Access to Health Care of Illegal (Undocumented) Immigrants in the Netherlands

Introduction

The issue of access to health care for illegal immigrants has generated great controversy in many countries of the European Union. Their access is probably limited because of fear of registration and lack of financial means. Moreover, several countries, including the Netherlands, have taken measures to restrict the number of new immigrants and their entitlements to publicly-financed services. Additional legislation to deter illegal immigrants in the Netherlands went into effect in July 1998. It consists of a number of measures that deny illegal immigrants all access to publicly-financed services, including welfare and public health care insurance. The additional legislation in the Netherlands is known as the Linkage Act, because of the linkage between residential status and entitlements to use public services. Two reasons were stated to justify this legislation. In the first place, the act was to prevent a proportion of the illegal immigrants gaining the impression that they have an entitlement to stay here. Secondly, the act was intended to discourage people from entering or remaining in the Netherlands as illegal immigrants. Besides this Linkage act a new Aliens Act became effective in 2001.

This legislation resulted in a lot of discussion in the Netherlands, especially in the health care field. Ethical and professional considerations mean that health care providers cannot refuse to provide care for illegal immigrants who require it. However, they may often not be paid for this care. To avoid this situation, central government has provided 5 million Euro per year as financial support for health care providers (general practitioners, midwives, pharmacists and some related services) who provide ‘medically necessary care’ to illegal immigrants. This so-called Linkage-fund only does so if a health care provider helps a disproportionately large number of illegal immigrants; if costs are not reimbursed in another way; and if costs are claimed by a regional health care network. Hospitals may book their costs for illegal immigrants as ‘doubtful debts’.

To monitor the influence of the Linkage Act on the accessibility of health care for illegal immigrants TNO conducted two studies: 1) Access to health care for illegal immigrants and 2) Financing of health care for illegal immigrants.

More information (in Dutch)

• 1 Reijneveld S A, van Herten L M. Toegankelijkheid van zorg voor illegalen (Acces to helath care for illegal immigrants).  TNO Prevention and Health,. 2000; 
• 2 van Herten L M, Reijneveld S A, Borghouts J AJ. Finaciering van zorg voor illegalen (Financing of health care for illegal immigrants).  TNO Prevention and Health,. 2001;