Some 100,000 inhabitants of the Netherlands have never paid the compulsory basic medical insurance premium since the system was introduced four years ago, according to health ministry figures.

A further 200,000 people are more than six months behind on their payments. A total of 600 million euros of premiums remain unpaid.

However, this month the health ministry will start collecting payments from premium dodgers by making deductions from their salaries or state benefits. Up to now it has been up to health insurance companies to chase up the premiums they are owed – a costly and time-consuming task.

The fact that they have not paid their premiums does not prevent people from obtaining medical treatment. Because everyone in the Netherlands has a legal entitlement to health care, it is not possible simply to terminate the policies of non-payers. Legislation which came in to force on 1 September provides for salary and benefit deductions of 100 euros a month in premiums, plus a 30-euro fine.

Reform
The Dutch health insurance system was reformed in 2006. Under the previous system, people with earnings below a certain level were entitled to insurance under a national health system. Those with earnings above the threshold were obliged to take out private insurance.

Now everyone has to take out a mandatory basic medical insurance with the insurance company of their choice. The insurers are not allowed to discriminate on the basis of risk, and the basic policy covers the majority of medical treatment. Policyholders are free to take out supplementary packages to pay for treatment ranging from dental care to complementary medicine. The basic premium ranges from around 70 to 95 euros, depending on the policy excess. There is a mandatory excess of 155 euros. People on low incomes are entitled to compensation in the form of a tax bonus.

Migrants
The universal entitlement to health care does not extend to illegal immigrants, who are not able to obtain insurance. The Dutch health system’s treatment of illegal migrants recently came in for criticism from campaigning organisation Doctors of the World. Although there is a government fund to compensate certain hospitals for treating illegal migrants, in practice many illegal migrants are forced to pay up front or do without medical care.