A visit to the hospital is one of the experiences I believe most of us, if not all, have experienced. You have either sought medical treatment or accompanied a loved one to a hospital. Personally, failing health has sent me to the hospital several times, or perhaps the healthcare system where I come from encouraged me to frequently use the available resources, even when my body could fight the illness on its own. Societal health care is a discussion I have been having for over a year.
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Coming from Kenya, and currently living in the Netherlands, the differences in the healthcare services have given quite a shock value. As a newcomer in Netherlands, you are required to first register with a General Practitioner (GP), or else you cannot access the health care services unless it is a matter of life and death. Even after registration, if you fall ill, you cannot just visit your GP; you have to first call and schedule an appointment. This appointment is given based on the available openings in the doctor’s schedule, usually a few days to weeks later. When you seek urgent medical attention, you have to call either your GP or an emergency line and explain your symptoms to them, during which they will establish if it is indeed serious and needs urgent attention, after which you get the first available appointment to visit a nearby urgent care facility called Spoedpost.
One Saturday morning, I woke up with severe chest pain. Every breath I took increased the intensity of the pain; even a slight shift in my sitting or laying position would induce the chest pain. I tried calling my GP only to realize that GPs only work on weekdays from 8am -4pm. So the alternative was to find the health service emergency number. You know how when you call a company or institution for something, the automated answering service tells you which number to dial in order to access the department that you are interested in. Here, the official language is Dutch, so if you are a foreigner, this will be a challenge for you; your only option is to guess the numbers hoping you will finally get someone to speak to and explain your circumstances. Only in very rare instances have I come across an automated answering service here that has English as an optional language. But this is to be expected given the citizens have to be able to use these services, and for them, Dutch is the preferred language, sometimes the only language they understand.
A bit of digress. Back to my experience. I finally got to speak to one of the urgent healthcare agents. I explained my symptoms to her believing that she would immediately schedule me for an appointment, but to my utmost surprise, she was skeptical about my urgent care need. I had to tell her that I felt like if I did not get immediate medical attention, there was a high probability that I would die. I believe this convinced/persuaded her to schedule me for an appointment at 3pm, 8 hours later (note that I called the urgent line at 7am).
Across the ocean, in Kenya, my experience was different. Whenever I fell sick, I would visit any hospital within my region. I was not restricted to a GP and I could visit a hospital any hour of the day. It was not limited to regular work hours on weekdays. The health care service in Kenya is available to everyone just as it is in the Netherlands. Kenyans have universal healthcare insurance under NHIF which covers everyone. Additionally, individuals enroll in private insurance to supplement the NHIF. With this, one is able to access premium health services or visit premium hospitals. In the Netherlands on the other hand, everyone is expected to have at least basic health insurance and you are restricted to using your GP; only through your GP referrals can you visit a different practitioner or a specialist.
The consultation fee in Kenya hospitals or to see a doctor ranges from 10-20 dollars per consultation in most general hospitals, while in the Netherlands it is 30 euros per 10 minutes. Is 10 minutes long enough to consult with a GP? If the consultation is longer the amount is increased based on the time spent. To see a specialist, for example, an ophthalmologist, you have to first visit your GP who uses their discretion to refer you to the specialist. Then, you book an appointment which in most cases takes at least 3 months before you are attended to. In Kenya, I visited an ophthalmologist without first consulting a GP.
Unlike the west, in Kenya, antibiotics and many other drugs are often bought in pharmacies or chemists without prescription. There are very few medications one cannot buy in Kenya over the counter. This has led to a lot of Kenyans and other Africans abusing drugs, making them less effective in treating ailments. Majority of Kenyans even self-diagnose instead of seeing a doctor, worsening their conditions in a few instances. However, in the Netherlands, drugs such as antibiotics can only be purchased with a prescription which you have to get from your GP every time you need the medication. Here, the GPs often prescribe paracetamol as antidote for most illnesses. Only in rare cases would they prescribe antibiotics and other drugs. It appears they believe in managing the pain as you wait for your body to fight the disease. This practice may help your body build a strong immune system that does not depend on drugs. However, this may be dangerous, possibly worsening the ailment and in some cases may lead to death. I have heard personal accounts of a few such cases.
In Kenya, it is easy to get admitted when one is ill and needs to be monitored. However, it has been reported that some private hospitals admit patients just so they can get more money from their health insurance, an abuse of the system. In the Netherlands, one is rarely admitted and only in cases where it is deemed “really necessary”. Even those in palliative care are usually advised to be taken home so that they can be managed from home. Here, the insurance system is not as obviously abused by healthcare providers as I have experienced in Kenya.
Kenya and the Netherlands have very different healthcare systems. They both have pros and cons. If you move from either of the two countries to the other, you will certainly be surprised by the differences. This short piece is a concise description of my experiences in both countries. Stay healthy!
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