Dutch Healthcare 2027: The “Eigen Risico” Roadmap & Ultimate Survival Guide

THE HAGUE – Healthcare reform was a central theme of the 2025 election campaign, with parties across the spectrum debating the future of the Eigen Risico (Mandatory Deductible).

The New Coalition Plan:

In the newly finalized coalition agreement for the “Jetten I” cabinet, the government has set the healthcare budget for the coming years. According to the protocol, the mandatory deductible will remain frozen at €385 for 2026, but is scheduled to increase to €460 starting January 1, 2027.

For expats, the Dutch healthcare system is often a source of cultural shock. With upcoming changes, understanding the technical nuances of this system is essential for financial planning.

In this definitive 2600-word dossier, we decode the planned 2027 rules, explain the difference between Eigen Risico and Eigen Bijdrage, analyze the “Arbo-arts” system for sick leave, detail how to handle pharmacies, and compare the system to the UK/USA/Germany.

Table of Contents

• The 2027 Plan: Why €460?
• System Clash: NL vs. UK (NHS), USA & Germany
• The Gatekeeper: Why Your GP (Huisarts) Won’t Give Antibiotics
• Choosing a Policy: Natura vs. Restitutie vs. Budget
• The Pharmacy (Apotheek): The “Preference Policy” Trap
• Eigen Risico vs. Eigen Bijdrage: The Great Confusion
• Emergency Guide: Huisartsenpost (HAP) vs. ER (SEH)
• Sick Leave & Burnout: The “Arbo-arts” & Employer Rules
• Zorgtoeslag 2026: Step-by-Step Application Guide
• Chronic Illness & Physiotherapy: The “Chronic List”
• Mental Health (GGZ): The Crisis & The POH Solution
• Payment Hack: How to Pay the €460 in Installments
• Healthcare FAQ 2026/2027
• Medical Vocabulary Corner
• Sources & References

The 2027 Plan: Why €460?

The adjustment of the deductible is linked to the structure of the Dutch “Solidarity System” and demographic trends.

The Math:

Healthcare costs in the Netherlands are rising due to an aging population (“Vergrijzing”) and advanced medical technologies. The system is funded roughly 50% by payroll taxes (Zvw) and 50% by private premiums paid by residents.

The Decision:

The “Jetten I” coalition agreement maintains the current deductible for 2026 to provide stability, while the increase to €460 in 2027 is implemented to balance the growing healthcare budget without sharply increasing monthly premiums.

System Clash: NL vs. UK (NHS), USA & Germany

Expats often struggle because they expect the Dutch system to work like their home country. It doesn’t.

The Gatekeeper: Why Your GP (Huisarts) Won’t Give Antibiotics

For many expats, especially those from Southern Europe, Asia, or the US, the Dutch GP (Huisarts) is a source of immense frustration. You feel terrible, you have a fever, and the doctor says: “Kijk het even aan” (Wait and see).

The Philosophy (NHG-Standaarden):

Dutch medicine is strictly non-interventionist. They adhere to the “NHG-Standaarden” (Guidelines of the Dutch College of GPs), which are based on scientific evidence showing that most minor infections (viral) resolve themselves. They do not prescribe antibiotics unless you are at risk of complications (pneumonia) or have a bacterial infection. This is a national strategy to prevent “Antibiotic Resistance” (Superbugs).

The Gatekeeper Rule:

You CANNOT go to a specialist (Dermatologist, ENT, Cardiologist, Gynecologist) at a hospital without a Referral Letter (Verwijsbrief) from your GP.

The Risk: If you go directly to a private clinic or hospital without this letter, your insurance company will refuse to pay the bill (often €400+), and you will pay 100% out of pocket.

Exception: You do not need a referral for the Dentist, Physiotherapist, Midwife, or Emergency Care.

Choosing a Policy: Natura vs. Restitutie vs. Budget

When you sign up, you face a confusing choice of policy types. Choosing the wrong one can cost you thousands.

1. Natura Polis (Contracted Care)

The Standard. The insurer signs contracts with hospitals.

Pros: Cheaper premiums, 100% reimbursement at contracted hospitals.

Cons: If you go to a non-contracted clinic (e.g., a specialized private orthopedic clinic), you only get 75% reimbursement.

2. Restitutie Polis (Freedom of Choice)

The Premium Choice.

Pros: You can go to ANY doctor, hospital, or clinic in the Netherlands, contracted or not, and get 100% of the “market rate” reimbursed.

Cons: Expensive. Warning: Many insurers have stopped offering true Restitutie policies in 2026 due to costs. Check the fine print!

3. Budget Polis (Selected Care)

The Trap.

Pros: Very cheap.

Cons: Extremely limited choice. You might only be allowed to go to specific hospitals for planned surgery. If you go elsewhere, you pay a huge penalty.

The Pharmacy (Apotheek): The “Preference Policy” Trap

So, you finally got a prescription. You go to the Apotheek. The drama continues.

Preference Policy (Preferentiebeleid):

Insurers contract with drug manufacturers to get the lowest price.

Scenario: Your doctor prescribes “Brand X” medicine. The pharmacy gives you “Generic Y.”

Why? Your insurer only pays for Generic Y. If you insist on Brand X, you must pay the full price yourself.

The “Terhandstellingskosten”:

You will notice a charge of approx. €7 to €14 on your receipt every time you pick up a new medicine. This is not the cost of the pill; it is the “Service Fee” for the pharmacist checking your record and explaining how to use it. You pay this even for a €1 box of pills. This fee also hits your Eigen Risico.

Eigen Risico vs. Eigen Bijdrage: The Great Confusion

This is where 90% of expats lose money. These two terms look the same but mean different things.

1. Eigen Risico (Mandatory Deductible)

Current (2026): €385 / year.

Future (2027): €460 / year (Projected).

What it is: The first €385 of healthcare costs you pay yourself. The insurance pays everything after that.

Applies to: Hospital visits, blood tests, ambulance rides, prescription medication, mental health care.

DOES NOT Apply to (Free): Visits to the GP (Huisarts), Maternity care, Care for children under 18, District Nursing.

2. Eigen Bijdrage (Statutory Co-Payment)

What it is: A fixed amount you must pay for specific services, even if you have already paid your full Eigen Risico.

Examples:

• Hearing Aids: Insurance pays 75%, you pay 25% Eigen Bijdrage.
• Hospital Birth (Without medical necessity): Approx. €560 Eigen Bijdrage.
• Orthopedic Shoes: You pay approx €130 yourself per pair.
• ADHD Medication: Certain brands (like Tentin) require a personal contribution of €20-€40 per month.

Warning: You can hit your deductible limit and STILL receive bills for Eigen Bijdrage. They accumulate separately.

Emergency Guide: Huisartsenpost (HAP) vs. ER (SEH)

It is Saturday night. You cut your finger deeply. Where do you go?

Option A: Spoedeisende Hulp (SEH) – Emergency Room

This is the hospital ER.

Cost: It hits your Eigen Risico immediately. A visit costs minimal €300.

When to go: Heart attack, stroke, broken bones, severe car accident, severe breathing difficulties.

Option B: Huisartsenpost (HAP) – After-hours GP

This is the GP service for nights and weekends. You MUST call them first.

Cost: €0.00. It is covered by basic insurance and does NOT touch your Eigen Risico.

When to go: High fever, stitches, sudden pain, sick child.

Pro Tip: Always call the Huisartsenpost first. If they think it’s serious, they will send you to the SEH. This call can save you €385.

Sick Leave & Burnout: The “Arbo-arts” & Employer Rules

What happens if you get sick and can’t work? The rules in NL are very employee-friendly, but strict.

1. Calling in Sick (Ziekmelden):

You inform your employer. You do NOT need a doctor’s note (it is illegal for your boss to ask for one).

2. The Company Doctor (Arbo-arts):

If you are sick for more than a few days (or frequently), your employer will send you to the Arbo-arts. This is an independent doctor paid by the employer.

3. The Verdict:

The Arbo-arts is the ONLY person who can legally decide if you are fit to work. Your own GP cannot write a “sick note” for work.

4. Burnout:

Burnout is a recognized medical diagnosis in NL. If the Arbo-arts diagnoses burnout, you can be on sick leave for up to 2 years while receiving at least 70% of your salary. However, you must cooperate with a “Reintegration Plan.”

Zorgtoeslag 2026: Step-by-Step Application Guide

The government helps lower-income residents pay their premiums. This is called Zorgtoeslag (Healthcare Allowance).

Crucial: You must apply for it via Mijn Toeslagen. It is not automatic!

How to Apply:
1. Go to toeslagen.nl.
2. Log in with your DigiD.
3. Click on “Zorgtoeslag aanvragen”.
4. Enter your annual income estimate for 2026.
5. Submit. The money will arrive around the 20th of each month.

Chronic Illness & Physiotherapy: The “Chronic List”

In the Netherlands, Physiotherapy is NOT in the basic package. You pay for it yourself, unless you have supplemental insurance.

The Exception: The “Chronic List” (Lijst Borst)

If you have a condition listed on the government’s official “Chronic List” (e.g., MS, recovery from a stroke, certain post-surgery recoveries):
1. You pay for the first 20 sessions yourself (or via supplemental insurance).
2. From the 21st session onwards, Basic Insurance covers 100% of the cost for the duration of the chronic indication.

Important: “Back pain” or “RSI” is generally NOT considered chronic under this list.

Mental Health (GGZ): The Crisis & The POH Solution

The demand for mental health care (Geestelijke Gezondheidszorg – GGZ) has exploded.

The Problem: Waiting lists for specialized psychologists/psychiatrists are 4 to 9 months long in cities like Amsterdam.

The Solution (POH-GGZ):

Almost every GP office has a Praktijkondersteuner Huisarts GGZ. This is a mental health professional working inside the GP practice.

Benefit:
1. Zero Cost: It is covered by GP care (No Eigen Risico).
2. Fast: Usually available within 1-2 weeks.
3. Scope: Good for burnout, mild anxiety, depression, and grief. Start here while waiting for the specialist.

Payment Hack: How to Pay the €460 in Installments

A €460 bill in January 2027 can ruin your budget.

The Hack: “Gespreid Betalen Eigen Risico”

Almost every insurer (Silver Cross, VGZ, CZ) offers a service where you can pay your mandatory deductible in 10 monthly installments (e.g., €38.50 or €46 per month) automatically.

Why do this?

If you don’t use any healthcare, you get the money back at the end of the year. If you do use it, you didn’t have to pay a lump sum.

Action: You must enable this setting in your insurer’s app before January 31st of the year. Check your app now!

Healthcare FAQ 2026/2027

Q: Do I need to carry my insurance card?

A: Not really in NL. Your ID card is enough, as systems are linked via your BSN. But for traveling abroad, you need the physical card (EHIC) on the back.

Q: Is Physiotherapy covered?

A: No. Like dentists, Physio is NOT in the basic package (unless you have a chronic condition from the “Chronic List”). You need supplemental insurance for sports injuries.

Q: I am an expat student. Can I keep my home insurance?

A: Only if you do not work. The moment you get a (part-time) job or paid internship in NL, you are legally required to get Dutch Basic Health Insurance. If you don’t, you face a huge fine from the CJIB.

Q: Does basic insurance cover “Alternative Medicine”?

A: No. Acupuncture, Homeopathy, and Chiropractors are never in the basic package. You need supplemental insurance (Aanvullend).

Medical Vocabulary Corner