The Healthcare System in Aruba: AZV, Reference Hospital, Emergencies and Health Risks

The system rests on a compulsory insurance run by the AZV (Algemene Ziektekostenverzekering), under the responsibility of the Ministry of Tourism and Public Health according to the Government directory. The public health department (DVG) oversees prevention, vaccinations and the surveillance of infectious diseases. Social health insurance is complemented by the Social Insurance Bank (SVb), which manages in particular work accident insurance, sickness allowance insurance for employees whose annual salary does not exceed 54,600 florins, and old-age pensions.

The reference hospital is the Dr Horacio E. Oduber Hospital in Oranjestad. The Government also lists the Instituto Medico San Nicolas among its services. The AZV website is the entry point for consulting the list of providers (hospital, specialist doctors, pharmacies); it could not be read live at the time of consultation, and the reimbursement conditions by provider should be checked with the AZV, reachable on (297) 527-9900 or at info@uoazv.aw. CLEISS (the French Centre for European and International Social Security Liaison) publishes no page on Aruba’s health system, and the France Diplomatie Netherlands page does not describe the local organisation of care for the Caribbean territories.

According to the Government of Aruba, anyone registered as a resident with the civil registry (Civil Registry Office) is insured by the AZV, with no separate registration formality. For a foreigner, access therefore follows the administrative chain described in the page living in Aruba: residence permit issued by DIMAS (the immigration service), then registration with the civil registry with a birth certificate legalised or apostilled and less than six months old. A tourist is not a resident and is therefore not insured on this basis.

The premium is 11.5% of annual income: 8.9% paid by the employer and 2.6% by the employee, up to an annual income of 85,000 florins. The employer withholds it each month and pays it to the tax administration before the 15th of the following month. The Government specifies what the AZV does not cover: the higher hospitalisation class, glasses, adult dental care and care abroad during holidays. These items are covered by supplementary insurance taken out with an insurer. For the split between schemes, see the page healthcare reimbursement in Aruba.

For a problem that is not life-threatening, the hospital refers to a family general practitioner or, outside surgery hours, to the on-call general practitioners’ post (HAP, Huisartsenpost) set up in the emergency department: it is open Monday to Friday from 6 p.m. to 10 p.m., and from 9 a.m. to 1 p.m. then from 6 p.m. to 10 p.m. at weekends and on public holidays. The patient takes a number at the security desk, then a medical assistant assesses the urgency before the doctor’s consultation.

For the examination required of permit applicants, the Government refers to doctors approved by the public health department, whose list is published by the DVG. Access to a specialist, its reimbursement by the AZV and any conditions of referral by a general practitioner should be checked with the AZV: the pages consulted do not detail them.

The Dr Horacio E. Oduber Hospital (telephone +297 527 4000) receives about 40,000 patients a year in its emergency department, open around the clock. For a life-threatening emergency, the hospital asks you to go straight to the emergency department or dial 911; on arrival, reception registers the patient, then a nurse assesses severity and patients are treated in order of medical priority. The hospital’s website lists many specialities, including cardiology, orthopaedics, paediatrics, gynaecology, neurology, oncology, nephrology, urology and general surgery, as well as the blood bank, a dialysis clinic, a wound care and hyperbaric oxygen service, radiology, a pharmacy and intensive care. The maternity ward and a dialysis service for holidaymakers each have a dedicated page.

On payment, the hospital asks for a deposit before admission, deducted from the final bill; any excess is refunded. It accepts most insurers on presentation of an insurer’s letter of guarantee, which the hospital must approve. If the insurer has no agreement with the hospital, if the patient wants a treatment that is not covered or if they have no insurance, care is billed at fixed so-called “passer-by” rates, which the finance department provides (info.finance@hoharuba.com). Ambulance fees of US$250 are included in the hospital bill, the hospital collecting them on behalf of the ambulance service. The billing department answers on +297 527 4075, Monday to Friday from 8 a.m. to 5 p.m. Common bank cards are accepted.

The Government portal refers to a page of on-call pharmacies for emergencies outside opening hours. Prescribed medicines are reimbursed by the AZV under its own rules, published by decree (medicines and medical supplies, dental care and devices, according to the Government’s index of texts); the detail of reimbursed products and of the co-payment should be requested from the AZV.

For regular treatment, France Diplomatie recommends, in the general part of its Netherlands page, carrying only the medicines needed in their original packaging, with a prescription written using the international nonproprietary name. The authorisation of a medicine on the island should be checked before departure with the public health department, particularly for chronic treatments.

France Diplomatie points to, for the Kingdom’s Caribbean territories, including Aruba, the risks of dengue (with no curative treatment; anti-inflammatory drugs are to be avoided), chikungunya and Zika, the latter having affected Aruba, Bonaire, Curaçao and Sint Maarten in 2015-2016. Women who are pregnant or planning a pregnancy seek medical advice before a stay in an affected area. For the Dutch overseas territories, vaccines against hepatitis A, typhoid and, for frequent or prolonged stays, hepatitis B should be discussed with a doctor or an international vaccination centre.

The Government of Aruba states that dengue is endemic, with sporadic cases all year, and that the DVG monitors the situation and warns of seasonal rises in cases. Prevention measures are to wear covering clothing, use repellent, remove standing water and, in case of fever or rash, see a doctor stating the date the symptoms began. The Government also reminds readers that yellow fever vaccination, indicated before leaving for certain neighbouring countries, is done at least ten days before travel at the infectious diseases service, at a rate of 31 florins.

France Diplomatie states that it is essential to hold an assistance policy or insurance covering all medical costs and repatriation, that the embassy cannot cover these costs and that the European Health Insurance Card does not cover the Dutch overseas territories. The Government of Aruba, for its part, reminds readers that travellers leaving the island must take out travel insurance, as the AZV does not cover care abroad during holidays.

For a resident, the combination depends on status: the AZV as a base, expat health insurance for the excluded items, evacuation and repatriation, or the Caisse des Français de l’Étranger (CFE, the French overseas nationals’ health fund) to keep protection in France. For a short stay, travel insurance with assistance is enough if it covers hospital costs and the deposit requested on admission; Expavy helps you compare these guarantees.