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By: Jim

Jim — Thu, 06 Aug 2009 17:10:09 +0000

My experiance with Canadian health care is the exact same as the French system described above. I show up to the Doctor’s office, show them my health insurance card, they see me and I don’t need to pay anything. If you don’t have a card you pay $30 and get a reimbursement form.
– Also people I have known that needed care for life threatning issues i.e. Cancer have recieved prompt treatment.

By: Maia

Maia — Tue, 28 Jul 2009 22:24:46 +0000

I live in the UK but my dad’s american and my mum lived and worked there, very poor, in the 60s. My mum worked in a Kaiser hospital in the 1960’s in California, and once patients’ healthcare ran out, they just got them carted off, god knows where by god knows whom, including a whole small family from a car crash – they didn’t ask who was taking them away, an ambulance came one day and they shoved them in it…She has loads of horror stories, some so bad she won’t talk about them.
UK socialist party Labour invited Kaiser, with a couple of other US hospital brands, to advise them on cost savings a couple of years back. Kaiser are one of the best providers I heard.
Very rich housemate from america (student) got loads of healthcare done here for free to save money; friend’s housemate from Czech Republic was sent back there (by coach, 3 days, in pain) for emergency cancer treatment, died there 2 weeks later. Don’t know how they vet this ‘health tourism’.
Italy (I worked in psychiatric unit there 1999) although they have little/no ‘pension’ for people with mental health or learning difficulties, and the doctor gets a kickback from the lab for every test you take, so my mate with asthma was made to pay for a blood sugar test and others every time she wanted a new prescription for medication, but they have a simple system of ‘free’ and not free drugs – i think it was named after the colour of the prescription slip and might have involved 3 levels. Anyway, some are free (lithium salts, insulin) others aren’t, and maybe some are a bit subsidised – all I remember is everyone ended up on lithium therefore.
Germany last autumn,I was working in a hotel there, in the news: the private health insurers held the government to ransome for extra money, claiming they were going bust and everyone’s healthcare would disappear: natch, Merkel had to pay out.
We have one emergency number, 999, for police/ambulance/fire, as logically they’re all state provided. I hit my head 2 years ago in Holland and passed out for 3 hours, came to briefly yelled friend called an ambulance. Ambulance wanted 200 euros up front or a private insurance number – didn’t understand about the nhs. Didn’t check me for concussion (at this point nobody realised that i had passed out when i fell over because i couldn’t communicate much – remember, by this time Natasha Richardson had died of a blow to the head) said i didn’t need stitches and left. I’ve called numerous ambulances in uk as a careworker and the FIRST thing they do is check for concussion, they’re really careful.
In Italy one man in our unit had a heart attack. They rang round all the ambulances (fire service, police, various catholic charities) finally got one but it got lost, took nearly 2 hours to come and take him to hospital. Golden hour, hahaha. Sardinia now has a national ambulance service you can access using the emergency number, rather than getting a phone directory and ringing round. Noticed Germany still doesn’t though.
Before I went abroad i believed all the ‘nhs is terrible’ stuff. But don’t worry, our ‘socicalist’ government is already privatising it, they already have the delivery service, or like their commissioning of the computer system, where they refused to commission to the standards the nhs said were necessary and went for a cheaper siemens: now, its failure proves the nhs is incompetent…Next year the rightwingers will get elected (a dead cert) and finish it off.

By: Brooke

Brooke — Tue, 28 Jul 2009 21:26:21 +0000

To JHS:
WORD.
Also: house calls. French doctors make them. So does my German GP. It’s f-ing miraculous. I think most US docs (except perhaps in very remote rural practices, where people don’t have any transportation–public or private–to get to doctor’s appointments) stopped doing that around the time of William Carlos Williams (physician and poet).

By: JHS

JHS — Tue, 28 Jul 2009 21:17:38 +0000

In my small village in France, the doctors handle everything: care, billing, etc. You go in, wait, see the doc, he takes your insurance card (if you are French) or you 22€ payment (if you are not) and then hands you a reimbursement form if you want it. No secretaries, no assistants, no overhead. Works ok for us. In NYC the situation is the opposite: several layers of assistants, the doc doesn’t do anything apparent with billing, and it’s often a convoluted process to get reimbursed even when you have insurance! I much prefer it here, even if I have had some out of pocket expenses (totaling about $400 in over a year, due to an emergency; it would have cost me far more in the US, where I also pay $6000 per year for the luxury of insuring my family).
Quite a contrast!

By: Elizabeth Mika

Elizabeth Mika — Tue, 28 Jul 2009 20:57:19 +0000

“The post-exam harassment (for $50!) is particularly egregious”

You’d think, right? (And of course it is.)

But as someone who helps my elderly parents deal with their insurance bills, I can’t begin to count the number of instances when they were hounded (for there is no better term for it — involving collection agencies, etc.) for, say, owing a $4.00 in some fee or other.

My parents are extremely hard-working, conscientious and decent people who’d rather die than suffer the indignity of not paying their dues. If they happen to owe something, they do so by an omission and/or (too often) an insurance error.

No matter. The blood-sucking vampires (i.e., insurance companies — I’m not being too harsh, am I?) will pursue them and anyone who owes them anything, no matter how small and/or ridiculous the charge, till the end of times (or your death, whichever comes first; but then, the burden shifts on your survivors).

There is no limit to the American health “care” system horror stories. It’s plainly unconscionable that there is even a debate about the necessity of changing it.

Alas…

By: Mary

Mary — Tue, 28 Jul 2009 18:42:38 +0000

I totally agree that the concepts of care and payment are antagonistic, and US MD’s used to separate the two, but the no show rate of appointments and the resulting overscheduling and delays has made the continuation of this impossible. I am a physician and both my parents are physicians and the combination of payment and care is distasteful to all of us, however the persistent abuse or neglect of patients to keep there side of the deal makes it impossible for a small business owner (which is what most private MDs are, whether they like it or not) to survive when they provide care without payment. Doctors use their appointment schedules to predict income and provide salaries and benefits (most expensive of which is health care While the occasional no show is understandable for unforseeable circumstances a no show rate of 50% or so is unsustainable. So, doctors overbook. I am digressing- part of the problem is the concept that people don’t seem to value what is free here in the US. Paying the copay at the time of service causes the patient to be invested in the care that is given. MDs really can only instruct the patient and the actual tasks are usually up to the patient (taking medicine, losing weight, quitting smoking- these are gross over simplifications considering all the cultural and societal facets). I totally agree that requiring the patient to pay in full or the bulk or the treatment costs at the time of treatment is ridiculous and untenable, however when the insurance companies continue to decrease reimbursements the balance has to be made up somewhere. I don’t understand why everyone is rushing to protect private insurance when their entire business is to reduce medical costs- putting the squeeze on both the patient and the care provider. Our system is broken in so many ways. Really, most physicians just want to provide care and are unwilling business people. I have joined Kaiser Permanente to try and avoid the burnout, but we’ll see how that goes.
I am interested in everyone else’s viewpoints on this subject.

By: Brooke

Brooke — Tue, 28 Jul 2009 18:19:02 +0000

I’m glad to know that VA is providing good-quality treatment; after the scandal broke last year about the poor conditions at Walter Reed, the veterans’ health care system seemed to be in bad shape. Perhaps the problems are more localized than systemic?

By: Brooke

Brooke — Tue, 28 Jul 2009 18:17:23 +0000

I’m so sorry to hear about this ordeal. The post-exam harassment (for $50!) is particularly egregious, but unfortunately not unusual. I hope your son recovered and didn’t have any problems flying home. My first thought when I read your story was to wonder if the hospital or the airline made some attempt to quarantine your son, given the pandemic fears of late (even though chicken pox is no swine flu, people are scared and will freak out at anything).