For the past nine days, I have had a hacking cough that wakes me up at night. The first couple of days, it was terrible, but now it is just annoying. The downside of this, aside from just being sick, is that I have been isolating myself from my newly established daily activities. I have not been going to volunteer at the wood shop, nor have I been going in to the startup office (more on that later) in which the CEO let me borrow a desk in exchange for my willingness to field any questions they may have about user experience design and team structure. The positive side, which Em and also my colleagues aptly pointed out, is that I got to experience the Dutch healthcare system firsthand.

Actually, I first experienced it several weeks ago. While I was staying in temporary housing, not sleeping very much, and struggling to figure out where I would live next while still working (which I learned was a bad idea), I got an infusion site infection. This is something that happens every now and again to people who use insulin pumps. The tiny aperture through which insulin gets delivered under one’s skin welcomes in some bacterial friends. It has happened to me once a few years ago, but that time it subsided on its own. This time, I waited a day or two to see if it would subside on its own, but it didn’t.

Interesting tidbit: Dutch health insurance is partly single-payer and partly very regulated private insurance companies, with incentives set such that they have no motive to deny patients coverage. It seems great for people inside the system but not helpful in my situation. Without an employee or university sponsor (or a spouse who is a citizen), it is not possible to enter into this and other systems.

I was dreading the costs I might incur having to pay out of pocket. Before I left on this journey, I actually called my health insurance company and asked about their policy for medical treatment while traveling abroad. They told me simply that as long as I keep all receipts and other documentation of treatment, I could submit it for 100% reimbursement. Great news. When I started seeking treatment for the infection, I called my insurance company again and asked if there was anything particular I needed to do (like get a referral from my primary care physician) before going to a clinic in order to make sure that I could get reimbursed. The person on the other end said, “No. Just keep all your documentation, and you should be fine. Wait, let me double check something… Actually, with your policy, we only reimburse for emergency room treatment.”

This became a probability problem. An emergency room visit would cost €250. In theory, my health insurance would reimburse all of it, but somewhere in the neighborhood of eight weeks after I submit the claim. I estimated at best a 50% chance of my insurance company coming through with this after about two reminders. A clinic visit cost €34. So the choice was .50 * €250 = €125 plus the annoyance of nagging my insurance company twice or 1 * €34 = €34. I opted for the clinic visit.

My experience from this point was surprisingly simple. I first had to figure out the word for a clinic or doctor who sees people who are not regular patients. A friend of a friend of a friend, whom I met here told me that the word for that kind of doctor is “huisarts” (that’s actually singular – the plural is “huisartsen”). I searched for huisartsen in the Hague (where I was staying at the time) and called the number to make an appointment. I showed up to the clinic a few minutes late because I had a bit of a hard time finding the address. I spelled my last name at the front desk, and the receptionist had a hard time with it because the spoken “E” in English seems to mean “I” in Dutch (I must learn how to say letters in Dutch. Mostly I just hand people my driver’s license when I am speaking with them in person.). I waited in a fairly crowded waiting room for about fifteen minutes. A guy called my name, and I followed him to a room. It turns out that was actually the huisart. He asked why I had come in. I told him about the infection. He asked to see it and closed the blinds for a bit more privacy. He said that it probably didn’t need to be cut and drained, and he would try to treat it with antibiotics. He wrote a prescription for said antibiotics and instructed me to take four per day, try to finish all of them, and come back if it doesn’t get better. I had to remind the receptionist that I was paying in cash. She gave me a receipt. I went across the hall to the pharmacy and gave them the prescription. The pharmacist went to a drawer, pulled out the antibiotics, told me about potential side effects, and handed them to me in exchange for another €30 or so. I was out of there in about 30 minutes. There was no checking of my vitals. There was no intermediary who came to fetch me from the waiting room and place me in an examination room (which at that point seemed, along with “waiting room” to be a misnomer because the amount waiting done in the waiting room pales in comparison to the waiting done in the examination room. The pharmacy was really just a pharmacy, not a convenience store with a pharmacy in the back corner of it. There was no backlog of prescriptions to fill at the pharmacy, and “filling a prescription” didn’t really seem to be any kind of process. And notably, even for the people who were in the system, there seemed to be very little procedure to do in order to verify and bill their insurance.

Here’s a photo I got of a local pharmacy. Almost nothing is within reach of the customer, so one must ask the pharmacist for everything. There is also a private consultation room though.

Anyhow, this time, with the cough, I went to a huisart in Delft. I went there for an 8:00 appointment, which was right when the place opened. As others trickled into the waiting room, they all said good morning to everyone else waiting. I thought that they knew the other people until they also said good morning to me. Turns out it’s just a common courtesy. I told the huisart about my cough that had persisted for a week at that point and also told her that I had been wheezing. She asked if I had asthma. I told her I had it in my youth. She listened to my breathing and said that she could tell I had “the talent for asthma”, but it didn’t sound too bad. Also, she checked my blood oxygen level with one of those clips that goes over one’s fingertips, but this was a tiny, battery-operated one. It checked out okay. She told me what I had was just a harmless virus and that I just need to be patient. I also asked her how likely I was to still be contagious since the main reason I had been isolating myself to some extent was because I didn’t want to infect others. She said that one is most contagious in the beginning and recommended that I stay out of the office the next couple of days and go back next week.