Transgender Healthcare Netherlands
General Healthcare Overview1
Dutch healthcare is divided in several ways. There are three lines of care. This care begins with the network of general practitioners, or “house doctors” (huisartsen), which lead to referrals to second- and third-line care. There is a distinction between physical and mental healthcare; there is also a divide between short term cure and long-term care.
The Netherlands runs a system of acute primary care centres which are open 24 hours a day and seven days a week. This system is provided by a combination of general practice health centres that operate outside of normal office hours and medical emergency units most often found at hospital locations and have surgical capabilities. In some instances, general practice centres and medical emergency units are found at the same hospital location.
The Netherlands National Institute for Public Health and the Environment performed an analytical exercise in 2015. The exercise showed that 98.8% of the population are only 45 minutes away from an emergency facility.
Out of hours telephone access to a general health practice allows a patient to ask for advice for an arising medical situation. Depending on the situation the patient can be asked to visit the practice or to head straight for a hospital’s emergency facilities for more serious cases.
Most hospitals in the Netherlands are privately run non-profit foundations that may belong to an organisation running a group of hospitals. Of these hospitals, they fall into three general categories: General, University and “Top-clinical” teaching hospitals. The eight university medical centres in the Netherlands are the largest hospitals in the country. They house the largest number and greatest variety of specialists and researchers allowing them to provide the most complex and specialised treatment.
In the Netherlands, health insurance is obligatory. Two statutory forms cover healthcare: “basic insurance” (Zorgverzekeringswet – Zvw) for common health care and long-term nursing and “care insurance” (Wet Langdurige Zorg – WLZ). Residents of the Netherlands are automatically covered by the government for WLZ, but everyone over 18 must take out their own policy for basic health insurance. Legally, one risks a fine for not having insurance, and insurers have to offer every policyholder a universal package no matter their state of health; no special conditions may be imposed, and no applicant may be refused. Minors are covered by their parents’ insurance.
Most insurance packages allow the patient freedom of choice from where they receive treatment. Government websites gather (https://www.zorginzicht.nl/) and disclose (https://www.kiesbeter.nl/) information about provider performance. Moreover, dissatisfied policyholders have the freedom to change their insurance package at least once a year.
According to the 2016 Euro Health Consumer Index (ECHI) the health system in the Netherlands was rated best of 35 countries and has been the only country to rank in the top three positions since 2005. The only aspect, according to the report, that required some improvement was waiting times.
Annually, Dutch healthcare costs around €1,200 per head for insurance alone plus a further €700 in excess charges, dental costs (which are not covered) and prescription charges, of which patients pay around 34 per cent the total.2
Apart from the EHCI, a 2017 Lancet review on which the Dutch broadcaster RTL reported3, marked Dutch healthcare among the top 10 of 200 countries worldwide. The ranking, of which Andorra was ranked first, looked at 32 avoidable or treatable causes of death and the ranking was based on accessibility and standard of care provided.
Overall, 41% of health costs are covered by the mandatory health insurance system. The remainder of the costs are covered by taxation, payment by the patient, optional insurance packages and other unspecified sources. A nod to affordability is given through allowances based upon income and premiums paid through one’s employment health provision.
Premiums in the Netherlands are not based upon ones existing health status or age. The risk is covered by a system of compensation paid to insurers through risk equalisation.
Transgender Rights in Netherlands4
Discrimination on the grounds of sexual orientation in housing, employment, public and private accommodations was banned by the Equal Rights Act (1994). Protection is afforded in this act towards transgender people under the ‘gender’ clause but gender identity is not specifically mentioned. There have been cases, though, where the Dutch Institute for Human Rights has specifically ruled where transgender people are included in this clause.
A 2016 report by the Ministry of the Interior and Kingdom Relations researched how protections over gender identity and gender expression can be included in the Equal Rights Act. Although discrimination against transgender people is already forbidden, they recommended that prohibition of this kind of discrimination should be explicitly made and that discrimination against intersex people should also be explicitly forbidden. As it stands now, the bill awaits advice from the Council of State. Thereafter, the bill may read in the House of Representatives.
After a bill received overwhelming support in the Dutch Parliament, a law took effect in 2014 allowing transgender people legally to change their gender on their birth certificate without the need for sterilization or gender reassignment surgery (GRS).
Transgender people can serve openly in the Dutch military.
In the Netherlands, the use of private health resources to transition is rare to non-existent as hormone replacement therapy (HRT), sex/gender reassignment surgery (SRS/GRS) and laser hair removal are covered under the health insurance system. Facial feminization surgery and breast augmentation are not covered and so they will be an out-of-pocket expense.
The main centres for the provision of healthcare aimed at transgender people are the VUMC (Vrije Univsersiteit Medisch Centrum) in Amsterdam and Groningen’s UMCG (Universiteit Medisch Centrum Groningen). Waiting lists are commonplace. For example, at VUMC, there has been a 6-month waiting list after registration, meaning the patient couldn’t begin a ‘diagnostic phase’ of appointments with a psychologist for at least six on up to ten months. Patients would be expected to have begun living full time in the real world in ones identified gender by the end of this phase. As this time the case would be discussed by a panel made up of the whole gender team to decide whether HRT would be appropriate. A patient would have to have been taking hormones for at least a year, but more likely three years, before expecting any surgery.
De Boelelaan, 1117 1081 HV Amsterdam Tel: +31 (0)20 444 4444
Centre of Expertise on Gender Dysphoria
De Boelelaan, 1118 1081 HZ Amsterdam Tel: +31 (0)20 444 0542
The Centre of Expertise on Gender Dysphoria (KZcG) offers patients of all ages a complete multidisciplinary care package suited to each individual patient. On the site, VUMC very thoroughly explains the care offered to each patient whether a child (which VUMC considers as being under twelve years of age), adolescent or adult.
Hanzeplein, 1 9713 GZ Groningen Tel: +31 (0)50 361 6161
Web: https://www.umcg.nl/NL/Zorg/paginas/Default.aspx (also in English)
The list of departments on the UMCG website does not include specifically one dealing with transgender patients, nor endocrinology. There are psychology and plastic surgery departments.
Supplementary Private Treatments
Facial Feminization Surgery
Dr. Bart Stubenitsky Velthuis Kliniek
Web 1: http://stubenitsky.com/
Dr Stubenitsky studied medicine at Maastricht going on to specialise in plastic surgery at Utrecht. He carried out doctoral research in reconstructive and cosmetic facial surgery in New York and Toronto. He works at the St. Antonius Hospital in Utrecht performing surgeries correcting craniofacial abnormalities. His work as an aesthetic plastic surgery is carried out at the Velthuis Clinic. Among other cosmetic surgery procedures, he performs facial feminization surgery.