Observation (CEACR) - adopted 2012, published 102nd ILC session (2013)

Social Security (Minimum Standards) Convention, 1952 (No. 102) - Netherlands (Ratification: 1962)

Part VIII of the Convention (Maternity benefit). The Committee notes that the Government’s report received in August 2011 did not contain replies to specific questions raised in the previous direct request of 2007 concerning provision of maternity medical care to certain categories of protected women and the rules of cost sharing of such care. The Committee notes however that the 45th report of the Netherlands of 2012 on the European Code of Social Security states that maternity care is subjected to out-of-pocket payments per hour or per day, the amount of which depends on the place where the child is born. In the event the child is born in hospital, a higher out-of-pocket payment is applicable if there is no special medical indication. The contribution consists of two parts: a starting tariff of €16 per day and the difference between the day tariff the hospital charges and €112.50, which is charged to compensate for the costs of the maternity ward in the hospital. Only when the mother must be hospitalized due to a medical indication no out-of-pocket payment is applicable. In the case of child birth without medical indication, such as child birth at home or in an outpatient clinic, the mother must pay a contribution on behalf of herself and her child, which amounts to €4 per hour and is indexed yearly.

The Committee wishes to point out in this respect that Articles 10(2) and 49 of the Convention prohibit sharing by the mother of the cost of the medical care provided in the case of pregnancy and child birth and their consequences. The types of such care specified in Articles 10(1)(b) and 49(2) shall be defined in the national legislation and provided to women protected under Part VIII of the Convention free of charge irrespective of the place where child birth takes place – in or outside hospital. The gratuity of this care cannot be subjected to the delivery of an additional special medical indication. In light of these explanations, the Committee would like the Government to assess to what extent these requirements of the Convention are reflected in the current Dutch law and practice, specifying in particular whether all types of medical care mentioned in Article 49(2) and (3), including prenatal care, are covered by maternity care included in the standard health insurance package, what types of care are provided free of charge and what types require for this purpose a special medical indication, and in what form the latter should be delivered. Please calculate the maximum amount of out-of-pocket money the mother will normally be required to contribute when child birth takes place in hospital without a special medical indication, as well as outside hospital, at home or in an outpatient clinic.

According to the Government’s 44th report on the European Code of Social Security, maternity care is provided for mother and baby for up to ten days after childbirth; there is no cost sharing for maternity care with medical indication. Please indicate whether, in the case of complications resulting from child birth, for example, maternity care with medical indication continues to be provided after the ten-day period without any cost sharing, in accordance with Article 52 of the Convention.

[The Government is asked to reply in detail to the present comments in 2013.]