Suffer rather than pay
Many students have the most basic – and therefore cheapest – health insurance available.
That usually works out fine because young and healthy people need relatively little care. But when they do need something, they end up paying a lot of money.
This can lead to avoidance and postponement behaviour. Students often forego regular dental checkups, for instance. They also do not get their cavities filled.
For others, the obligatory excess deductible can be such a hurdle that they defer getting an operation.
Cisca, for example, has had a torn cruciate ligament for three years. She is waiting to have the operation until she graduates and has a regular source of income.
There are cheap alternatives to expensive healthcare that allow people to keep costs low. Therapy sessions with a psychologist cost money, but with a psychiatric nurse, they are free. But be careful: a bargain can be deceiving.
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Approximately five weeks ago, Eva’s wisdom teeth started coming through. All four of them: in her upper and lower jaws, on the left and on the right. And they are making themselves known. ‘It’s kind like I’ve got braces again but they’re pushing the wrong way.’ She has to take painkillers to cope.
Her dentist wanted to refer her to a hospital, but Eva, who is still a student, has health insurance with the maximum excess deductible. Having four molars pulled by a dental surgeon would cost her nearly 700 euros. That is money she does not have simply lying around.
Many students have the same type of insurance as Eva: the basic package, which has the highest voluntary excess deductible possible in order to reduce the monthly premium by as much as possible. It is a gamble that usually works out just fine if you are healthy and young and do not need a lot of care – until something does suddenly happen and you have to pay a high price for treatment.
Eva’s wisdom teeth will be staying put they are until the new year, which is when she can adjust her excess deductible. She hopes her molars will not get infected in the meantime. ‘It does hurt’, she says, ‘but not so much that it’s worth spending hundreds of euros on.’
Laura Verburgt, a dentist at Studentist, notices that students are often preoccupied with how much treatment costs. ‘They’re preoccupied with it more than ever. It’s understandable of course, because their lives are expensive enough as it is.’ Studentist focuses specifically on students and tries to take their financial situation into account. ‘We always send them a treatment plan that outlines the costs, even if it’s just 15 euros. That way they know what they’re getting into.’
It takes the average student two and a half years after registering at university to visit a dentist, which means they’ll have missed five checkups by then. That is not without its consequences, but Verburgt’s patients are typically not in a hurry to change this. ‘They postpone treatment often. That includes filling cavities, even though that can lead to nasty complications. It’s really best to get regular checkups and have proper insurance, if for no other reason than you never know when you might fall off your bike and break all your teeth.’
Suddenly falling over
After all, accidents happen, no matter how young and healthy you are. Cisca experienced this as well, and for her, the consequences are a little more severe than a couple of painful molars.
‘It happened almost three years ago, during a theatre class’, she says. ‘I wanted to hop away, but my partner had his hand around my ankle and pulled on my leg.’ She landed so badly that she could no longer walk. An MRI scan showed that her anterior cruciate ligament was torn. ‘The GP recommended three months of physical therapy. If it hadn’t healed by then, I would need an operation.’
He may as well have told her to heal her busted knee with magic. Cisca, who is training to be a personal companion to handicapped people, only has basic insurance. She would have to pay for the first 20 physical therapy treatments, which would amount to approximately 800 euros, herself. And any operation would be taken out of her excess deductible. Cisca’s mother is on debt relief, and her boyfriend’s income pays for all their living expenses. There simply is no money.
Cisca can walk, but she tires easily. Sometimes she falls over suddenly for no reason. She can only take the stairs slowly and can only run for a short time. She tries to do sports to strengthen her leg muscles and to keep her weight under control as much as possible – she has gained 20 kilos since the accident. She hopes to graduate this year and find work with a higher income which would enable her to go to the hospital.
Cheaper STI tests
‘I would probably advise her to just have the operation’, says GP J. J. Stam. ‘It’s such a shame to keep suffering from this, especially if you’re still young.’ But, he says, ‘I have no insight into her finances, of course. It’s her choice.’
Stam sees a lot of students at his practice at the Ossenmarkt. He sees that students in particular keep a close watch on the costs when it comes to STI tests. ‘They often want to be tested for every single STI. That’s fine of course, but including all the blood tests can cost them 150 to 180 euros. They often stick to a chlamydia test when they hear that.’
Ali Louwenaar, who owns a practice in the Oosterparkwijk, sees the same thing. ‘Sometimes they’ll ask for the treatment straight away rather than having a culture done first. Those antibiotics are much cheaper than the tests.‘ That is a great, albeit pointless, trick, Louwenaar says. ‘I’m a GP, not a drugstore. I can’t treat something if I don’t know what it is.’
Stam has switched to a different – cheaper – laboratory for STI tests. ‘So many people said: “Wow doc, 120 euros for a test, isn’t that a bit much?” So I did some research and found a lab that is much cheaper. It’s my way of helping my students with their costs.’
There are other ways for students to keep healthcare costs low without foregoing treatment. Suzanne has been receiving psychiatric help since February – not from a psychologist, but from a psychiatric nurse. Because they work from a GP’s practice, the time Suzanne spends there counts as a regular GP visit. Which means she does not have to pay for it.
The high pressure of Suzanne’s studies and her ‘gloomy disposition’ kept her from getting out of bed in the morning. ‘I didn’t recognise myself anymore, so I saw my GP. He mentioned the psychiatric nurse as an option.’
A psychiatric nurse is a trained professional who specialises in conversational support for people with psychological issues. ‘We talk about things I struggle with and how I could handle them’, Suzanne says. ‘For example, I saw my master’s thesis as this mountain of work I would never be able to handle. The nurse gives me tips to help me get it done anyway.’
Suzanne is doing much better and will soon have her last treatment. ‘It really helped. It was like someone was holding up a mirror.’ But not all cheap alternatives for expensive health care work out.
Dentist in training
Finn studies in Groningen, but is still registered at a dentist’s office in his hometown. When he felt it was time to find a dentist in Groningen, he decided to go to the UMCG. ‘You can get cheap treatment from dentistry students. It seemed like a good idea to keep costs low.’
Finn spent more than an hour in the dentist’s chair to get a cavity filled. A bad omen, just like the fact that he only saw one instructor in the entire room at the time, when nine people were being treated at the same time. ‘The instructor was keeping an eye on how the students were doing, but he had to be everywhere at once. He couldn’t really handle it on his own.’ Finn’s filled cavity kept bothering him so much that he ended going to the dentist in his hometown. ‘He said, “Oh, I can see the problem” and he fixed it in ten minutes.’ But he was a lot more expensive than the dentists in training at the UMCG.
Nothing in life is free. Students might not like it, but Stam says there is not much to be done about it. ‘People are always complaining that everything should be free and with no waiting times. And sure, it’s unfortunate if you don’t have a lot of money and need to pay your health insurance. But the simple fact is that healthcare costs money, and there is no perfect system. All in all, and especially compared to other countries, I think we’ve got a pretty sweet deal going here.’
The surnames of the (ex-)patients featured in this story have been left out for privacy reasons.