This article was last updated on September 6, 2023
Table of Contents
More and more people without a residence permit are requesting care
More and more often people who do not have residence papers rely on healthcare. The number of claims for these uninsured persons has increased by 30 percent in the past year, according to figures from the government agency CAK that were requested by the NOS.
This often concerns care for people who have been in the Netherlands for a long time and who cannot or do not want to return to their country of origin. That group of people is getting older and therefore more vulnerable, say scientists from the University of Amsterdam and Erasmus University.
“More and more elderly people visit street doctors in homeless shelters and they often need complex care,” says Richard Staring of Erasmus University. He conducted research into this group in 2022. “They often only seek help when their problems are so serious that avoiding care is really no longer an option. The fear of the government is great.”
Last year, more than 58,000 claims were submitted under the Uninsurable Aliens Regulation. In 2021 there were still about 43,000 and the year before about 37,000. The amount of money spent on it also grew, from 43 million euros in 2019 to 51.4 million in 2022.
Right to care
People without papers, who are therefore not insured against healthcare costs, are still entitled to healthcare that falls under the basic insurance. Every general practitioner can submit a declaration to the CAK for medically necessary care for an undocumented person. 80 percent of the costs are reimbursed.
But many GP practices do not know this arrangement or the assistant who gets the undocumented person on the phone is not aware. GPs also shy away from the administrative hassle that comes with a claim.
Tens of thousands without papers in the Netherlands
The Netherlands has between 23,000 and 58,000 foreign nationals who reside illegally in the Netherlands. That’s one latest estimate from 2020 over the period 2017-2018. Experts believe there are actually many more.
The majority of these undocumented migrants work and have built up an existence in the Netherlands. Scientists distinguish three groups:* rejected asylum seekers* ‘adventurers’* ‘investors’, often from South America or Asia, who work undeclared in order to send money back to their families.
According to estimates, there are about 15,000 Brazilians in Amsterdam who fall into the latter category. About 1000 older Surinamese undocumented people who no longer qualify for Dutch citizenship also live here.
Street doctors are concerned: while these frail elderly need more and more complex care, the number of general practices that provide this care is declining.
Fleur de Meijer works as a general practitioner in the Bijlmer in Amsterdam and as a street doctor in the Pauluskerk in Rotterdam. Due to the shortage of GPs, many practices have a patient freeze, she says.
This is an additional disadvantage for undocumented migrants: “Because they do not have a permanent address or GP with whom they can register, it is also difficult to do something about preventive care. As a result, the problems are getting bigger and the care is becoming more expensive. It is especially important for chronically ill elderly people to be registered with a general practice.”
The Pauluskerk in Rotterdam therefore offers temporary shelter to nine vulnerable elderly people who have nowhere else to turn and it is the intention that in January a general practice in Rotterdam that focuses specifically on undocumented migrants. In Amsterdam, a list is being drawn up of GPs who still have room for undocumented migrants.
Dokters van de Wereld has been offering help at its own out-of-hours GP practice in Amsterdam since January. This concerns care covered by the basic insurance and dental care, because undocumented migrants are not reimbursed elsewhere. “The total number of patients has been increasing since the medical post opened,” says a spokesperson.
Referrals to hospitals are often complicated. “Not all healthcare providers are aware of the fact that the uninsured are also entitled to healthcare,” says the spokesperson.
For example, sometimes undocumented migrants first receive a bill from the hospital, says Gianni da Costa, who assists the Brazilian community of undocumented migrants in Amsterdam. “They then think they have to pay for it.”
In addition to the post where around 800 people have been helped this year, Dokters van de Wereld also provides care in buses and at other temporary points. In total, the organization conducted about 2,000 consultations in the first half of 2023. In 2019, there were still 2,000 consultations throughout the year. These are emergency solutions, the organization emphasizes, until there is more room at regular GPs again.