Access to health care: also for refugees?
Under Dutch law, refugees start paying for health insurance overnight once asylum is granted or denied, threatening their right to access to health care.
Many asylum seekers arriving in the Netherlands are in a bad state of mental and physical health. It is therefore good that the Regeling zorg asielzoekers foresees in a generous package of paid health care services. According to this regulation, asylum seekers are also entitled to make free use of a professional interpreter when in contact with a health care provider. These entitlements change, overnight, once the asylum application has been granted (or denied). From that moment on, the right to access to health care and fundamental patients’ rights are no longer guaranteed under Dutch law. It is time to change this situation.
Under Dutch health and insurance law refugees are treated as other legal residents. This means that refugees have to start paying insurance premiums (about € 1,200 per year) and that they have to pay the first € 385 in medical expenses themselves. Moreover, the costs of a professional interpreter are no longer covered by the health insurance system. Subsequently, refugees often do not understand the information provided by a health care professional and are deprived of the right to informed consent, at least as long as they lack a fluency in Dutch. In this respect, it is noteworthy that asylum seekers are not allowed to learn Dutch as long as there is no decision on their application. As a consequence, refugees often have to start learning the language from scratch once the application is granted.
The rapid transition from totally different health insurance systems threaten the health and rights of refugees. The Dutch health care system is one of the best, but at the same time one of the most complicated systems in the world. No wonder that refugees do not always understand how to enroll for health insurance and how to choose between 150 insurance policies, why and when patients need a referral from a general practitioner to get access to specialist health care services and which health care services are deducted from the € 385 in medical expenses insured persons have to pay themselves.
When the Dutch Patients’ Rights Act (Wet op de geneeskundige behandelingsovereenkomst) was introduced in 1992, the legislature acknowledged the importance of good communication between patients and health care providers. The legislature therefore stipulated that costs of a professional interpreter would be covered by a special public fund in the case of insufficient knowledge of the Dutch language on the side of the patient. In 2012, the current Health Minister abolished the entitlement to a free professional interpreter for most situations. In her view, it was the patient’s autonomous choice to learn or not to learn Dutch.
In my view, most refugees are highly motivated to get to grips with the health insurance system and learn Dutch. It is, however, naive to believe that the necessary skills are immediately at hand as soon as an asylum application is granted. Extending the Regeling zorg asielzoekers by a few months and the entitlement to a professional interpreter until a refugee can realistically have learned Dutch, would be in the interest of their health rights.