Tens of thousands of people in the Netherlands are being denied needed medical care because they do not have health insurance, the Dutch Health and Youth Care Inspectorate (IGJ) warns in a new report. The inspectorate estimates that around 100,000 people are uninsured. This includes homeless people, EU labour migrants who lost their insurance after losing their job, and people without residence permits who are afraid to seek help.
Many of them avoid doctors and hospitals because they fear high bills or worry that their identity or residence status will be reported to the authorities. As a result, they often wait too long to get help, and health problems become more serious.
Why uninsured patients are turned away
According to the IGJ, some healthcare providers do not know that uninsured patients are still entitled to medically necessary care and that there are special schemes to cover the costs. Others are unsure how to claim the money and therefore refuse or delay treatment.
This can lead to people being turned away at:
GP practices and out-of-hours doctors
Pharmacies
Hospitals and specialist care
Nursing homes and other care institutions
The inspectorate stresses that these refusals are not only harmful to patients but can also lead to higher costs later, when untreated conditions become emergencies.
Photo Credits: Karola G/Pexels
Legal right to medically necessary care
Under Dutch law, all residents are entitled to medically necessary care, even if they do not have health insurance or cannot pay. The Netherlands has a system of mandatory basic health insurance, but the IGJ notes that this principle is not being applied in practice for many uninsured people.
To support providers, there are two national reimbursement schemes:
One for people without a residence permit, allowing doctors and institutions to claim back most costs from the government.
One for people who are uninsured for other reasons, such as administrative problems or unpaid premiums.
The inspectorate says these rules are not widely known. Front desk staff, in particular, may refuse patients because they assume treatment is not allowed or not reimbursed.
Street doctors and local initiatives
The IGJ praises street doctors and street nurses who work with homeless people and other vulnerable groups. These professionals often know the rules well and treat uninsured patients regardless of their status, helping them access follow-up care where possible.
The report also highlights positive examples of:
Municipal projects that actively search for uninsured residents
Regional partnerships between healthcare providers, social organisations and local authorities
Guidance services that help people arrange insurance or connect them to suitable care
However, the inspectorate warns that these good practices are not yet standard across the country and depend too much on local initiatives and individual professionals.
What the inspectorate wants to change
The IGJ calls on healthcare providers and policymakers to take several concrete steps:
Train all staff, including reception and call-centre workers, about the rights of uninsured patients and the existing reimbursement schemes.
Make sure organisations have clear internal procedures so uninsured patients are not turned away at the door.
Use interpreters more often when language is a barrier, especially for labour migrants and undocumented people.
Strengthen local cooperation between GPs, hospitals, municipalities and social services to identify uninsured residents and guide them into care.
The inspectorate stresses that denial of care to uninsured people is both a health risk and a breach of legal obligations. It urges the sector to treat medically necessary care for everyone as the starting point, and only then look at the administrative steps needed to arrange payment.
