2 These migrants often suffer from mental health problems In a s

2 These migrants often suffer from mental health problems. In a study of 100 female UMs in the Netherlands, psychological problems such as anxiety, sleeplessness and agitation were kinase inhibitor Pazopanib mentioned by more than 70% of the women.3 In a European survey among UMs, more than one-third of 177 UMs in the Netherlands perceived their mental health as bad or very bad.4 Their limited access to healthcare services may impede adequate treatment of these problems by healthcare providers, usually general practitioners (GPs) who are in the Netherlands their

first contact with healthcare.3–5 Accessibility problems In 1998 a Dutch law named Linking Act was passed making it impossible for UMs to obtain healthcare insurance.6 At the same time, however—in accordance with various universal covenants—they are entitled to free ‘medically necessary

care’.7 From 1998 to 2009 the care was regulated by the Linking Act and financed by a special fund called ‘Koppelingsfonds’. In this period ‘medically necessary care’ and care to protect public health could be reimbursed, but it became apparent that service providers used different interpretations of these concepts. Therefore efforts were made to formulate a uniform system for reimbursement, and in 2009 a new law came into force with the following legislation:8 The definition of ‘medically necessary care’ is equated with ‘basic health

coverage’ as defined by the 2006 Health Insurance Act. UMs should be treated according to the same standards and guidelines as of other patients, unless they are expected to leave the country soon. Costs can be reimbursed by a special fund from the National Health Care Institute to healthcare providers if they have failed in their efforts to let the UM pay his own bill. With the exception of care for pregnant women and childbirth (for which 100% reimbursement is possible), only 80% of the costs of directly accessible care (general practice and emergency department) can be reimbursed. ‘For non-directly accessible’ plannable Cilengitide care (eg, other hospital departments, pharmacies, nursing homes, dispensaries) 100% reimbursement is possible, but only for a selected group of healthcare providers appointed in each region by the National Health Care Institute. For this care, UMs need a referral or prescription. UMs are therefore entitled to receive primary care delivered by GPs which they have to pay for themselves. However, if UMs are unable to pay for these services, GPs can get a reimbursement from the aforementioned fund. After referral by the GP, UMs have access to all secondary care services but will be referred mostly to those hospitals, mental healthcare institutions and pharmacies that are appointed by the National Health Care Institute.

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