Due to the serious shortage of general practitioners (family doctors) in Rotterdam and due to the complexity of the Dutch healthcare system, international students are not receiving the care they need, say Jansen and Dolk. When their practice opened in June, they called on international students to register as patients, but the response was such that they have been forced to temporarily stop accepting new patients. “We are overwhelmed by the severity of the problem,” says Jansen. “Other general practices often refuse to accept these students as patients because they require so much additional admin. Since we were new on the scene, we decided to accept patients from this group, and as a result, the practice has come under an enormous amount of pressure.”
No basic healthcare plan
One major complicating factor is health insurance. International students are required to take out health insurance, but are not allowed to sign up for the basic healthcare plans offered by Dutch insurers. As a result, they must get a European Health Insurance Card (EHIC) or take out special student insurance with AON. “These students require far more complex admin than students who have a Dutch basic healthcare plan,” Dolk explains.
“Those practices that do accept these students as patients generally don’t receive a monthly allowance for having them on their books, and the costs of the care they receive aren’t automatically taken care of, either. In other words, patients must pay their medical bills as an out-of-pocket expense and submit a reimbursement claim to their insurer after the fact. It’s no use sending the students to an after-hours service provider, because those are only allowed to accept emergencies. And they can’t go to the hospital, either, because that requires a referral by a GP. As a result, we’re seeing students with advanced medical issues in our practice.”
And those are not the only problems Jansen and Dolk have run into at their own practice. “International students’ GP consultations tend to take a lot longer – for instance, because they are generally unfamiliar with the Dutch healthcare system or because we lack information on their medical history. For instance, when you have a Dutch student in front of you, the system will tell you what medicines they are taking or what kinds of allergies they have. With international students, that kind of information doesn’t automatically show up in their medical records, meaning we must obtain it,” Dolk explains. “Most GPs are quite busy with their own patients as it is, so they generally won’t accept such students as patients.”
Jansen and Dolk feel that the way the Dutch healthcare system is organised is causing international students to fall through the cracks. They are seeking to come up with a sustainable solution to the problem in association with the university. “At present, international students cost our general practice more than they bring in. We really want to help these students, but must do so in a way that really helps them. For instance, in addition to the types of services normally provided by GPs, they must be provided with information, as well, such as information on the various options available in our healthcare system, and on health insurance.”