It Start with Trust & understanding

1 Jun 2017 | Deborah Valentine

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First appeared in  THEXPAT Journal Summer 2017 publication


It Starts With Trust & Understanding


“Health care systems differ the world over, and while the Dutch system is acknowledged to be one the best in the world by official organisations, it is very different to that which many internationals are used to. For instance, your doctor acts more as a gatekeeper to the rest of the health service, you may not be able to get the periodic check-ups you are used to and you may find insurance very cheap, or very expensive.”


Discovering What People Think

In 2013, ACCESS, together with DutchNews, published a book entitled Ready, Steady, Go Dutch – a book full of tips, tricks and testimonials from internationals who have already ‘gone Dutch’. It revealed as much about the country as it did about the many people and nationalities who commented – on everything from health care to housing, and more. The opening above was taken from the Health Care section of the book – in which internationals shared their thoughts and experiences with health care in the Netherlands. Later that year, ACCESS, together with International Health Services (IHS) undertook a survey into this same topic, in order to gain insights into the health care experiences of internationals.

The results “provided interesting insight” into the internationals’ “areas of special satisfaction and difficulty. Areas of attainable improvement were identified, along with areas not likely to deliver significant improvements in patient satisfaction”. Perhaps the most revealing aspect of the survey was the conclusion that at the end of the day, there was very little “trust and sense of confidence” in the care they received, or in the way in which health professionals and international patients interacted.

This was again confirmed when International Health Services (IHS), together with SGE (Eindhoven Corporation of Primary Health Care Centers), embarked on a consultative project, and conducted a similar survey in the Eindhoven region in 2014. Here too, trust, confidence, understanding the system came out as areas to be worked on. The result of this process was the opening of an International Health Centre in Eindhoven, which (among other things) has a consultative panel of internationals to help the centre respond to and work well with (and for) internationals. Their efforts have been rewarded with the acknowledgement (in 2016) of 73% of their patients, indicating that they strongly agree with the statement “they trust that their GP knows the best treatment and that they feel confident in his or her care”.


Sharing What Can Help

ACCESS plays a role in managing the expectations of internationals as they arrive and come to live in the Netherlands, by answering questions, leading people to further support, and investing in explaining how things work here (on our website, in our guides & magazine etc.). We know that our activities play an important role in helping people settle here successfully. However, in the course of our work, we are also spending an increasing amount of time managing the expectations of the service providers working with and for internationals. And, sure, this is not the only way to improve things, but it is, and can be, a step in the right direction, as the SGE example shows.

One of the most important steps towards building that trust among the patients of International Healthcare Eindhoven, has involved listening to the panel of internationals – appreciating that since people come from so many and varied experiences with health care, time and effort are needed to not only explain how things work, but also to listen to the patients themselves and to pinpoint where the ‘gaps in their understanding’ are. Then, and only then, can trust be developed, and confidence gained.

The experiences of SGE in Eindhoven, together with the work of the Network Healthcare for Internationals (H4i), are building on the lessons learnt. Together with the Royal Tropical Institute (KIT) – which has extensive experience with health care systems in other parts of the world, as well as expertise in intercultural understanding and communication, a programme has been developed for Dutch health care professionals. This one-day programme, ‘Zorg voor internationals’ – Care for Internationals – helps doctors and other medical professionals better understand the needs and expectations of internationals and in so doing has contributed to improved communication, understanding and a building of trust. So far it has been positively received by the health care practitioners, as well as by their support staff at SAG (Stichting Amsterdam Gezondheidscentrum). Elsewhere in the country, surveys are confirming the ‘trust/confidence’ issue and the experiences described above will no doubt contribute to plans there.


ACCESS is proud to have been associated with the original survey which has led to these developments: making practitioners aware of differences, finding ways of closing the gaps of understanding, and contributing to better health care experiences for internationals in this, their new home. It will not solve all the issues, but we do believe it can go a long way, and we will continue to play a role in sharing what we know (and gather through surveys) about internationals, with those serving them.


As one respondent in ‘Ready, Stead, Go Dutch’ said: “Once you understand the health system, the better you can use it to your advantage. Be sure to get registered with a house doctor when you first arrive and book an appointment to meet him/her while you’re well. They will give you an overview of how the system works and the right numbers to call in an emergency. Trying to find out what to do and who to call in a time of panic, crisis or when you’re just not feeling well, is not advisable.”



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See also:

Ready, Steady, Go Dutch –

Winter 2016 issue of the ACCESS Magazine - “Building trust in healthcare for internationals”

International Health Services (IHS) –

SGE - Eindhoven Corporation of Primary Health Care Centers -

Network Health for Internationals –

KIT (Royal Tropical Institute) –

International Community Advisory Platform (ICAP) – (to sign up for an upcoming health care survey in September 2017)

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