How to navigate Dutch healthcare when the incentives are the opposite of what you're used to
Part of: Expat Essentials, Healthcare
If you come from a country where healthcare is privately paid — Lebanon, Brazil, Turkey, the US, much of the Middle East and Latin America — you have been shaped by a specific set of incentives, even if you never thought about it that way. Doctors in private systems earn more when they do more: more tests, more scans, more procedures, more follow-ups. A doctor who sends you away is a doctor who isn't getting paid. A hospital that delivers a baby by C-section earns significantly more than one that doesn't. Brazil's C-section rate in private hospitals runs above 80% in some surveys; across parts of the Middle East and Latin America, rates of 50–60% in private facilities are not unusual. Those are not clinical numbers. They are economic ones.
In the Netherlands, the incentives run the other direction — and the whole system behaves accordingly.
The huisarts (GP) is the centre of the Dutch healthcare system. You cannot see a specialist without a referral from your GP; they are the gatekeeper to everything else.
Dutch GPs are paid primarily through inschrijfgeld — a fixed annual amount per registered patient, regardless of how often that patient visits. The amount is set by the NZa (Dutch healthcare authority) and paid by your insurer automatically. In addition there are small per-consultation fees, but the dominant payment is the registration fee.
The consequence: a GP who sees you more often is not paid more. A GP who manages to handle your problem by phone, by advice, or by telling you to wait and see — that GP has the same income as one who calls you in for every complaint. The incentive is to keep you out of the office, not to bring you in.
This is not corruption or negligence. It is a deliberate policy choice, backed by evidence that the Netherlands achieves good health outcomes relative to how much it spends. But you need to understand the incentive to navigate the system.
When you call your GP practice, you will usually speak first to a doktersassistent — not a receptionist, but a trained healthcare assistant who performs triage. Their job is to assess whether you actually need to see the doctor, whether a phone consultation is enough, or whether you can manage at home with advice.
This can feel like an interrogation designed to turn you away. It is not exactly wrong to feel that way. The questions — how long have you had this, have you taken anything, does it affect your daily life — are genuine triage questions. But they are also questions that, if you answer passively, may result in "we'll call you" or "try paracetamol for a few days and call back if it doesn't improve."
What to do: Prepare before you call. Be specific about duration, severity, and impact on your functioning. "I've had chest tightness for three days that gets worse when I breathe deeply" will get you further than "I have a bit of pain in my chest." If you feel you are being turned away from something you genuinely need, say so directly. "I understand it may not be serious, but I would like to be seen. I am concerned." Dutch directness works both ways.
Neem maar een paracetamol — just take a paracetamol — is a genuine cultural phenomenon here, to the point where it has become a national joke. It is not entirely unfair.
The NHG (the Dutch GP association) issues evidence-based clinical guidelines for GPs. Those guidelines recommend paracetamol first-line for a wide range of conditions: back pain, headache, mild fever, joint pain, toothache. The scientific basis is real — paracetamol is effective for many of these and is safer than alternatives for regular use. Dutch medicine tends toward the minimum effective intervention, which is often the right call.
The problem is that "take paracetamol and see how it goes" is sometimes applied to situations where it is not the right call — where something needs investigating, where a patient is worried and needs to be examined, where the minimum intervention is insufficient. The system can fail people who do not advocate for themselves.
What to do: If you receive paracetamol advice and you are not satisfied, ask specifically: what would be a reason to come back? What symptoms should I watch for? If you have already tried paracetamol and it has not worked, say so clearly before the appointment ends, not after.
Closely related to the paracetamol phenomenon is the Dutch medical preference for afwachten: watchful waiting. Many conditions, especially in children, are managed by observing rather than treating. Ear infections, minor injuries, certain fevers — the evidence in many cases supports waiting over immediate intervention.
This is medically defensible. It is also disorienting when you are used to a system that acts immediately. The Dutch approach is: most things resolve on their own, treatment has side effects and costs, don't intervene unless there is clear benefit.
The risk is when watching tips into missing something that needed attention earlier. Again, the mitigation is active engagement.
Dutch doctors — and the healthcare system generally — operate on a model of responding to what you ask, not proactively surfacing everything they know. This is partly cultural (directness applies here too: they answer what you asked) and partly a deliberate model of shared decision-making that respects patient autonomy.
In practice it means: if you do not ask about a test, they may not mention it. If you do not ask about a side effect, they may not list it. If you do not ask what happens if this treatment does not work, they may not tell you.
This is the opposite of systems where the doctor talks at you for twenty minutes covering every scenario. Neither is inherently better, but you need to switch modes.
Before an appointment, prepare: - Write down your symptoms: when they started, what makes them better or worse, what you have already tried - Write down your questions — the doctor will stop when you stop asking - Think about what you want from this appointment: diagnosis, referral, test, prescription, or just reassurance - If you are managing a chronic condition, think about what monitoring or checks are normally recommended for your situation — the GP may not propose them
During the appointment: - If they say "let's wait and see," ask specifically: wait how long? What would change the decision? - If they say there is nothing to do, ask: is there any test that could rule out X? Is there a specialist who would have a different view? - If you have done research and have a specific concern, raise it. "I read that [symptom] in someone my age can sometimes indicate [condition] — is that something we should rule out?" Dutch doctors respond reasonably to informed patients who ask well.
Pushing back is acceptable and, when done calmly and specifically, usually effective. The Dutch system is not impenetrable — it responds to persistence paired with clear reasoning.
If you feel dismissed: - Call back after a few days if symptoms persist — document that you called, when, and what you were told - Ask for a second opinion — you have the right to one - Ask for a referral — you can request a specialist referral and your GP cannot simply refuse without explanation - If you cannot get a timely appointment and feel it is urgent, go to the huisartsenpost (HAP) — the out-of-hours GP service, open evenings, nights, and weekends for acute issues that cannot wait
It is worth saying: the Dutch system, for all its conservative instincts, produces good outcomes. The Netherlands has high life expectancy, low infant mortality, and good chronic disease management. The emphasis on paracetamol over antibiotics has kept antibiotic resistance lower than in countries that prescribe freely. The gatekeeper model keeps people away from unnecessary specialist exposure and the risks that come with it.
The frustration people from other systems feel is real. But so is the evidence that less medicine is sometimes better medicine. The goal is to understand the system well enough to get what you actually need from it — which is usually achievable if you go in prepared, ask specifically, and push back when something does not feel right.
See also Zorgverzekering for insurance and deductibles, and Medication in the Netherlands for bringing medication into the Netherlands, getting foreign prescriptions recognised, and the difference between a medication passport and a vaccination record.
These guides are written to help you understand the Netherlands — not to replace professional advice. We do our best to be accurate but we make mistakes and information goes out of date. For anything that affects your legal status, taxes, finances, or health, verify with an official source or a qualified advisor.