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Healthcare for undocumented migrants: the situation in the Netherlands

More and more professional health care workers meet migrants who are ‘illegal’ in The Netherlands. Part of this group of migrants are ex-asylum seekers, who have not returned to their country of origin but remained in The Netherlands. As a result the number of undocumented migrants is rising steadily. Since the Koppelingswet (Linkage Act) came into force in 1998, these undocumented people are not entitled to social security services.
During the 70’s and 80’s undocumented inhabitants were mainly men who worked without a permit. In the past few year’s asylum seekers who have exhausted all legal procedures also belong to this group (their women and children included). Exact numbers are not available, but the most recent estimation is that there are between 75.000 and 185.000 undocumented migrants in The Netherlands. Most of them live in one of the four big cities: Amsterdam, Rotterdam, Utrecht and Den Haag. 
As a result of the Linkage Act, undocumented migrants residing in The Netherlands are excluded from public collective benefits and services; e.g. financial support, housing and health insurance. They can only get healthcare services if they pay for it, which they often cannot. An exception is made in the situation of medical necessary care. Initially the practical interpretation of medical necessary care was assessed by the treating physi-cian. In recent years, the autonomy of physicians is under-mined by financial arguments. This makes it more and more difficult for undocumented migrants to be treated in hospitals due to the restrictions by hospital management. As a conse-quence, the medical necessary care to undocumented migrants runs the risk to be gradually narrowed down to urgent medical care.

The Dutch government created a special fund, the Koppelings-fonds, for the treatment of undocumented migrants. The fund only compensates the costs of caregivers in primary health care e.g. general practitioners, pharmacies, dentists and midwives. The high number of claims received by the Koppe-lingsfonds puts the system of reimbursement under pressure. General hospitals cannot address to this fund. They can request for (partly) compensation from health insurance companies. This compensation has been limited in the recent years. Psy-chiatric care and nursing homes are not at all compensated for the care given to undocumented migrants.

In 2006, a number of large clinics complained publicly about their growing financial burden for the treatment of undocumen-ted migrants. An extension of the Koppelingsfonds or an adap-tation of the existing arrangements with the different health care providers and institutions is currently part of the discussions between parliament and government. 

Pharos long-term plan on Undocumented Migrants and Health