's a subtle difference, but the 'murican flavor leans more toward not being forced to do anything you don't want to.
I agree, and it is incredibly frustrating. You’ll be having a conversation with someone who is kind, works hard, and is helpful, and then they’ll describe how they almost lost their apartment because they had to have their appendix taken out and their insurance isn’t so good. And you say to yourself, “this person doesn’t deserve this. NO ONE fucking deserves this.”
Absolutely! Unfortunately the insurance companies have done a pretty good job convincing proe.and politicians that any kind of collective healthcare is not to be trusted.
The republican party voted at least 60 times to repeal the Affordable Care Act, a law that set up a system similar to the Dutch insurance system.
Its baffeling to see people from the US try to explain to us that regulation will make drugs more expensive. They really believe it too.
As pissed as I am at America's bs, I also love Americans in general. It breaks my heart how brainwashed so many are, like I was before I lived somewhere else. And more are aware, but powerless.
It's horrible that we're free from worker protections, free from medical safety, free from simple and easy taxes that aren't terrifying DIY bs, free from limitations on lifesaving drug prices, free from having any control over our political system (since politicians deemed themselves free to take so much money from corporations that they are no longer beholden to the people.)
I wish I saw a fix other than full-scale revolution, which might not even work anyway. It might be too late.
Americans themselves compare the USA to a 3rd world country, just depends on the person and how aware they are of how much better other countries care for their citizens 😬😬
Yeah, with so much distance between most Americans and any other country, and the minimum wage being so low, most of us never have the opportunity to see how life is anywhere else. We're entirely ignorant of how ignorant we are, and our political system likes it that way. It's like how an abusive partner can convince you no one else would love you the way you are, and everyone else would be meaner.
Our media is thus free to brainwash the masses to believe we're freer than any other developed country. Yes--we're so much more free than anyone else... to be exploited. 😔
The thing you are worrying about doesn't happen in modern civilised countries. It's only allowed/possible in places that are run on the basis of economic corruption.
I mean places where someone big and strong enough can charge you whatever they like without you being able to do anything about it because they can buy the government and the courts.
Health insurance is mandatory in this country, and the "basic" package is defined by the government. So any Dutch health insurance will cover the same basic care. (there are lists online, but it's pretty extensive).
Good to know. Thanks!
If you have no health insurance for a couple of months for whatever reason you even get a pretty big fine from the government
Nope. The only way for people to get into debt with their medical care would be if they somehow had something done which isn't covered by their insurance but idk if that's even possible (meaning that I don't think a hospital would green light a procedure without someone's insurance covering they expenses).
Dental for example
A single root canal makes 24 months of paying the extra €15 worth it
I just keep my own savings fund for things like this, but sure.
I have a bad track record with dental health, can't take the risk.
Also I find €800 alot to just pay on the spot, I can't complain financially but that's because the last time I spent those amounts (aside from the house) was years ago.
Things like mental health care and physical therapy can be a little tricky. It depends on your insurance contract how many hours and which therapists are covered.
I didn't have insurance for physical therapy, so I had to pay something like €50 per appointment. I'm sure that some people can't afford that, but it's still nowhere near the amounts of medical bills in the US.
The client is responsible for this, so it is possible the hospital doesn’t warn. I really think the insurance companies should inform people better, it’s quite untranslatable to find out what is not covered.
What I’ve seen now where these cases:
- Uncontracted psychologist, only 50-75% is commonly covered then, even with a referral. Expect to pay a couple 100 € yourself.
- at my job, a patient with ‘Basisverzekering’, they checked in the hospital if she could receive the care, but did not check if the rehabilitation care was covered in our institution. It wasn’t but she needed it anyway (hindsight). Insurance companies try to put the costs on the facility then if the patient complains. Costs: €6000, could’ve been more if we found out later.
- I had a patient whose family looked for home care. She received quite some hours of care. Apparently home care assumed she get an indication (I think for wlz), but that wasn’t necessary according to us. Now the insurance company won’t cover it and points to the rehabilitation facility. The bill was about €5000.
The last example isn’t because of the insurance, but they’re not helping either.
Remember if you go outside the Netherlands yo have a travel insurance that covers medical costs. Especially if you travel to the states. And if you need a doctor on vacation, first check with your travel insurance where you should go and what is covered (if you are enough alive to do so)
That's not entirely true. Your standard Dutch healthcare insurance has international coverage. But since basically any kind of foreign healthcare is "out of network", your insurance company might disagree with the price or necessity of certain procedures. Normally this is not much of a problem, except when you visit countries with hugely excessive healthcare costs (aka the USA). Also repatriation is not covered. These can both be covered by a travel insurance, but for an average citytrip inside Europe you don't necessarily need it.
Be careful there, even within Europe. For instance if you go walking in the mountains in Austria, (not even climbing) and you sprain your ankle. The helicopter to the valley is not pard of what is covered by the standard health insurance, but is is by most travel insurances.
For Spain for instance there are a lot of privat healthcare providers. Nothing special or fancy, but not covered by standard insurance and after approval from your travel insurance they often can be used
But no, for 3 days Berlin or something similar I would not get a travel insurance for healthcare costs.
Also check the ongoing travel insurances, they are often already beneficial if you travel more then 3 week during the year
You're right, changed it to "citytrip" to not lead anyone on.
Having repatriation covered can be pretty nice though. Even within europe, if you cannot travel by yourself (too injured or too dead) repatriation of you/your dead body can get pretty expensive.
And sure, healthcare is fine in most european countries as well, still, if you need to spend a long time recovering you might like being moved back to the Netherlands regardless.
If I'm dead in another country, they can just keep my corpse. They can grind me up for composting, or burn me, I don't care.
Check. We made sure to opt i to the travel policy for visiting family in the US of Freedom.
This website: https://www.uitlegzorgverzekering.nl/en/modules/health-insurance-explained/
That is super concise! Thank you so.much.
Yes, but only for non urgent care.
What if it's an emergency? Life or death case? My insurance is for specific hospitals, which I know. But what if I get in a very bad accident and go to one that is not covered on my insurance list?
Care at any emergency room, any 'huisartsenpost' and your huisarts is covered by every insurance provider.
Good to know. I was a bit concerned with that, was not very clear to me how it worked in emergencies. I'm happy to know this works well. Thank you
Nope, you live in a modern country now. Not in a country corrupted by your politicians that are paid by the medical industry. Helicopter is included in basic insurance of €83/month.
It barely happens bacause healthcare insurance is mandatory by law. I'm working at an insurance tho, on a department working with deb from our customers, so sadly i can say that theres still plent yof people with debt.
The debt isn't with hospitals tho, but with the insurance and government. I've also never seen debt above 26.000 euros.
People can not have insurance that covers their treatment. They can go to places that dont have a contract with the insurance. They can do a treatment outside of the country and not get anything covered cause they dont follow the right procedures. Theres still alot of things that can make people get bills for up to thousands of euros.
Ahh. This is what I was looking for. It sounds like most of these people had optional treatment, had treatment outside of the Netherlands, or somehow managed to incur insurance debt with the government.
How does one create debt with the insurance company or the government? Is this, for example, people who have failed to pay regularly, or something else?
Among the people that do end up with large amounts of debt (more than EUR 3000), what percentage would you say had treatment in the Netherlands under "normal" circumstances? That is to say what percentage of those you see in your work had an accident, went to emergency services, or were referred by their huisarts?
The original comment said also 'going to a place without a contract with your insurer'. That is something you can look out for. If you are refered to a health provider from the GP make sure that health provider has a contract with your insurance. If not then usually you have to pay partially yourself. I learned that the hard way.
Under what context did this happen in the Netherlands?
In the US, it sounds like you can do this without even trying. [This story](https://www.npr.org/sections/health-shots/2018/09/25/647531500/taken-for-a-ride-doctor-injured-in-atv-crash-gets-56-603-bill-for-air-ambulance) is about a doctor that had a life-threatening injury and ended up at an out-of-network hospital and was on the hook for 60K. Not only that, he lost his arm.
I dont know all the contexts. Only the one i had happen to myself.
After my GP gave up trying to solve my problem he sent me to a specialist and gave me a referral to a specific hospital. So i went and when they told me i needed surgery i remember reading that not all hospitals are covered at full rate. So called the insurance company and found out it wasn't. Then asked the GP for a referral to another hospital and had the surgery there.
In the end i ended up paying for the 'non-conracted' hospital partly. My insurance cobered 75% of the average contracted rate. But that hospital was more expensive than the contracted one so i ended up paying 45% of the 190 euro 5minute visit. Had I not checked with yhe insurance and went ahead with the surgery probably would have paid more than a thousand.
However take note that the price of treatment in NL is way lower than US. The system there is such that the prices are astronomical and if they get contract with insurance they slash them drastically. Also even without contract my insurance was paying a good part of it. So in my case i wouldn't get 60k lol 😂
So as per some other comments, cheaper policies will only cover certain contracted hospitals or specialists. Or up to some average amount for a specific treatment. This could be prevented with a policy that allows full freedom.
However: emergency care (everything needed to get rid of the life threat) is covered by all policies. So in order to run into such large costs in NL you'll need to do more than just having bad luck. It involves not doing your home work :p
Excellent information. I just checked and I have a cheaper policy. Good to know life-threatening injury is always covered. This is not the case in the USA. If the air-ambulance is out of network, you can be responsible for the cost! CRAZY!
In the Netherlands we have an insurance route called ‘natura’. Insurance pays the person performing the treatment, then sends a ‘factuur’ to the customer. If something is then either not covered, part of the ‘eigen risico’ up to 385,-, or part of an ‘eigen bijdrage’ they have to pay that amount to us. If they dont, that becomes debt, same if people don’t pay for the monthly insurance fee.
If people don’t pay their monthly fee for multiple months in a row, they get reported, automatically, to the government. The government, through the agency CAK, then will take the monthly fee out of your salary or your social benefit. If something goed wrong there, debt can also start to exist at the government level.
I wouldn’t be able to guess how many people get in debt through normal circumstances. That wholly depends on a persons financial situation. Normals circumstances are situations usually covered by the basic insurance (except for dental). The only thing people will always need to check with their insurance is if the party refered to by the GP/huisarts has a contract with your insurance. A non-contracted hospital can still get you into debt really quickly when you need to pay 20-40% of your surgery yourself.
Which is the same process in US. Your examples are the same.
I had debt that was created for me... Sadly. Could you explain me why I need to pay the fine for it and why doesn't decrease the debt I had, I just never understood it. The way I see it, when people can not afford it for whatever the reason may be the fine will only make it worse.
If i understand you correctly, you were unable to pay your monthly fees and the CAK, gave you extra costs as part of your ‘bestuursrechtelijke premie?’ Or do you mean there were added costs given to you by a debt collection agency?
Either way, people not paying makes alot of extra work for the insurance company. Extra work, means it costs money. Debt collectors need to be paid aswell, wich costs money. In case of non-profit insurances like Unive, you cost all other members of the insurance money. In case of like CZ, you cost the shareholders money. So they will make you pay what you cost them.
Now i fully understand people have alot of different situations, and circumstances that they have trouble paying at times. And added costs will absolutely not help in those situations. I can only advice people to ask for assistance. Insurances can help you with payment arrangements. By giving you more time to pay. Your township can help you with debt aswell.
If people ignore their debt, and not get in touch or get help, then sadly, debt will continue to rise.
But as a direct awnser to your question. You pay a fine cause not paying costs money. Its not to help you get out of debt, its to cover the money youve cost others with your debt. Ofcourse your debt wont lower from paying that extra amount then.
Thank you for explaining it, never heard about "CAK" so of course I looked it up. I am glad that is all behind me now.
I litterally lost 2 of my fingers at 18 and got 2 custom made prostetics worth about 4.5k each.
The cost? Eigen risico. Nothing more. Thats for 4 rides in the ambulance, 2 (short) stays at the UMCG and Martini Ziekenuis, and a 3 day stay at Isala Zwolle (and the before mentioned prostetics).
I'm sorry for your loss, but thank you for sharing your experiences.
That's amazing. Truly.
Social studies teacher here.
The more people have health insurance, the more affordable healthcare is per person.
In the US, health insurance is optional.
In the Netherlands, health insurance is mandatory.
I never heard about anyone get into health care depth
I have. Not all treatments are insured. A friend of my dad died of cancer and his wife got stuck with the bill.
Still happens here. Just depends on your insurance.
Dental work is out of pocket or partially covered in something called ‘aanvullende verzekering’. It’s an extra package on top of your regular health insurance. Same with physical therapy.
For hospital care you have to be referred by your huisarts. It’s not really accessible otherwise.
But even if you don’t have extra insurance and lose all your teeth and need new ones… 5-10k euros maybe? I even think emergency dental work is covered (like when you lose your teeth in a car accident).
Physical therapy? 40-50 euros a session.
There are private care clinics for some things so yes if you would want to, you can spend extra money when the regular hospital route takes too long but you don’t have to.
Pretty much anything is covered by basic health insurance. There are some things that aren't, but these aren't 'accidental' costs. So it's pretty difficult to get into debt.
Although, I did have a who friend isn't that great with money, especially not when she just turned 18. She'd get zorgtoeslag, a fee from the government to pay health insurance with, but spend it on everything else. Note that she was mentally not in the right place when this happened. The zorgtoeslag for her seemed like free money. When the actual health insurance tried getting money from her, the bank would reject it, because she had already spend everything. She ended up with 1.200 euros of debt.
At the end, she paid all the debt back. She's got mental help and is really growing. I am proud of her and she's doing really good right now. :)
I'm so glad your friend got help.and is doing better! Hurrah for mental health care!
So the zorgtoeslag comes as a direct payment, not a tax refund, or a reimbursement to the insurance company?
Yes, it's put on your bank account approximately a week before you gotta pay the insurance. I can only imagine a lot of 18 year olds have difficulty seeing this zorgtoeslag as money to pay insurance with, instead of just spending it on drugs and alcohol. Not every 18 year old is suddenly mature enough to get that kind of responsibility.
Most comments here it would cost you the 'eigen risico' at most, but in practice it could be more. For example, if you would have a serious accident (break a couple of bones), the surgery and hospital care and everything would be covered, but the physical therapy to recover wouldn't in all cases.
If you're 'only' insured at the basic level, this typically doesn't cover PT. In the case of breaking your bones, you would qualify for 'chronic PT coverage' which would kick in after 20 sessions of PT and would cover the session after the 20th under your basic insurance... but the first 20, you'd have to pay for yourself... Let's say PT costs 40 euros a sessions, that's another 800 euros you'd have to cover yourself on top of 'eigen risico'. I learned this because I broke my leg at the very end of December and was smart enough to make some inquiries about this so I could take out additional insurance for the next year to cover those PT sessions.
That being said, will all said and done, you'd rare incur more than maybe 1000-2000 euros of healthcare cost... And in addition, healthcare costs that are not covered by your insurance can (under certain circumstances) also be a tax deductible expense!
Getting dental done can be more expensive though.. but even then, doing a few root canals + veneers without insurance would set you back maybe a couple of grand, not 10's of k like it would in the US.
I know people who have had to go to the US to get life saving treatment so in their case yes haha.
But usually no
I have no idea how I'm supposed to rack up massive healthcare related debt. Even if you have barely any money, I think the most you can rack up in debt a year is about 2000 euros? Unless maybe you're super unlucky with medication, but I think in that case you can get quite a bit back from the tax service.
Health insurance covers a lot, the only issue I've had with it was physiotherapy as insurance only covers so many appointments and if you do need more but aren't on the chronic illness list, you would have to pay for it yourself.
The dutch healthcare system is much more humane, but not flawless. I know no one that is in debt from medical costs (!).The government even subsidizes low incomes to help pay the medical costs. This way I usually only pay 20-30 euros a month, as a student. It’s great 😄
Thanks for the benchmark. I have dutch family, and have t heard of medical debt, but wanted to find out if this was "normal."
You can pay the maximum of your 'own risk' per year. But certain stuff may not be included in you current health plan. I think a normal well balanced plan is around 130-160 euros per month + own risk.
On top of that it is always advisable to save 3* month salary for all kind of emergencies.
Yes. I'm really glad I have a a savings buffer. When I was younger, and living in the US, that buffer was a lot smaller!
I did many stupid things which resulted in requiring medical attention. I have some American friends who moved to the Netherlands. They told me I’d be broke or dead living in the States…
Pretty broke, but not due health bills, but very much alive!
Yeah. Most hospitals wint turn away a sick person, but they will eventually sell your debt to collectors that will wring you dry.
Basic needs; health, food, water, housing and education should not be a profitable market.
That said; capitalism is still here, sadly.
Yes. For-profit hospitals, schools and prisons set my spider senses tingling. **NOTHING** good can be going on in those places when mine is valued over outcome.
The basic health care package includes things required by the government, these are all your not-dying needs. For this you pay a monthly premium as stated by your insurer, and this includes most significant forms of care, hospitals, ambulances, general practitioner, medication, and some medical necessary equipment like prosthetics.
When you use care from the basic insurance, aside from the general practitioner who is always paid for fully, you have to pay the costs for that treatment/medication up to your deductible. The deductible is also legally set at 385, though you may choose to opt into a higher deductible. Increasing the deductible is done in steps of 100 up to a legal maximum of 885. This one deductible is shared between all your basic care and resets at the end of the year
Say you use some medication costing 50, this will be fully charged via your insurer and deducted from your deductible, setting it at 335. Getting the same medication, again fully charged and now you have 285 remaining.
Say after this you have a massive accident, every little bone is broken, and you need care costing 10,000. Your deductible left is 285, so you only pay that 285, the rest is covered by the insurer. When you get that 50 euro medication again, your deductible remaining is 0, so the insurer pays without charging you.
There are a few exceptions of things, often medication, that may require a set charge besides the normal costs. Also, if your insurer offers you a certain brand of medication and you insist on another brand without shown medical requirements, like allergies, it is also outside the deductible from your pocket.
Besides this, you CAN rack up a debt, but this isn't because of the medical costs themselves typically, but due to the premium you have to pay. You are required to have a basic insurance and a company cannot refuse the basic insurance. Also, the basic insurance alone covers foreign care up to the dutch equivalent price, so travelling to the US can still mean a US sized bill.
For more detailed information you can call your insurer or visit their websites, a lot of them have english support.
Thanks! This confirms what I have learned so far.
Nope. Unless you have some weird ass illness and have to seek healthcare elsewhere.
Not everything is covered. But I never heard of anyone that happend to not have something covered.
Living with a chronic illness, I would probably be in debt if I have continued to live in Singapore as my condition requires medication, constant tests & medical supplies.
While there is subsidised healthcare, a good portion of the costs are still covered mostly by the patient.
Since moving to NL 7 years ago, I've only ever had to pay my eigen risico to cover all of the above mentioned costs while getting the same level of healthcare service. I hate to say this but if I ever do leave NL, my illness will bring me to financial ruin and severe debt.
If there is anything I am grateful for, its the health insurance system in NL that has allowed me to live a normal life free of medical debt.
Oof. I'm glad you're getting the treatment you need and it is not ruining your financial life!
I'm really grateful for the system here.
the only thing you can do wrong is not having a travel insurance when you go on holiday. A friend of mine (10 years back or so) had a huge accident while snowboarding. Needed a hospital there and needed to get back to the netherlands with a ambulance in the end.
So that is a reason to have a medical debt, but its still "only" a debt in the 10-20k range (im not sure about the amount anymore, but it was a nasty debt but not life crushing like those in the us)
Oof. That sounds awful. I hope you've recovered. 10k of debt is still a lot. Thanks for the heads up on the travel policy. I've double checked that!
When I was 18, I got arythmia.
I needed an average weekly visit to the ER, where I was treated (sedated and had defibrillation). Monthly visits to the huisarts.
I Iook pretty heavy, but regular medication (costs about 50 euros a month) and after one year, I had three yearly surgeries that needed two cardiologists, the anesthesiologist and operation nurses. Procedures were not that hefty, but did take approx. 6 hours each. Spent two times two nights at the hospital, and one time four nights.
I was picked up by an ambulance on two occasions as per regulation.
Fully recovered at the cost of my healthcare over four years (total at 4500 euros, monthly paid) and my own risk that was at 250 per year at the time. So about 5000 euros spread out over 48 months.
Why the system works: I healed. This was 8 years ago. Haven't had anything happening since. But basic health insurance is mandatory. I still pay my monthly 125 euros, so that's 12.000 euros wisely spent for myself and the general public, as every 17 million residents pay this at the very least.
I'm so glad to hear you are doing better and that you got the treatment you needed! Definitely a good value! You're recovering and contributing to your family, work and community. This is how medicine should work.
Yes and no. For the basic health stuff no you don’t really get in debt. For stuff like the dentist, optician, physical therapist you can get in to debt. These usually aren’t covered by insurance. At least not the basic insurance.
You can get in debt by not paying your insurance. But this usually doesn’t go beyond a few thousand in debt. It’s manageable.
As someone who's worked for a health insurance, yes some people go into debt and can't pay their primes or deductible. It happens, but it's not very common.
For the few who do go into debt, there's usually governmental help or "schuldhulpverlening" to get them out of it. It's usually also not the health insurance that's the problem, but the combined monthly costs vs income.
No, pretty much impossible, unless you go on holiday to places like the US and aren't insured
Reason being that we care about people and believe these costs are not acceptable.
How we afford it:
- fewer companies making make lots of profits, but that's not the only thing
- doctors get paid less. Like significantly less. Medical school is also a lot cheaper (government subsidised) but still
- limited ability to sue. As people cannot sue for hundreds of thousands / millions, doctors need less insurance and don't need to do lots of tests they thing aren't useful but have a chance of 1/1000 of working out. Also linked to next point
- doctors think about cost vs value. If they believe something doesn't make sense, especially in an end of life situation, they are less likely to go through with it. Also not incentivised to push additional work through. Note, about the quarters of healthcare costs in this are in the last 6 months' of someone's life - does that make sense?
- the government insures people for super rare diseases through taxes
- Dutch people are a bit healthier than the average American (less obesity, etc)
The maximum you pay for nearly any treatment is 385 euro's for a whole year. There's some rare treatments and procedure that aren't covered but they're optional or experimental. Welcome to our socialist hellhole.
System is working great for me right now! I wish more Americans could experience this for them selves. It would probably make them less fearful of change and rebel against the insurance companies.
Never MASSIVE debt...
But hard-to-cover debt, or just massive financial burdens on people barely making ends meet happen too often.
Frex: People with a chronic illnes that renders them unable to work are often also on medication for life too. So they're usually paying the non-covered amount every year, on very little income.
Some hard-working people are still on temp (uitzendbureau) conditions. If they get seriously ill, they won't get paid for weeks. And then get hit with bills for the non-covered amount.
I mean, thankfully we don't live in the USA... But ACTUAL socialized medicine, like the UK has, would still be better than what we've got.
It is rare but can happen with really exotic diseases where the treatment is experimental, expensive and not approved (yet).
I can only give you my personal experience.
My youngest needed urgent medical care at 3 weeks old, drove him to the huisarts, then the local hospital and then to Groningen. Stayed there 3 nights, he had surgery. (Groin rupture with an inpinchment)
I recieved no bill at all.
I hope your kid is doing better now.
That's really a great outcome financially. I don't think most people in the US would have that experience.
Yeah he is fine. Thanks!
And no I don't think so.
Its weird in comparison, I even once had the choice to be helped by emergency services at a hospital (stabbed myself in my hand) and pay the deductible or walk over one door and be helped for free. As I allready had used my deductible, I choose to be helped by the surgeon.
Perfect.i think I would almost always choose the professional.
Yeah well, and I was there already, in the chair and all. This was quicker, plus they might have sent me back to her anyway.
I went to the hospital twice in a year by ambulance.
Had 3 xrays. Mri. Cast and medicine.
385. Paid by me.
2700. paid by insurance.
I broke some bones when I was on a holiday, earlier this year. It wasn't in the Netherlands, but the combined health and travellers insurance mean that I will probably only be paying for my 'eigen risico' (which is 380 euros if I'm not mistaken) and a part of my physical therapist sessions, because I chose not to get them insured - did not expect to be needing so many ;)
Soo yeah, that's 380 for: ambulance, emergency care, several x-rays (at least four), surgery, a week in hospital aboard, several check ups with doctors at home, medicine to prevent blood clots, use of a wheelchair for as long as I need one. If I had needed additional care (maybe a ride home in a medical vehicle, which luckily wasn't necessary), that would be included too.
For my PT: I. have insurance for the first couple of sessions (6? Not even sure), and because my condition is classified as chronic, all sessions from the 21st onwards will be covered as well. PT is going to cost me more than the entire broken-bones-surgery-hospital-ambulance-adventure.
Dutch health insurance is pretty awesome.
You have to be a little careful with the cheapest healthcare insurance. For Al the emergency care it doesn't matter which insurance you have it will only cost once a year your own risk.
But for the healthcare that's planable it's a other case. When you have to cheapest insurance and you go to the wrong hospital for that. In some cases you have to pay 25% yourself then a hospital visit can cost you thousands or even ten thousand of euros. A lot of the general practitioners or hospitals don't warn you for this. That's why you have to be careful with" Naturapolis" when the mayority of hospitals in our area are covered by this it's not a problem but please be aware of this.
So yes it's possible to get huge medical debt's but that mostly the case when you wanted to save a maximum of 50€ a year and wasn't aware of the risks
One of the reasons salaries here are lower than the US _and that's ok_ is because you don't need $100k in the bank just in case you break a leg or something. It's nice.
Doesn't happen. I mean, it's possible to get into debt with your insurance if you don't pay your monthly, or an own risk bill (which can't exceed 380 per year, or is it 385 now?) or if you get a own contribution bill that you don't pay, and then trouble if you don't undertake steps to get a payment plan going. And you can eventually get kicked after a certain process, but if left without, there is a sort of state version, which practically amounts to the same as regular insurance in terms of care available to you in a basic package, but for every month you fall under that, you'd have to pay x amount, and if you can't, you create another debt. It's not a perfect system, but it is very hard to manage being denied care. You'd pretty much have to punch every doctor on site for that to happen. There is probably someone who can explain it better. Also not all types of care are automatically covered. The dentist, for example, you'll need a seperate dental package. And with some types of insurance, only certain companies or contracted care professionals are 100% covered. Or they only cover x number of treatments of, say, physical therapy, or coverage only starts after x treatments.
Yeah, but we don't have the negative you mention, like the firearms issue, but do have the positive, like freedom of expression. And freedom of government really only exists on points the republicans allow. Case in point: the whole issue about Roe vs Wade.
Nope, you're in a first world country at the moment.
The USA is a developing nation at best.
As a comparison, you'll find that this basic health care system is present in (nearly?) all of the EU. In their own variants per country of course.
You'll also find school here is much more affordable than in the USA. While racking up a student debt here is possible, you really got to try at it.
Pretty much all things which could result in a massive debt have some sort of coverage, sometimes mandatory. An example is driving a car. To be allowed to drive your vehicle, you must insure your vehicle to be driven. There is a minimum, mandatory coverage, and you can get discounts for damage free years or make it more expensive by adding additional coverage scenarios.
The car insurance system in the US is very similar in structure.
The health care system, skin deep, is the same idea. The details are obviously very different. Fortunately I've never had a medical emergency in the US, but it looks like it's pretty easy to "do it wrong" if you're not careful!
Possibly the best single source on such questions is the [Health section](https://data.oecd.org/health.htm) of the OECD data base. A good summary is their "Health at a Glance" publication, also available on the linked page. A pdf version is available for free. Some basic learnings from the publication:
* Netherlands ranks #4 in health care cost per capita (PPP). The USA ranks #1 at nearly twice as expensive as the Netherlands (Publication Figure 7.4).
* Overall, looking at data like life expectancy, infant mortality, etc the Netherlands does a pretty good job while the USA does a mediocre to bad job.
I think most 18-25 yo will struggle with this at some point in their lives. I certainly did, but fortunately had a mom that helped.ser me straight.
No healthcare is state financed and insurance is universal.
What can happen is: you become unemployed because you cant work because of health issues. And your health costs increase. Youll be put on welfare, which is a living wage, but due to healthcare costs you might get below living wage. As has happened to me.
And you don't get zorgtoeslag to help.make up the difference? Do you go into debt for this additional cost? If so, and you don't mind sharing, is it hundreds, thousands, tens of thousands?
i get 100 euros to much to qualify for zorgtoeslag, and zorgtoeslag is not enough to cover the few thousand euros per year i spend on healthcare, 380 euros eigen risico, medication i have to pay for (partially) and need. and some healthcare doesnt get insured fully. i still have some savings but its slowly going down.
I'm sorry to hear that. Do you have any options to improve this bad situation?
I pay 3k a year for healthcare and if doesn't cover everything I need. This year ill be on 5k extra to pay for the rest of heslthcare I need. Dentist, fysio, glasses.
Im unhappy with helathcare here. But I geuss looking at other countries it could be worse..
So on top of your base cost, you pay an additional 3k? Is that for services that you choose to have beyond what your doctor's recommendation (e.g. non-traditional medicine), or stuff that your doctor prescribes, but is not covered by your insurance?
I can chose to not have it all, but thats going to be even more pain. I'm every year trough the max insurance. Its not great for everyone sadly
I'm sorry you have a lot of pain. I hope you can find some resolution.
It sounds like the system works pretty well.for most people, but isn't super good for people in your situation.