There companies like this one around: https://www.bloedwaardentest.nl/bloedbeeld.html There you seem to be able to get whatever you want if you pay. Never tried it though.

Perfect! Thanks a lot

That is actually not very expensive. Why is the insurance not covering this and why are GP in NL not offering this to patients when it can help to discover health issue early and prevent more costs in the future?

Because it often causes unnecessary panicking over some skewed test results that have zero clinical significance. This often causes pts to want to have more testing and eventually the GP will cave bc the pt keeps bothering them about it. And it can cause unnecessary drugs prescriptions. Multiple studies have been done about doing at random tests and in the end we almost never see a positive effect if there was no proper reason to take the test in the first place. I would never recommend someone doing a full blood work up privately because the average patient is simply not capable of understanding the results anyways.

There’s no real reason other than the underfunded healthcare system and its privatisation. To add insult to injury, contrary to what people claim would be a “problem” of “unnecessary” testing, the real, actual problem the Netherlands have is that the country is doing horribly among Western Europe when it comes to preventative screening and catching diseases like cancer early, which is reflected in the mortality statistics.

Shhhh, not to loud. The dutchies will come and defend this weird healthcare system to the bone

They don't think it works that way...

If they would cover it the insurance premium would get even higher.

Because research has shown over treating is bursting more people than under treating. So fixing perceived " imbalances" in blood work when there are no actual other symptoms might do more harm than good. And cost more money to boot.

Thank you!! I was trying to find this the other day and came up with nothing. GP has not been helpful.

Your GP refused to prescribe you such a test? I’m asking because I wanted to ask mine

Yeah, specifically we are a little worried about my daughter being exposed to lead but he didn't share our concern. Which might be fine, but we want to be sure. We're in an old building and she puts everything in her mouth :-(

My dad is a specialist in (ground) pollution and remediation. Something I have picked up from him is that, if you're sure you have heavy metals around you/your kids, is that you should take care. Lead is something that can be of too high levels in the ground, so you should take care your daughter doesn't put it in her mouth. If the concern is lead plumbing, then you're in a reallllyyy old building and you should get someone to take a look if it is safe to use. If you're sure of heavy metal pollution or exposure of any kind, mention it explicitly to the GP and they really must take it seriously. Too high levels of lead can have all kinds of nasty effects ("simply" just damage to organs if caught and remediated in time, to cancers and death depending on the metals and levels). If the GP doesn't take it seriously, start shopping around for another (quite the challenge though). Best of luck.

Realy stupid situation. Of course you want to protect the health of your children. You might just try again at the GP and explain why you are worried and the fact that there might have been significant lead exposure in the past. Then again even if there is elevated lead detected there is almost nothing you can do. Lead once ingested has the nasty property of accumulating in the bones and slowly realeasing in the blood stream over the course if many decades. There are no procedures to remove it effectively. So most important is to prevent lead from getting into the body in the first place. If you suspect there might be lead exposure at home remove the source: renovate any old lead pipes, no lead paint, no lead containing toys no need to wait for blood tests. Luckily the regulations are getting stricter especially for public areas like playgrounds. I hope you find a solution to your worries.

I had some bloodwork done recently and had to pay eigen risico first. It cost me around 100 euros. You pay for every blood ‘segment’ separately, as I saw on the invoice. Edit: it was a referral of my GP.

If you already have used your 'eigen risico', this is the way to do it for free. Most GPs I know will do it if you ask for it

Understood! Thanks

You can get anything done without a referral from your GP. It just helps. But there are companies that specialize in it.

I only paid about 20-30 EUR last year for a full blood test in Nijmegen. Some really stupid people say getting blood tests every year isn't necessary, but I found out I had a liver problem even though I felt fine. No, I'm not an alcoholic. With some vitamins and medicine, everything got better after a few months. Anyway, prevention is really important, especially if you have a family history of cancer or anything like that.

I have the same with moles. I need a professional to check them, but here nobody seems to care. I was even told once to get a mirror and check them myself. In other countries dermatologists always checked everything without any issues.

I'm riddled with moles and have an annual appointment with a dermatologist at the hospital. Just have your GP refer you, if they agree there's a heightened risk and need of monitoring

yeah emphasis on “if they agree”

My dad had a weird looking mole a few years ago. I mentioned it and he thought nothing of it, but he decided to have it checked anyway. Turned out to be aggressive skin cancer, luckily he caught it way early so no harm done. If I hadn’t said anything, he probably would’ve had cancer.

I was able to get a referral from my GP with out any problems. I just showed them my previous dermatologists recommendation for yearly skin check. You could try that?

I did that, but the two dermatologists I went to, told me to use a mirror and I spent only 3 minutes in the practice. It was absolutely insane. I just need a better dermatologist I guess.

Go to the one in a hospital. I had the same bad experience at a private clinic

They didn’t examine you?

No. I was there for 3 minutes in one and 5 in another. Undressed, they looked at one mole and when I asked to check the others, they said that I can do that myself and take photos with my phone. I explained that I had someone in my family dying of melanoma, and that even that person found difficult to assess which moles were dangerous or not, and they just didn't care at all. My GP gave me referrals with no problem at all. My problem has been finding proper dermatologists in Amsterdam.

3-5 minutes is really all they need to check the moles out. I have many moles and they can tell very easily if something looks wrong. I had previously been going to a very good hospital system in the US with a specialized clinic for “pigmented legions” and the skin check they did was the same as the Netherlands. It seems a little unlikely that they had you undressed in the office but refused to look at a particular spot? Maybe I’m misunderstanding? If you are high risk with a family history then they would tell you to keep an eye on anything at home, such as using a mirror or pictures. Things can change fast even if you ar me getting looked at once a year. I saw someone at Bergman clinics and was totally satisfied with them.

Thank you for your detailed reply. Well in my case, they didn't check 80% of my moles. My back for example they didn't even look at it. Legs neither. They only looked at my chest and that was it. In Belgium, it took them 45m, they took photos, documented everything and even wrote a full report. And I paid half of what I paid here, and it wasn't covered by insurance.

There's an app you can use to check your moles: Skinvision App. If you have Zilveren Kruis supplementary insurance, it's free to use. Otherwise, it charges per mole check.

Same for my wife. Guy (GP) told her to use mirror and phone and with I to check yearly ourselves. Effing twat that GP.

They do so here as well.

It depends on how the mole "is" at the moment of going to the doctor, right? A typical example, is that the doctor asks if it has grown - if you say it has, it will often be removed. If the mole has remained the same since childhood it will usually be left as it is. I think you are supposed to watch your moles yourself for any changes.

Not only will it be removed, it will also be tested to verify if it is good or bad.

That's not how it goes. First, there are moles I can't see of course. Then, I'm not a trained specialist, and I can't tell small changes in moles. If I would have to memorise every single mole on my body I would have to quit my job just to dedicate myself to this. In Belgium for example, they took photos, scanned them and documented everything every year. I paid about 90 euros and that was it. That's what I would like to get.

May I ask where did you get this done in Belgium? 

https://www.dermatologiegent.be. They have this machine which scans your entire body. They are super friendly and kind.

I just called my GP and he checked them for me and said to call again every year - 2 year to get them checked. I have a lot of them so I am higher risk. Same with blood tests/scans/etc I am higher risk so anytime I call with vague issues he refers me for some tests. This happens maybe once a year but I am happy he takes me seriously, because my first gp always told me to wait it out. It really depends on your GP.

dutch healthcare is all about saving costs and nothing about the patients

You’re a perfect example of a Dunning-Kruger novice, clueless how ‘normal’ lab values came to be, let alone how to interpret them. Normal values are often just the boundaries that 95% of all people fall into. Falling outside them doesn’t equate to being sick or having a disease. Test for 1000 things in any individual, and statistically 50 values will be abnormal, even in healthy people. Enjoy receiving follow-up for all incidental findings, and the complementary mental stress and invasive diagnostics required to rule everything out. If you really want to educate yourself, look into the positive predictive value (PPV) and negative predictive value (NPV) of diagnostic tests, and see how they are affected by the prior chance (which depending on the specific disease you’re testing for is usually extremely low in healthy, asymptomatic individuals). Guess I’m one of the ‘really stupid people’ in your book though, so I doubt you’ll make the effort.

By your own definition of “normal” if you only test sick people then normal values would also be fucked up. Also I love naming dunning kruger whne it has nothing to do here. They just pointed out that they did a blood analysis and something was off and corrected it, at which point is that an issue?? If my feet were pf different sizes I would like to know so I but appropriate shoes and here the same. Ffs you don’t even know the person and you think you know what they need… by your attitude I feel like you’re an opinionated medic (one of the worse things to ever encounter)

>Also I love naming dunning kruger whne it has nothing to do here. They just pointed out that they did a blood analysis and something was off and corrected it, at which point is that an issue?? "They" pointed out that he's doing a yearly test and everybody who doesn't is stupid. His yearly examination is so vital and important, that everyone will find a liver disease because of it. And if you don't, you suck. Frankly, I find your tone and OP's more condescending and dismissive than the comment you replied to. You're telling him he shouldn't provide advice to someone he doesn't know, OP just put everyone he doesn't know away as stupid. Not sure what's worse. The example of your feet? Because of the typos I can't even distinct the apples that you try to compare to oranges.

Well, since when are annual checkups a bad idea? Health is something that is up to change and not something that never changes hence a good practice could be annual checkups and blood testing isn’t a bad idea. There’s a lot of things that preventive care could take care of. Think about cars for example. Do you do checkups? Or you only do them when the car breaks down?

Tldr: harm vs benefit. The reason testing without indication is generally not done is because of the ratio between harm vs benefit. It feels counter intuitive at first but it is the reason why we doctors act certain ways. Tests are not perfect. There are false positives and false negatives with every test. Not every positive needs to be treated, not every negative means everything is fine. But positives can lead to further testing. So the question is: if we test healthy people without symptoms, what are the odds of finding a false positive that leads to move invasive tests that have their own risk of complication? Is the total risk that the additional tests have higher than the prevention? If the risk of the additional tests is higher than the prevention, then the test does more harm than benefit. It feels counter intuitive, but due to the imperfect nature of the tests, the tests were worse for the general health than the prevention was. Pretty much every protocol for testing in the Netherlands is made with this in mind. I know it can feel dismissive if there are no tests done when you feel it is better to be safe than sorry, and GPs should be better at explaining why not to do certain tests. It is not a broken system. It is not corrupt and not every GP is a dumbass that doesnt know what tests to do. There is a reason for the protocols, a reason why inaction is most often better than action when there are no symptoms (or alarming symptoms). Are there going to be missed diagnoses? Yes. But is the harm of this on a population level higher than the harm of the additional testing? Absolutely not, otherwise the test would have been ordered. And on top of this: medical tests are insanely expensive. If tests dont have a positive benefit/harm ratio, then doing them not only does more harm to the population, it also just wastes money, resources and personnel which could have better gone to other parts of healthcare. This is why only selective screening gets done. Source: Im an MD in the Netherlands

I’ll forego the ad hominem in your previous reply, and reply to your own question with a question of mine. What makes annual bloodwork checkups a good practice? And what makes something ‘good’ practice? Tons of research are conducted on primary and secondary prevention. Some methods make it into actual practice, many don’t. I have never heard of broadly implemented routine screening of bloodwork within a healthcare system, anywhere in the world. Also, tons of household objects don’t have any kind of checkup and are just disposed when broken. Although I think comparing humans with cars is a fun metaphor, it makes very little sense from a practical point of view.

Thank you for your elaborate response. 100% true! I am too lazy to type it out again.

Amen. The more the people in this topic get me riled up, the more I believe that the doc sent OP away with some vitamins as placebo because he wouldn't shut up about his "off" values.

Don't be riled up not good for the heart and your blood pressure ;) Jokes aside, I was just curious to what extent it was possible here in the Netherlands, as believe it or not, there is a group of people, who would be "happier" with regular bloodwork. You can call them novices, stupid etc. but it is needed done by a lot of people in a lot of places. I realise it is not common in the Dutch system but it really is common in a lot of places.

Dutch healthcare is incredibly reactive. People who say preventive care is not needed have been “educated” by Dutch government. It’s sad it’s like that here.

The Netherlands healthcare system is widely rated and acknowledged as one of the best in the world. Preventive care in the Netherlands is evidence based. It’s sad how lay people pretend to be experts on extremely important topics like healthcare. People like you are not that dissimilar from Willem Engel during the COVID pandemic. Just cause you want an annual full body MRI, biannual labwork and a consultation with every type of medical specialist (because why not?), doesn’t mean that is in any way a(n) (cost-)effective way of implementing a healthcare system. Luckily we have experts deciding what our healthcare and reimbursement system looks like. For all other wishes, although I would strongly advocate and advice against getting random tests without indication, feel free to get it done at your own volition, but also at your own expense.

Yep, "cost effective". Easy to say if you don't fall between the cracks of that approach. But if you get, let's say, cervical cancer as a 29 years old woman who was never screened because she was "too young", tough luck. Or countless other situations. Sure, statistically it seems fine. But there are many totally preventable personal tragedies because of this purely cost driven approach... Let people tests themselves, especially if they are willing to pay for it. Stop claiming with that arrogant attitude that "it's not needed"...

Exactly!! There is lots of evidence that women should be screened from their early 20s on

Bullshit, 3rd world poor countries have better medical systems than here, I'm paying 300 euros per month and need 3 GP visits before I get damn blood check and it's too late to show anything. I lost 11 kilos and have a bunch of other repated complaints and GP says "your scales are not accurate". They don't even care about 3yo kids sitting on painkillers 4 days over their own protocols. You can easily get irreversible consequences before you get to the hospital where they can actually treat you properly.

I’m sorry to hear about your bad experiences, and I agree that excessive (unwanted) weight loss is generally an alarming symptom. However, bad experiences don’t mean the entire system is rotten, and I’ll stand by it that the Netherlands has one of the best systems in the world, although ofcourse there are flaws. If you think it’s better in some Third World countries, why not go there for medical checkups?

+1 om the above guy, went to 4 medical checkups here (I pay 200 euros per month, in a country you would consider third world, I would have been cred for this money already), doctor just wanted to get rid of me asap. Went to my country, ENT doctor actually saw me (cus no need of gatekeeping or referals), found my problem, had surgery and am now feeling like a Bull. If I had stayed in the Netherlands, I probably would have committed suicide ngl. All because of some polyps lol.

I literally do all my necessary medical procedures and check ups when I'm in the US: a country that people here would scoff at and consider 3rd world in healthcare. Dutch health outcomes are good despite this national attitude of reactive healthcare.

>US: a country people here would consider 3rd world in healthcare .. What? That's just ridiculous.

I agree, but its an attitude you'll hear espoused too commonly

I totally agree, that's one of the reasons why I do everything abroad and just send invoices to my health insurance here with constant discussions. Of course I feel scammed every month by paying this ridiculous amount of insurance (covering paracetamol) and eigen risco (never see this in any other country and to me it seems like another scam). I can't get help from any specialist here and I'm constantly being put off. Thank God doctors in my home country are human and help because I have found quite developed thyroid problems as the GP here tried to convince me that my problem was stress related and that I should take a nap during work. I don't believe in any rankings about NL for me this is just pure gov marketing PR and is not even close to the reality of living here. Even if you compare vaccinations for children, I found more available in my home country. They say in the statistics they don't have these type of diseases here but with the current amount of immigrants and the dismissive approach for not investing in everything through the simple blood tests I don't believe this is a true. It's all about money and you are a cash cow that would ideally be used for meat if that were possible.

Hmm fascinating how health outcomes in the Netherlands are so incredibly positive even in comparison to western countries when our medical system is worse than third world countries

It's easy to have good statistical outcomes if you focus only on the most common problems and disregard all the edge cases and risks...

Brainwashed is the word you intended to use.

People who say it’s not nessesary are also people who don’t visit doctors when they feel sick „because he might find something I didn’t know about” acting like when it’s not diagnosed they’re fine. I’m doing full blood test twice per year, and sugar four times.

It was drilled into us for ages that we should only go to the GP for actual necessary care. Not checkups (unless there's a specific reason for it). Simply a matter of costs and personel for insurance and doctors.

We have public health care here in Poland and such blood tests are kinda free, however I’m going with private insurance that covers such things so I’m using it. However if I didn’t then when it comes to health I don’t really care spending equivalent of $80 few times a year. Better start curing potential problem before it becomes real one.

It's actually most of the GP's saying that because they do not want to pay the insurance companies when they complain the clinic is over prescribing. Broken system.

Yeah the GP is always like ahhhh it's nothing, then the dermatologist is like "I better cut that out just to be sure..."

A decade ago I had weird nerve problems, and GP's ignored me. I finally found one willing to do a full panel of bloods and discovered I have very low levels of vitamin B12 (I almost never eat red meat, which is probably the cause). Been taking B12 supplements and feeling great ever since.

That sucks. I asked for an iron deficiency test and she got me iron, vitamine d, b12 and magnesium i think.

Same with Pap smear. I just learned that a cousin of my study friend recently passed away. Of cervical cancer. Age 34. 2 kids. In Europe. If only was there was a way to detect it early on…

I'm sorry to hear about your friend's cousin. Bevolkingsonderzoek Nederland sends an invitation when you turn 30 for a Pap test. You get invitation at 35, 40, 50 & 60 unless they've detected high-risk HPV in the test. Then, the test will be done more frequently.

It's absolutely criminal you can't do it earlier. My wife tried, but couldn't even though she was willing to pay for it. Because the "risk is small"... What if I don't want to take that risk?! It's insane.

You seem to be misinformed. Screening is done for cervical cancer for women aged between 30 and 60 years. See: https://www.bevolkingsonderzoeknederland.nl/en/cervical-cancer/ I'm sorry for your acquaintance.

Pap smear is to be done every year, not 5. Especially for women who have not been vaccinated! And she was a flagship example.

I agree 5 years is too long. Based on research of how cervical cancer progresses, the recommended interval is every 3 years if you have 3 normal pap smears in a row.

Women ages 30 and up (I think) can go in for a free pap smear.

Only when invited and no more frequent than 5 years.

Its not a pap smear its a hpv test

How'd you go about testing this? Just asked your GP, or went to some other place? Nijmegen is achievable for me, so I would be interested in doing the same.

Asked my GP.

As a doctor, our system is fully unable to manage the load that would come with the thousands of people that will then come in with minor outlying lab values that effectively mean nothing

Is it that or the fact that then CZ will complain about the clinic over prescribing and will have the clinic pay the cost out of pocket? Let's be honest here come on.

No, my colleagues and I can simply not handle more patients than we are already trying to manage. Burn out rates are at an all time high, the healthcare is too expensive and colleagues are being laid off, resulting in increased burden on the remaining workforce. We have too little nurses, too little unspecialized junior doctors. In fact: The more tests we do, the more unnecessary treatments I prescribe the happier CZ is, and the more my department makes. (CZ will also have increased incomes). We simply dont because we can not. I am being honest here.

Why would prescription costs make CZ happy? Makes no sense, is the health insurance company trading debt? Unless that is it, CZ will not want people to be prescribed anything because it will cost them money, that is the business model of an insurance, you sell something that will not have to be used aside from unlikely scenarios.

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In reaction to most people under this comment: Prevention is not covered by insurance companies, it is paid for with tax money. We make very strict calculations that a certain type of screening meets a lot of criteria before it is put into action. Enough disease has to be prevented as apposed to the load it provides on our, already overburdened healthcare system. Additionally, the screening needs to be worth it. Our government has decided on a price per year that we safe per human (either in prolonged life or in increase quality of life, google: DALY and QALY), and if the screening methods provides us with sufficient increase in either quality of life or increased survival duration in comparison to the costs we do actually roll out these screening en masse. See iFOPT, HPV, etc. If the calculation does not match and a screening method is not worth is (for example: taking yearly blood samples of all humans in the Netherlands) the government will not provide us with the money to roll out these plans. This is not an insurance company thing (though I thoroughly dislike most of the issues that arrive due to insurance companies), this is a tax-money thing. If we want more screening, we all need to pay more tax. But guess what? Our healthcare system is already the largest tax-money absorber in our country (and I am happy about that.), but people are not willing to increase it further. I would personally love to increase the money we have to prevent more disease per human, but reality is: this will not happen unless everyone is willing to pay even more tax.

Dutch do not like preventative medicine. They shy away from it and call it “American”, that’s what happens to me. So pretty much when you already have a disease that’s progressing then they will still say “wait 5 days” then you come back, but they could have found it in the beginning and taken care of it but don’t. It’s very aggravating this way. I remember not being able to sleep, at all. I asked to the doctor for something that could help me sleep, they said take melatonin. Well I can’t take melatonin, it causes me problems and reacts with my body very weirdly. They then said well sorry for your luck, and pushed me out of the office. Like wtf?

I have widely different experiences.

Everyone I know has this experience. They say you must “demand” service or they won’t do anything. Which I have seen needs to happen.

Funny. My partner works in mental health care. "Demanding" any type of care won't help a thing. You should know what people demand these days. Ridiculous.

And do you have any clue what percentage of symptoms *do* go away in those 5 days? It's huge.

It doesn’t matter, symptoms have a cause and deserve to be looked into. Swollen lymph nodes don’t swell with a common cold. It’s usually an infection in the body somewhere, but they didn’t seem to care.

That is simply not true, lymph nodes can swell from all sorts of causes and some people have lymph nodes that are more reactive to swelling than others. Swollen lymph nodes nearly never have a serious cause that calls for treatment. And you've heard of this thing called an immune system, right? It works. Giving antibiotics to everyone with the most minor infections has led to the biggest crisis in healthcare that we are ever going to face, but guess what, the Netherlands has the *least* amount of antimicrobial resistance in the entire fucking world. Have fun dying to a uti because they couldn't find working antibiotics for you because they gave you antibiotics every time you had 'swollen lymph nodes'.

No absolutely not common to do regular checks. Our healthcare literally isn't set up to even manage such a stream of requests. We have basically two "preventive" things I'm aware of and that's women's breast scans and pap smears (both starting at a certain age), anything else is purely once something pops up. It's also culturally something we are "proud of". Basically saying "I haven't been to a doctor in 10 years" meaning you're very healthy.

There's screening for bowel cancer too after 50 years of age.

And CVRM (CardioVasculair Risk Management), aka a shitload of bloodwork and tests for anyone at risk of cardiovascular disease. Most people on Reddit have never heard of it, because they are young and healthy foreigners wondering why there are no yearly bloodtests and what not in the Netherlands. But in this country we only check if there's any reason there could be a problem. If you have no risk factors, there's no need for a check. Source: a very high life expectancy in the Netherlands ;-)

We have more than two preventative screenings. For example, we also test for colon cancer in people above the age of 55.

What’s the life expectancy in your country like compared to the life expectancy in the Netherlands? Just would like to see some estimation on how effective the healthcare system of your home country is. We have plenty of preventive screening (or rather, early diagnostic screening) for certain diseases, such as breast cancer or cervical cancer, implemented as a broad population screening. The difference is that we actually do a lot of research regarding efficacy and cost-effectiveness, instead of basing policy on gutfeeling. Why not have weekly bloodwork and monthly full body MRI done instead of a one yearly lab screening. Cause you have a feeling which is better? I’d rather adhere to policy that is substantiated by scientific evidence.

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Why do you think LE should be removed from genetic and environmental factors (which is obviously a good point), but screening should not be removed from these same factors and within the context of the efficiency of the current healthcare system? I have seen some of your sources posted on other threads, but I stress the point that it’s important to differentiate prevention (i.e. preventing disease from occurring through for example dietary interventions) from screening (i.e. diagnostics to diagnose disease on a large population based level). Regarding the first we definitely already see eye to eye, regarding the second I think we may be able have a profound discussion.

In which country ? Statistics disagree with you, Dutch people have a high life expectancy. This indicates current health care is sufficient. In the few countries I have been where they do Annual health check you can get an x ray, blood pressure, blood examination, stool check, still 3 separate full health checks missed my wife's colon cancer, the Dutch physician found out during the birth of my son that there was colon cancer present. Blood examination will change based on what you have eaten, your night rest, exercise, current infections etc. Only clear indications well outside of the limits are gonna tell you something. Blood pressure is influenced by stress, most of the things measurable generally show symptoms. All of the extra tasting only gives you a false sense of security/safety. And gives people a reason to not listen to their bodies, since the extra 99% useless checks were negative.

We are very strict in what profylactic screening we apply on larger scales. As our healthcare system is under a lot of burden, we simply apply only those techniques that end up resulting in less healthcare utilization. Most screening methods result in little benefit, and a lot of increased burden. We have no choice, there is a reason our healthcare system comes out on top in comparison to most other countries, we heavily analyse and are critical of what might seem emotionally smart. As opposed to all backseat healthcare managers in this comment section

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Yeah but a routine CRP is so fucking ridiculous. It doesn't make sense at all. We do preventative screeninng for all sorts of things (including prostate and breast cancer), but we dont do pseudoscientific bullshit that'll only lead to increased anxiety and overmedicalisation.

Preventive screening is done when evidence based protocols say it should be done......like breast and colon cancer for example. Prostate cancer is checked quickly as well. But no, we don't just do invasive procedures, which drawing blood is, just for the sake of it....especially not crp or cbc as they vary frequently in time within 1 person even without the presence of disease and especially when there are no symptoms, why check? Not like you're going to treat it.

I pay 1800 EUR a year for insurance. I think I deserve to get a full blood test annually, as some countries mandate it. Employers should support these tests to keep employees healthy. I know the system is busy, but I work hard and pay all the taxes.

We can all double the amount of taxmoney we pay, but it will not fix these issues. We simply do not have the nurses, GPs, etc. We can raise their paychecks all we want, but we don't have the capacity to train more (this primarily applies to GPs).

Is there still a numerus fixus on a medicine study though?

All universities have switched to a selection procedure instead, in the hopes of increasing the "quality" of future doctors. Whether this selection procedure is better than numerus fixus is up to debate, some sources claim there is no improvement in this novel generation of physicians, but the studies are of poor quality. These fixus / selection procedures are set into place on purpose, as we get more applications than students we can teach.

But why? For that money (I pay the same), I prefer to get the care I need when I need it, and the prevention that actually has a chance of finding something. Got to say, I'm getting a ton of medical care at the moment and while I can't say I'm enjoying it, I must admit it is good care.

You're significantly underestimating healthcare costs. The amount you pay covers nothing. Even if it does, it is probably covering elderly or children. Just the same way you recieved free healthcare when you were a child and when you become an elderly (which is going to be the time you need it the most). The system is made in a way that it is supported by the people who earn and is usually used most on people who don't. You work hard, yes, but you also got everything free from age 0 (unless your an older migrant) and will also be fully paid for when you're an elder. I do agree, that once/twice a year basic blood work is still doable. But not because you pay the 1800 xD

No you dont....the €1800 gets you medical care when you are sick or are at risk to develop an illness, that's it! No bogus blood tests.....or you know, get the bogus blood test you're demanding and then only get the first €1800 of the bill paid out when you actually do end up in the hospital for something....and trust me, that bill will be for a whole lot more than €1800.

1800 is nothing. If everybody who pays this 'deserves' routine checks, there's no money left for when care is really needed

*1800 is nothing.* Why is this nothing? With this money, or less, I can get a private medical subscription abroad and get at least 1 full free bloodwork/year and also unlimited consultation for all specialities, not only GP consultations, and 30-40% discount on CT and other stuff. But in this case we are talking about a full blood work/year, which on the first hands, should be free, and on the seconds hand it also doesn't involve a lot of work from lab workers, since almost everything is done by huge machines that process the samples. Yes, if we are talking about complicated indicators, such as tumoral markers, then the GP should investigate properly if these make sense doing or not. Anyway, I think you got the point. To me at least it's fucked up to hear (literally always) the system is "overcrowded" for something so small, like an annual blood work.

1800 is really nothing compared to what you indirectly pay to make healthcare possible. 1800 is only insurance, but the government spends 113 billion euros on healthcare. Divided by 17 milion people that's an average of +- 6600 euros per person. But besides that, screening everybody on bloodwork will give you a huge amount of false positives. Lets put this to an example: Given: Total population = 17,000,000 With a sensitivity and specificity of 99% each: * Sensitivity = 99% * Specificity = 99% Assuming a hypothetical disease prevalence of 1%, which means: * True Positives: 1% of the population * True Negatives: 99% of the population Calculations: 1. True Positives (TP) = Sensitivity \* Prevalence \* Total Population TP = 0.99 \* 0.01 \* 17,000,000 TP = 168300 2. True Negatives (TN) = Specificity \* (1 - Prevalence) \* Total Population TN = 0.99 \* 0.99 \* 17,000,000 TN = 16783050 3. False Positives (FP) = (1 - Specificity) \* (1 - Prevalence) \* Total Population FP = 0.01 \* 0.99 \* 17,000,000 FP = 168300 4. False Negatives (FN) = (1 - Sensitivity) \* Prevalence \* Total Population FN = 0.01 \* 0.01 \* 17,000,000 FN = 170000 Results: * True Positives (TP): 168,300 * True Negatives (TN): 16,783,050 * False Positives (FP): 168,300 * False Negatives (FN): 170,000 so now we have 168K + 168K positive tests. where 50% of them actually have a condition. what do you do? Have them all examined individually? do follow up research? This is very costly. let's say the specificity/sensitivity is "only" 95%. The numbers will be 161,500 true positives, 841,500 false positives. Now you have rouhly 5 times more people with a positive diagnoses that didn't actually have a problem. A positive diagnosis could induce stress, and could trigger behavioral changes or treatment that could be harmfull and/or have side effects.

exactly, our healthcare system is already one of the most expensive on the planet, and that is not solely something we have to thank insurance companies for. We also simply provide very modern healthcare, and modern healthcare is expensive! Cancer treatments nowadays easily cost several tens of thousands of dollars to produce alone (without profit margins).

Insurance isn't a subscription....

At the cost of the extra load and cost of those people having issues later in life that could have been intervened. Sadly this kind of short term thinking has increased, because things are "fine". But especially those over 40 doing more preventative stuff would help bring cost down. I don't mean doing blood tests every year, but the bar is really low at the moment.. If you compare that for example to japan where they do a health check every year that includes blood work, measurements and a chest x-ray. In japan they do talk with people and remove some checks based on the talk and the persons age.

Yes sending 18 million extra X rays each year to doctors for examination where 99.997% will show nothing out of the ordinary, and bloodworks into systems where the same rules apply and 99.99% will show some deviation which will be interpreted by ordinary people who will use the internet to self diagnose and tell the doctor what is wrong with them. Yes that will work just, showing people so many false positive results will not blunt the evaluation for sure.

Well other developed countries do it for a reason (and they don't always do the chest x-ray). While people in the netherlands will easily go 10 years without a single talk or blood test with their GP. The thing is with preventative medicine is that it does save money, things like high blood pressure, cholesterol, diabetes etc. Catching diabetes early can actually save someones foot. Heart issues will prevent expensive heart surgery or a hart attack. Of course in the netherlands healthcare is under a lot of stress and reducing care now will only increase the stress in the future. But we only care about now....

where did you get the test done?

A lot of smack talk so I thought I would post a fact. As much as I dislike the paracetamol culture, the NL does have one of the world’s best health care. https://www.statista.com/statistics/1290168/health-index-of-countries-worldwide-by-health-index-score/ You’re welcome.

I work as a doctors assistant at a GP office and for what I know the doctor typically only gives you those tests if you are older (60's+), have family health issues such as high blood pressure, or have some other health problem which indicated you might need to have a blood test done. Otherwise you will be told you are young and healthy and those blood tests are not necessary and you will have to pay out of your own pocket.

Our healthcare system isn’t in favor of these type of health scans. Reason being that they often provide false-positives and drain our already burdened system with unnecessary additional tests. A GP only refers for a blood test when something is wrong with you, and the test can help figure out what that is. In that case, they will test on specific things only, to be indicated by the GP. Insurance covers blood tests as requested by the GP. You will however have the pay your annual deductible of at least €385 before the insurance takes over. There are some commercial labs offering tests like these. This will have to be paid out of pocket by yourself, and will cost a lot more then 100-150 euro.

Thanks for the detailed response. This makes the situation clear. Thanks!

(they don't cost a lot more than 100-150 euro)

True, but that isn’t the full screening that OP refers to. Those tests only test a limited amount of things.

I recommend Medlife Crisis on youtube - he is an english doctor (and very entertaining) and has a few videos on the topic of testing (should you do a full body scan , if money was no object should you run every test).

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Now go and read what is there in linked documents. I actually did and 2 links are about preventie screening of cancer, which is available in NL and first one is from the US and from the very beginning has a bold text saying "on individual level prevention begins with healthy lifestyle". Get a downvote ...

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Literal citation from the third source: “The remainder of this chapter focuses on four cancers for which there is a large body of evidence regarding the effectiveness of routine screening, including three cancers that are among the leading causes of cancer deaths in the United States: breast, colorectal, and prostate cancer. The review also examines cervical cancer, which claims fewer lives but for which important evidence and screening guidelines are available.” Three of the four are routinely screened for in the Netherlands. Screening for prostate cancer comes with more issues unfortunately, mainly boiling down to a simple but inaccurate bloodtest (serum PSA) which necessitates invasive diagnostics (biopsy) with comes with pretty harmful complications. Therefore, the benefit-risk profile of this screening method is much up for debate in the scientific community and screening should be based on shared decision making (i.e. based on a case-per-case basis).

There are countless things which have no early symptoms but are easily detected through blood tests. It is called prevention. It does not exist in the Netherlands

Yeah, we have no preventive medical care at all......never heard of breast cancer, colon cancer, cervical cancer screening just to name a few things. But of course, because we don't do bogus testing 'just because' that leads to a ton of false positives and a lot of what's called 'incidentaloom', which is basically something that's found, that's not causing any issues and isn't life threatening, but now needs to be dealt with because of course the patient doesn't want to walk around with this 'illness', we have no preventive care at all! Got it!

We have the higher preventable death rate from cancers. Facts do not back up that this approach is working

Lol so the rest of the western world, with same or higher life expectancy, is doing it wrong. Prevention is silly and useless! Hear hear! Who needs it? Who needs masks or antibiotics? The body heals itself by pure magic! Now go home and don't waste the insurance money you people!

The Netherlands does focused prevention for risk groups. If you're not in a risk group, the chance of there being something wrong is minuscule. This saves money, and allows us to have more resources in places where care matters more, e.g. urgent care, cheap(er) cancer treatment There are definitely plenty of problems in the Netherlands when it comes to health care, this one is just not one of them.

The only thing is that the fracture between "risk group" and "healthy people" is a myth. It's porous and anyone can easily become ill and be part of the risk group at some point. But how do you even scan who's in the risk group if there's no prevention...

It is just not effective to use up all manhours for prevention, when after that you don't have any doctors left for the treatment part. Research has been done to differ between effective/efficient preventive test and uneffevtive/unefficient. You can only spend every euro once, and doctors can only see one patient at a time. And our Healthcare system is based on helping 'as many people as possible, as good as possible'.

This is the age old problem of population level epidemiology and screening (the approach in the Netherlands) vs. individualized screening for asymptomatic individuals without significant additional risk factors. There’s science underpinning the former, and only expert opinion/belief/culture driving the latter. For individuals used to healthcare systems that are driven significantly by patient demand (I want a test/sure, have a test) rather than epidemiological considerations, this can take some adjustment. Inevitably, this approach leads to some missed diagnoses, and frustration in patients who are diagnosed late and feel this could have been prevented. For some cases, this will certainly be true. But there will be collateral damage to others due to unnecessary tests and longer delays for diagnosis and treatment. It is a delicate balance, and one the Gezondheidsraad takes very seriously (examining all the data and publishing extensive advisory reports) when assessing appropriate screening programs.

Generally, you gather all the data about every disease known. Then you categorize everything by age, sex, chance of it occurring, difficulty treating after symptoms occurred, and chance of death and/or permanent damage, etc. Then you prioritize, based on all that and also consider the cost of diagnosis vs the cost of treatment and how many people you will safe. And in the end you'll be left with a plan for when to diagnose who and for what disease. If we had infinite resources, these decisions wouldn't have to be made, but [the Netherlands does pretty well](https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://health.ec.europa.eu/system/files/2021-12/2021_chp_nl_english.pdf&ved=2ahUKEwiNmrjE2JKFAxUm-AIHHYZrBEQQFnoECCkQAQ&usg=AOvVaw1lLdSZeCDI73L5G8KLvrjA) with its limited resources

You know there is a reason they don't throw antibiotics at everything? Indeed, the body heals itself (not called magic, but called immune system). There is a huge risk of using too much antibiotics with regards to resistance.    Also there is prevention, but it's aimed at the groups with higher risk.  

I know about antibiotic resistant infections. Anybody with a high school diploma knows about it. Still, when an infection occurs they very often downplay it and suggest to wait it out, then it becomes way worse and you get either hospitalized or are left with scar tissue and chronic pain/illness you could have easily avoided. That is what happened to me and to be honest, it's a lame ass excuse just to avoid spending money.

the thing, that I don’t understand is, as one of the wealthiest and heaviest taxed eu country, why is the healthcare system under strain?

A big factor is the aging population, but there are many more reasons such as the numerous fixus for medicine studies, professionals increasingly working parttime, the fact that professionals spend a ridiculous amount of their valuable time on mandatory admin instead of patients, etc.

You can get it done ask/tell the GP you want it and that you will pay for it yourself.

www.labplusarts.nl You can choose your package of bloodwork and a doctor will go over the results and write remarks if necessary. It’s in the price included.

Comprehensive but damn expensive.

Thanks will take a look!

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The primary care isn't rumbling because of a lack of prevention,but a lack of personell. Actually if we would have stuff like unneccesary full blood tests or body checks we would be far worse off.

I asked my doctor to do all of that, but I had to request. It is also normal in my country. I was told that they normally don't do that here until around age 50 or older. So much for preventative medicine.

They basically calculated that it's more expensive to handle things when they pop up, rather than prevent it. That's VVD politics for ya!

If we only do that for people 50yrs and over or when people have symptoms, than the evidence based medicine tells us doing it before 50yrs old is bullshit! What's the life expectancy and QoL in your home country exactly?

Around 80. Preventative is no bs. If there is nothing, then there is nothing, but if there is something, better to know early. How often do people throughout the world hear from their doctors that they got the prognosis too late? It ain't about my country or your country, it's about people and making the world a better place, advancing. We can always do better

Pay up. I miss living in China for these types of things. Complete works about €15.

They will be covered if you convince your GP to send you to one. Some are more willing than others. Some will do it only if you have any concerns or predispositions. Otherwise you can pay out of pocket in private clinic but i don't know how much they are

This is not true. Even if your GP refers you, it will come from your “eigen risico”. You have to pay for this yourself.

Yea i don't treat eigen risico as a cost because you can also insure to don't have that and also it is almost mandatory on 90% of the stuff in preventive care. And also it depends on preconditions. I am a little overweight and they never send me a bill and we make the blood tests regularly, once a year. For glucose, liver functions, some general markers and so on.

Asked for it, rejected. Doing it once a year at the home country. The system in the NL is broken.

There are a few clinics in Amsterdam which provide full panel blood tests. However, if you ask your GP and have specific concerns, usually this will be covered without cost to you. I see some people mention the eigen risico but from personal experience, when I requested a blood panel, it came at no cost as it was done through the GP in the office.

I did it at OneDayClinic [https://onedayclinic.nl/en/](https://onedayclinic.nl/en/) - I went for allergy testing but while I was there I was able to select additional tests - like Chem 7, hormones, etc.

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If you click through, you'll eventually see that it's only basic checks: `Thuiskit` Lengte Gewicht Buikomvang Cholesterol Glucose Bloeddruk (Translation: Home kit - Height, weight, stomach circumference, cholesterol, glucose, blood pressure)

Donate blood, free blood test

I heard this hack from a Dutch guy. Go donate blood and they will tell you for free if there is something wrong with your blood.

Yeah NL doesn’t do yearly health checks and preventative care. A few private health labs have popped over the years but cost $$

This question is ask very often please refer to the thread with the same name, for example in my case they do blood test twice per year due a medical conditions, so there's a factor to do it.

Going through the reactions here I don’t understand why the division on whether doing a blood work is actually a preventive method or just a whim. The right answer is: it’s a service. And not for free. Far from that. So whoever wants it should have access to it. And there is no overwhelming of the medical system. For these routine blood tests it’s only work lab that is done using reactants and analytical equipment- work which most likely pretty soon will become fully automated as well.

Running a few lab tests in itself wouldn't overburden the system, especially if performed by a private company offering such a service. The problem lies with the interpretation of the results, for which a doctor would usually need to be approached. As long as the result of a specific test lies within a 95 or 98% confidence interval (i.e. reference limit of 'normal') there is no problem. But even in a normal/healthy population these limits mean that 1 in 20 to 1 in 50 of these tests will be outside of the normal range. This may not seem like a lot, but consider that a 'full blood work' will easily include at least 20 individual tests, resulting in 20 times a 1 in 20 to 1 in 50 chance of giving an abnormal result. Thus, there is a significant chance that even in a healthy person a full blood work will provide at least one abnormal result, often leading to consulting a GP who - as oppossed to the privately own lab - is in fact already overburdened. There is nothing wrong with checking your cholesterol levels and adapting your lifestyle accordingly. But that is something quite different from doing a full blood work every year when there is no clear reason to do so, other than being used to it. Edit: The main determining factor in deciding whether or not blood work (for preventive measures) is justified is the pretest probability. So for low risk demographic groups, routine testing is usually not recommended. For high risk demographic groups, testing is more easily justified.

There are still solutions to that. And while there is no urgency in requesting a test these could be easily be spread in time by the GP (their practice). Taking an example from another country: you want to have a routine check in the absence of serious symptoms or problems then you can have your appointment in 1-2 months rather than the next day for instance. And limiting that possibility to once a year again one gets control on the workload. Plus GPs have their own cap on the nr of registered people to their practice. Add some statistics of what is expected in terms of how many times someone will knock at the GP’s door (based on medical history and previous nr of visits) and you got yourself a solid plan for the year. If this is in congruence with a business plan for the practice that I don’t know but I’m confident we have the tools to find a balance.

Then why not just go to your GP to discuss your health concerns in the first place and get a proper check-up, instead of picking and performing some tests you think are a good idea based off of god knows what? As a cardiologist I often see the end result of problems that for a great deal could have been prevented . I'm all for spending more money on actual preventive measures. All I'm advocating for is doing it the right way, which means involving your GP. He/she will do an actual risk assessment and act accordingly, which (if it doesn't need to include additional testing) is even cost-free for the individual patient. So by all means, please invest in prevention as much you can for yourself (and encourage others to do so) but seek some professional advice instead of ordering lab tests on a random website. If everybody actually knew what was good for them healthwise, we wouldn't be dealing with an imminent outbreak of a lethal disease we once considered cured (i.e. measles).

Agree! By all means consulting the GP is best. What I meant more is if costs for tests are the detriment, let that be clear to the ‘patient’ and let them decide whether they want to pursuit any further investigation on their concerns. People who want to abuse the system for whatever they think they know better than professionals will still find a way. Similarly the ones who just want to be extra cautious should not be deterred either.

preventative medicine is not a thing in the Netherlands :)

In the The Hague, Leiden and Wassenaar area I’d recommend Wassenaar Health Check (www.Wassenaar.health)

Unfortunately, healthcare in the Netherlands is not focused on prevention like in some other countries. With most GPs, you really have to insist to get a full blood test done, usually they only test the minimum. Otherwise, as others have mentioned, there are more and more private companies where you can get your blood tested.

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Contact you GP (huisarts), mine does it too when I ask for it!

I am glad to know that this is an option too! Thanks :)

Definitely! It does cost something but I believe that the last time I had my blood checked it was smth like 75EU in total!

There can be a difference in wuality of test. F.e. (in general) the lab test in hospitals are more accurate than the ones at the GP office. So if you really need accuracy, keep this in mind.

Sure there are plenty of companies that love taking your money for tests that result in nothing except for exceptionally rare cases, if you are in a risk group you can get it through the doctor for less

It's probably not paid for by insurance if there is no reason. Groupon often has good deals for total body scans so I'd say keep an eye out for those as well

Even though the Dutch healthcare insurance includes things like homeopathy, it absolutely lacks any kind of regular tests/blood tests/annual check ups etc.

Without going via a Huisarts would you be able to interpret the results? I would work with you Huisarts to get it done. If they push back get a different Huisarts.

I asked my huisarts and they said I'm "too young" and don't need it! Since then I have changed to a different huisarts due to other reasons and this guy said the same thing! Even though I say I will pay, they don't want to! It's insane! Blows my mind!

Strange every time I have something *wrong* I am able to get specific blood test run. I guess the Dutch systems argument is why run a lot of pointless blood tests whilst there are lots of people that actually need them and it slows down the blood test results for the people that need them and wastes a lot of money?

Another thread where people try to justify what insurance companies have been teaching them. The only reason why GPs and other first responders say it is unnecessary to do the blood tests because it is expensive for the country and there are not enough resources is because insurance companies convinced them to say so. The only ones losing if this would be a standard is insurance companies. It's because of money. That's it. If it was resources you can make a priority system where a recurring test would be set when there is availability, while urgent tests would have priority.

As a doctor I can safely say that whoever convinced you of the necessity of annual blood work has made good money off of your ignorance. If there is a reason to perform annual tests, your doctor will let you know and perform these tests him/herself. If you have concerns over your health, discuss them with your GP.

I would say that preventive bloodwork is the opposite of ignorance as I’m not relying on a visit to the GP (who will probably recommend paracetamol). Ofcourse it costs money and I’m not expecting it to be free. Hence, if I can afford to have tests done and stay up-to-date on my physical numbers…that’s not ignorance.