The Dutch government is investigating doctors’ claims that hospitals are increasingly refusing uninsured patients—such as homeless people and illegal immigrants—their right to “medically necessary care” under the new national health insurance system, which took effect in January.
Two Rotterdam doctors, who work with homeless people, drug misusers, and illegal immigrants in the deprived inner city, voiced their concerns in the Dutch Medical Association’s journal Medisch Contact (Medisch Contact 2006; 61:843) They are treating more than 20 uninsured patients every week who have been denied hospital treatment, they say.
Marie Kok and Frans Sikken say they regularly treat patients with hernias, gall stones, and cataracts or who need diagnostic tests for rheumatoid arthritis or with active hepatitis B or C who have been refused treatment. They claim that patients without identity or insurance documents are being turned away without being seen by a doctor.
They argue that their medical training and ethics preclude them from choosing who should receive care on the basis of who can pay. It is “unacceptable,” they write, that “medical help for some patients in our country has declined to a third world level.”
The Dutch Medical Association is calling for immediate action, and last month wrote to MPs warning of the “threats to public health” of not sufficiently guaranteeing access to health care to uninsured people.
Dutch hospitals accept that doctors should screen for “urgent” care but believe that insurance can be arranged for non-urgent care. A spokesman said: “Our objection is that the cost and responsibility are left to the hospitals, whereas a political solution is required.”
But the health minister, Hans Hoogervorst, is resisting pressure to establish “immediately” a fund to guarantee the cost of hospital care of an estimated 250 000 uninsured patients. In a parliamentary debate provoked by the article, he announced only that the Health Care Inspectorate will investigate.
Since 1 January the Netherlands has lacked a provision specifically for meeting the cost of unpaid hospital bills. Plans for such a “guarantee fund” are included in the law, but Mr Hoogervorst has said that he wants to reduce the number of uninsured people first. Local authorities, for example, are offering collective insurance for people on benefits and low income. Meanwhile the number of uninsured people is being investigated before the “usefulness and necessity of a guarantee fund” is considered.
But as premiums have risen sharply the number of uninsured people is also expected to rise.
Loes Markenstein, speaking on behalf of the Dutch Medical Association, argues that funds to guarantee hospital care for uninsured patients are urgently needed. In its letter to MPs the association said that it was “irresponsible” to wait any longer.
Mr Hoogervorst has said he accepts his predecessor Els Borst’s position that uninsured people have a right to medically necessary care, as judged by a doctor.