Care - People without valid residence documents
Care providers are obliged to provide (basic) care, even if people are not insured. The Netherlands has signed a treaty that states that undocumented migrants can receive care. Care providers can apply for reimbursement if they have provided care to a patient without a residence permit who cannot afford the care (see box).
There is a distinction between directly accessible care and non-directly accessible care for people without a residence permit. Immediately accessible care is the care provided by general practitioners, midwives, maternity assistants, dentists, paramedics and acute care in hospitals. These care providers are obliged to provide every patient with the medically necessary care, whether or not that patient is insured. This includes acute care as well as all care from the basic package that is also given to insured persons. A doctor must determine whether there is any medically necessary care. In principle, every patient must be assessed by a doctor, not by the assistant, receptionist or desk clerk. In practice, time and again it appears that doctors often regard medically necessary care as acute care.
Institutions are designated for care that is not directly accessible (care by pharmacies, hospitals and mental healthcare institutions and ambulance transport). Only there can people go without a residence permit (with prescription or referral).
There is a major bottleneck for oral care. The basic package includes only care for children up to the age of 18, fully removable prostheses and special dentistry. No provision has been made for basic dental care for oral care for undocumented adults.
On the site http://www.basisrechten.nl/ it is stated how care is arranged in a number of cities.
On the one hand, laws and professional codes state that a healthcare provider may not refuse to provide medically necessary care if requested to do so. That is a duty of every healthcare provider. A doctor must therefore first determine whether there is any medically necessary care. And here a residence status and financial capacity may not play a role. That a patient does not want to show proof of identity, or does not want to mention a name or address, should not play a role in assessing whether the care is medically necessary.
On the other hand, the government regards medically necessary care as all care in the basic package. A large part of oral care is not included there. Necessary oral care must therefore be paid by the patient.
A patient has a duty (WGBO) to pay the costs of care. If he is insured, the health insurer will arrange that. Undocumented people are not allowed to take out health insurance, even if they could afford it. Undocumented migrants must therefore pay the healthcare costs themselves. That is often difficult in practice, but should not be a reason to refuse care. There is an arrangement that the care provider can claim the costs of medically necessary care. The care provider is reimbursed 80% of the costs. The other 20% are for the care provider's account. Only the costs of care during pregnancy and delivery are reimbursed for 100%. The caregiver must prove that he has done his utmost to get the amount of the undocumented patient (reminder, second reminder, payment arrangement). Healthcare providers often find that a lot of work.