Internationals want more attention, more checks and easier access to healthcare. Velichka Georgieva, sports instructor at the Student Sports Centre: “I have never managed to make an appointment here quickly. Sometimes I cycle to the practice and negotiate there to get a consult, as if I am doing business."

Different cultures experience ‘being ill’, differently. Where Dutch people wait a while and only then go to a doctor, many other cultures are used to intervening faster with medication because the flu, for example, is seen as more serious. Not necessarily physically, but due to its consequences for work or education, for example. This results in friction with our reluctance with regard to checks, medication and preventive testing.

The Brazilian Bárbara Dias felt that too: “My mother died of breast cancer and shortly after I moved here, I got a very sharp pain in my breast. My father freaked out and asked the doctor for a check-up. The doctor spoke as if my father was totally unreasonable. And I assure you, he wasn't. He just asked for a check-up, never raised his voice. He stood by my mother's side during her treatment, so he knows the symptoms very well. And the doctor was so dismissive. I thought that was very rude.”

Doctor Dalinghaus also notices the internationalization of the region at Lidwina practice in Eindhoven: “You see more people with a different cultural background and different ideas about healthcare. Certain questions and expectations show this change. Internationals sometimes ask to have a smear taken by a gynecologist. In the Netherlands, that is not the job of a gynecologist. So I tell them. It means that the doctor often first has to explain something about why healthcare is different in the Netherlands than in their country of origin. An introductory chat is a good opportunity for such a talk."

“It is important to bond with the patient so that he or she accepts such comments from me. Then at a certain point you can also start a conversation about other things that have to do with living in another country with a different culture. We can learn something from them, but they can also learn something from us. It is the art of give and take."

Stanimir agrees: "It's easy to say ‘oh, the doctors here don't speak proper English,’ it is also true that we internationals come here and do not speak Dutch. I sometimes feel guilty about that. I've been living here for five years now, so I'm really trying to learn the language. At work I always tell my colleagues to speak Dutch with me, so that I can improve my language skills."

“The desired improvements in the field of healthcare are two-fold: I would like a little more attention, more thorough checks and easier access to a specialist. But the awareness of both sides also needs to improve. So that doctors understand that internationals have different backgrounds and different habits. And that internationals gain more knowledge about how Dutch people go to the doctor and how the system works. Knowledge about insurance and what is covered, what is not, how the (mandatory and voluntary) own risk and the own excess work, et cetera.”

Georgieva: “The doctors themselves are polite and kind in my experience. Unfortunately I had to deal with language barriers a few times that could make it problematic. For example with the problem with my ear. I got a nasal spray for that. That didn't make sense to me, because my nose wasn't blocked at all. The doctor couldn't explain in English why I got the spray and I didn't trust it so I decided not to pick it up at the pharmacy. Maybe, had the explanation been clear, I would have."

All doctors expatproof

Dalinghaus has a different view on providing care to internationals. “I am familiar with SGE international as a practice for internationals, but I don't really believe in that. I don't think you should put all internationals together in a practice. You can better use that money to make all doctors ‘expatproof’. If the expat goes to the doctor in his or her neighborhood, a broader interest of well-being can be served more easily. I know my neighborhood and the initiatives. That can help with local integration. At SGE international, expats from all over Eindhoven come to the practice. Integration is easier close to home, preferably in one's own neighborhood. That is why I would rather invest in care for other cultures in every district of Eindhoven than concentrate it in one center in the city. But the patient can make his own choice of course."

Hazenberg thought it was important to see whether the efforts of SGE international actually paid off. “We repeated the The Hague research in our practice, with the limitation that it only involved 200 participants and one doctor, but it nevertheless gave hopeful results. 72 percent of the respondents said they trust our doctor."

Georgieva: “I heard at school that the EU health card from back home also applies here, but only for emergencies or the GP. So I decided to get a Dutch health insurance in case something should happen. For international students, this is not the first thing they think of when they come here. They feel that they will only be here for a while and do not need Dutch insurance. But it's risky, if you need something and it's not an emergency or primary care, it's not possible. I now have a Dutch insurance and the process became much easier. And as a student, you get the healthcare allowance from the government, so it's not that expensive."

TU/e works together with AON for (collective) insurances. Paul Dekker is an insurance advisor at AON and has weekly consultations at TU/e that internationals can visit to ask questions. “During my consultations I mainly get PhD and PDEng students. They are seen as employees here in the Netherlands and are therefore obliged to have a Dutch health insurance. This is not the case for students. European students have their EU health card that is valid here in the Netherlands for emergency care and primary care, such as the general practitioner. But this does not apply to secondary care (e.g. referral from general practitioner to specialist care). That is planable care and therefore only declarable if the (foreign) health insurer has given authorization for this."

“There is a special student policy for non-EU students. This offers the same coverage as the EU health card. A collective health insurance policy is also available for Dutch students via the TU/e. In the Netherlands, foreign students without a Dutch health insurance cannot simply use secondary care. If they get a(n) (additional) job, they are eligible to get a Dutch health insurance and then make use of that secondary care. Many do so. Good to know: an internship is not valid as ‘work’ to insure you with a Dutch health insurance company. That is only possible if your internship allowance is in total per hour (may also be combined with, for example, a compensation for rent) at least the minimum wage."

Watch out when you travel

The most frequently asked questions from students? "What if I go abroad?" and "How does the system work here?" Dekker answers. “Many foreign students are used to a system regulated by the government. Here we actually have kind of a private insurance. In addition, the concept of ‘own risk’  and ‘own excess’ is also new to many. As an answer to that first question, I always advise students to get proper travel insurance, or to include an additional module in their health insurance that fully covers medical costs abroad. If you only have a basic insurance, it covers healthcare costs at Dutch rates. (This also depends on which form of the basic insurance you have chosen.)

The costs in America, for example, are many times higher than in the Netherlands. That can be tens of thousands of euros that you have to pay yourself if you end up in a hospital there. You can prevent this with a travel insurance or extra module with the right coverage. When traveling abroad, also pay attention to the activities you plan to undertake while you are there and which activities are covered by your (travel) insurer. Your policy states this information. For example, it may be that ‘hiking’ is considered a dangerous sport and you are not covered if something goes wrong. So take a good look at the policy before you travel."

Preparation is half the battle when you fall ill in the Netherlands:

• Check for health insurances in the first week you arrive in the Netherlands, or even already back home. You may think that you can skip it because you do not need them at that moment. But if you fall ill it can be really problematic to not have one. Of course you’ll get the right care in case of an emergency, which is obliged by law here, regardless of your insurance.
  But things like dental care, or secondary care such as psychological support are not simply included and they are not just reimbursed with a foreign health insurance policy. The choice between a contracted care policy and a non-contracted care policy determines your freedom of choice and there are all kinds of rules concerning reimbursement, depending on whether you have a basic insurance or also have supplementary modules. For example, dental care is not reimbursed as a standard and many treatments have an excess.
   
• Register with a GP as soon as you have arranged your accommodation and insurance.
   
• Consider a practice focused on internationals such as SGE International. There they take more time for you, the practitioners speak English and people are familiar with questions that frequently occur among internationals.
   
• Also register at a pharmacy so that the doctor can send a prescription there directly.
   
• Keep receipts of the pharmacy and preferably take a photo immediately. Sometimes you have to submit them to get the costs reimbursed.
   
• Trust that our doctors and specialists have up to date knowledge and lots of experience, even if there are no diplomas on the wall and not all of them wear a white coat. Our healthcare system is number 1 in Europe according to the Euro Health Consumer Index (EHCI).