Medical services for refugees before insurance

We have written more than once that shelter, food, children's education and medical care are guaranteed for everyone who arrives in the Netherlands. This is laid down in the Constitution of the country (Grondwet). Every Ukrainian who arrives in the country is provided with a roof over his head in one way or another. With the allowance for accommodation and food, it is understandable, even if not everything, but the main thing is that there is an allowance. Children have already begun to be enrolled in Dutch schools and even give lessons remotely. But let's deal with medicine again: what types of medical care are guaranteed to Ukrainians who have refugee status or who have requested temporary protection, more before obtaining health insurance.

The regulations for the provision of medical services for refugees are officially described. This scheme was developed by the government, it is called "Regulations on the health care of asylum seekers" (De Regeling Gezondheidszorg Asielzoekers (RMA)). All types of guaranteed medical services for refugees are based on three laws:

1. Basic medical services. Most of them correspond to the articles and rights provided for in the Basic Health Insurance Act.
2. Services covered by the Social Assistance Act or Wet maatschappelijke ondersteuning (Wmo).
3. Services covered by the Long Term Care Act or Wet langdurige zorg (Wlz).

In practice, this gradation cannot be clearly distinguished: all three laws work simultaneously, complementing each other.

Important:

For medical care, Ukrainians who have requested refugee status will not have to pay exactly until they get a job. In accordance with the RMA protocol, the costs to the doctor are compensated without your participation, i.e. without your money. They should help you for free. This is the norm of the law.

Read more here: https://www.hetcak.nl/zakelijk/regelingen/regeling-onverzekerden.

Show the screenshot below to your doctor to confirm that he will receive a government subsidy for his work helping refugees.

                      

What can a refugee expect in terms of medical care? Almost the entire range of basic medical services, up to a nutritionist, psychologist, speech therapist or orthopedist. You can even be sent to a kind of rest home. The rehabilitation program after a number of diseases can last up to six months and is also included in the list of medical services that refugees can count on (if there is a referral from a general practitioner or you receive an appropriate referral after laboratory tests or a visit to a specialist doctor).

General Practitioner (De huisarts)

The general practitioner is the first point of contact for health and illness matters. Those who are accommodated in refugee camps, country parks or hotels should contact the official representatives of the COA (Centraal Orgaan opvang asielzoekers) - Central Refugee Reception Agency for a doctor's visit. For those who are accommodated with host families, it is better to check with the GZA (GezondheidsZorg Asielzoekers BV) which doctor in your area to contact so that you do not have to pay for an appointment.

The patient has the right:

•  get an appointment with a general practitioner;
• receive a referral for laboratory and functional tests at the request of a general practitioner;
• receive specialized medical care in the direction of a doctor;
• get advice or referral to mental health professionals such as psychologists or psychiatrists.

Specialist doctors

A specialist doctor is a doctor who, after basic training, has undergone special training and is registered as a specialist doctor. There are about 30 different specialties in the Netherlands. Most medical professionals are associated with the hospital.

A referral to a specialist is given by a general practitioner. Often reluctantly, but if you have a medical history and a volunteer translator with you, then it is realistic to get a referral to see a doctor in a hospital. What is included in the list of those services of a specialist doctor that a refugee from Ukraine can count on:

•  research and diagnostics;
• treatment according to the disease profile;
•  materials used by the medical specialist, such as medicines, bandages or instruments;
• hospital treatment;
• lung ventilation, oxygen masks and related specialist medical care;
• medicines and care in intensive care units and intensive care center.

As a rule, in case of a chronic disease, specialist doctors “lead” the patient themselves and in order to get an appointment with them, additional visits to the family doctor are no longer necessary.

The right to specialized medical care is only available after a prior written referral from a general practitioner, youth doctor, specialist doctor, mentally retarded doctor, dentist, obstetrician, maxillofacial surgeon, geriatric medicine doctor / nursing home, company doctor, emergency doctor, psychologist or a psychiatrist, an infectious disease specialist, etc.

Second opinion (Second opinion)

In case of doubt about the diagnosis, a “second opinion” can be requested. There is a right to this too. In this case, you must provide the second doctor with the diagnosis and proposed treatment plan from the first doctor. This second physician must be independent and work in the same specialty or field of medicine as the first.

To obtain a “second opinion”, the consent of a general practitioner or specialist will be required. Besides, RMA Healthcare prior approval required. To do this, you need to apply by sending an email to the address info@rmasielzoekers.nl indicating the name and position of the first doctor and the reasons for the need for an alternative (second) opinion.

Medicines (pharmaceutical care)

In the Netherlands, you will be prescribed drugs that are approved by the government and are on the list of approved drugs for use in the country. But do not expect drugs to be freely available: without a prescription, you can only buy vitamins and the simplest painkillers and anti-inflammatory drugs. Ask for a prescription and do not forget to check with the doctor if the prescribed drug is included in list of those covered by Basic insurance (List 1), or to the list of those associated with appointment of a number of specialists (List 2).

The drug can also be made by prescription at a local pharmacy. It may be called differently than you are used to, but the active substance will be the same as that prescribed by the Ukrainian doctor (if we are not talking about a rare disease and specific treatment).

You will have to buy at your own expense homeopathic medicines, nutritional supplements, IVF-related drugs, and a number of drugs that are not included in the list above.

Is it worth repeating that without a prescription the drug will not be sold to you even for money? And the delivery of the drug may depend on the price, severity and uniqueness of the disease.

Special equipment (Hulpmiddelen)

Medical aids include, for example, a walker, a hearing aid, glasses, a wheelchair or a prosthetic leg, as well as materials for the treatment of urinary incontinence, materials for diabetic testing.

All this equipment can be obtained as part of free assistance, you just need to request them through an appointment with a doctor or directly from SOA representatives. It is better that you have documents, a medical history or a prescription from a Ukrainian doctor confirming the need for this equipment with you.

For more information about special equipment and conditions for its provision - here to register:.

Obstetric care (Verloskundige zorg)

Part of the obstetric care for pregnant women is provided by obstetricians - they guide and supervise women during pregnancy and childbirth. Childbirth takes place in a hospital, although Dutch women often give birth at home.

What can a pregnant woman expect?

• obstetric care and prenatal screening;
• counseling (information and consultations);
• combined test;
• structural ultrasound in the 2nd trimester (ultrasound at 20 weeks);
• prenatal diagnosis such as chorionic villus biopsy, amniocentesis, and non-invasive prenatal test (NIPT) may be required based on medical indications.

In addition, the package includes the actual organization of obstetric care, making an appointment, including at an ultrasound center or a gynecologist, providing explanations for obtaining a social package for pregnant women.

Important:

A doctor's referral for obstetric care is not required; it is enough to register with GezondheidsZorg Asielzoekers (GZA) as early as possible. This can be done by calling the “on duty” telephone number 088 – 112 21 12.

Childbirth care (Kraamzorg)

Kraamzorg is a unique and "signature" Dutch care, home care after childbirth. When a nurse helps a midwife or doctor during childbirth, and after that the midwife helps take care of the mother and baby at home for a week, so that both mother and baby get used to each other and are busy only with this. The kraamzorg sisters will clean the house, and wash and iron, and cook dinner, that is, they will take care of household chores. They will also teach the young mother how to take care of the baby. And, of course, they will provide information about the woman in labor to the doctor, observing the mother and child in the first days after childbirth.

This right extends to a maximum of 10 days from the date of birth, more often this period is shorter.

National Program for Maternity and Pregnancy Care (Kraamzorg).

Palliative Care

Palliative terminal care in an institution or at home includes all care aimed at achieving the highest possible quality of life for a person (and their loved ones) with a life-threatening illness. 

The patient is only entitled to free palliative care after prior written referral from a therapist.

Household Help

Relevant for those who came with elderly people who need help in everyday affairs, or patients with disabilities, limited in movement. They are guaranteed the arrival of assistants who will make sure that the house is in order, food is prepared, the patient is well-fed and tidy. You can request this help through your family doctor (huisarts).

Nursing care (Thuiszorg)

Focuses on physical health care, social self-reliance, mental well-being, own life and environment.

As a rule, we are talking about young people who need care and assistance. If we are talking about children and adolescents up to 18 years of age, care is provided and organized through the service of pediatric nurses - or through the municipality, when it comes to the social adaptation of young people in need of care. If we are talking about people over 18, then through a family doctor.

Dental care (Tandheelkundige zorg)

A distinction is made between ordinary dental care provided by a dentist and special dental care. Special dentistry is for people for whom conventional dentistry is not enough due to special treatment: for example, cleft palate or a very serious malocclusion.

Children under 17 years old:

• one periodic preventive dental examination per year, unless such an examination is required several times a year;
• one-time dental consultations;
• removal of tartar;
• two applications of fluoride per year, if the child is 6 years of age or older (unless such application is required several times a year), from the moment the permanent teeth erupt;
• sealing;
• periodontal care (gum treatment);
•  anesthesia;
•  endodontic care (root canal treatment);
• restoration of teeth with plastic materials (fillings);
• gnathological care (help with problems with the temporomandibular joint or grinding);
•  removable prosthetics (dental and frame prostheses);
• replacement of teeth with non-plastic materials and the installation of implants, when it comes to replacing one or more missing permanent incisors or immature canines; or if the missing tooth(s) is a direct result of an accident;
•  surgical dental care, except for the installation of implants;
• X-ray examination (photo), except for X-ray examination for orthodontic care.

Adults (over 18 years old)

The basic principle of emergency care is to preserve the current function of the teeth as much as possible using the simplest possible means, including the preservation of existing functional elements.

Service list:

• emergency care according to The list of emergency dental care (Appendix 5);
• surgical dental care by a dental surgeon and related x-ray examination (with the exception of periodontal surgery, implant placement and uncomplicated removals); 
• removable full dentures on the upper or lower jaw;
•  to emergency care not applicable replacement of front teeth (replacement of permanent incisors and canines with implants), if they are not formed or are completely missing as a result of an accident.

When visiting a dentist outside office hours, the patient is only entitled to dental care if the visit cannot be rescheduled for another day.

The insured person is only entitled to treatment by a dental surgeon after a prior written referral from the dentist or general practitioner.

Caring for people with a "sensory disability" (Zintuiglijk gehandicaptenzorg)

Sensory impairments are visual, hearing, communication impairments resulting from impaired language development or a combination of these limitations.

A person needs such care if he:

•  has a visual impairment (blind or visually impaired);
• has a hearing impairment (deaf or hard of hearing);
• has communication impairments (severe difficulties with speech/language) due to impaired speech development;
•  under 23 years old.

Care includes:

• diagnostic study;
• interventions aimed at psychological training to cope with disability;
• interventions that remove or compensate for limitations and therefore increase self-confidence.

In addition to treating the person with a sensory disability, it also includes (indirectly) system-oriented co-treatment of parents or caregivers, children and adults around the person with sensory disability who are learning skills for the person with sensory disability.

Of course, the referral to paid treatment in this case should be from a specialist.

In addition, the list of medical services that should be provided to refugees free of charge includes transportation services to and from the place of treatment (except for delivery to the place of stay in a day hospital), emergency care in case of an accident, diagnosis and treatment of tuberculosis, assistance to patients with diabetes diabetes, accommodation and care in clinics for people with mental disorders.

To find out what else is included in the list of free services, to find out where in your city a doctor working with the Central Refugee Reception Agency (COA) sees, you can call the hotline of the Refugee Medical Assistance Association - GZA (GezondheidsZorg Asielzoekers BV).

Contact phone numbers GZA:

•       make an appointment: 088 – 112 2 112.
•       Appointment with a dentist: 088 – 112 2 132.

More information about medicine in the Netherlands and medical care for refugees can be found in the materials on our website:

https://www.nalog.nl/news/2022/03/22/medicinskaya-pomoshh-i-straxovka-dlya-ukraincev/

https://www.nalog.nl/news/2022/03/28/medichni-poslugi-u-niderlandax/.