Healthcare System(s)

[nalpak retrac]

How do different systems work in different countries? For example, how would this scenario play out under different systems:

I had a bladder infection a month ago. I guess my immune system was down. Too much work, maybe? Stress? Well, things seized up and my bladder filled up like a balloon. Could have kicked the bucket with this one! I went to the ER and they stuck a catheter in me (I had gone to the Dr. a few days previous and he gave me the wrong antibiotic!). I hobbled around for a week with a plastic sack strapped to my leg and that horrible rubber tube jammed up my poor John-Thomas! I am on antibiotics and Flomax as a safeguard against possible complications--prostatitis!--and I go back to the urologist Friday.

I went to the ER three times. The first time was Sunday, when they said I was given the wrong antibiotic and they gave me a new one. The second time was Monday, when I couldn’t go to the bathroom and they gave me the catheter. The third time was Monday night, when I really had an problem. I had a catheter in me! Now that was an emergency! I went back to the ER and tried to get admitted to the hospital because I live alone and I couldn’t take care of myself. I was in a lot of pain, and then there was this sack thing! I couldn't believe they had sent me home. It was nuts! Well, as things went they didn’t admit me and I went back home and toughed it out till that Friday when the catheter came out, thank goodness!

The third time I was in the ER there was across from me a very old woman with all kinds of problems. She was in her eighties and she was with her sixty-something son and her forty-something grand-daughter. They were practically begging the doctor to move her from the ER and properly admit her to the hospital. Well . . . the doctor in charge was waiting for a telephone call from the woman's "primary care provider" and who knows what bureaucratic "rubric" that needed to be filled out. Obviously the woman needed to be admitted, but then there is this system in the way….

In both cases (mine and hers) I couldn’t help wondering, say, if fifty years ago in this country both the woman and I would have been admitted as a matter of course and the cost would have been reasonable. Where is common sense? Who do we thank for this, the MBA’s?

[Livebrain]

How do different systems work in different countries? For example, how would this scenario play out under different systems:

In both cases (mine and hers) I couldn’t help wondering, say, if fifty years ago in this country both the woman and I would have been admitted as a matter of course and the cost would have been reasonable. Where is common sense? Who do we thank for this, the MBA’s?

I don't know how they play out in other systems (I am not even sure what system you are operating under!), but who do we thank? The patients themselves who think this is all free, then carp (and in the worst cases, sue!) when things don't go as they think they should (being doctors and all....).

(I'm being partly facetious, but not 100%)

And it will get worse - much worse - before it gets better, if things go according to promises.

[Nathaniel]

In Australia, if you had gone to a public hospital, you would have been admited and treated, and the cost would have been absorbed by the public health system. Any non-critical surgery you get placed on a waiting list, and when your turn comes, you are admitted and treated, and the cost is absorbed by the public health system.

You can choose to go to a private health clinic, and you will recieve treatment pretty much straight away, but you will shell out big bikkies for it, unless your private medical cover covers it, in which case you will only need to pay the first (x number of dollers) of "excess", $250 - $400 depending on your policy.

Drugs you recieve as part of primary treatment are covered by healthcare in public hospital, and insurance in private... Ongoing drugs perscribed by midico are up to you to buy, but many are heavily subsidised to make them afordable.

As for doctor error (wrong antibiotics) that is pretty much the same world wide.

Of course, this is all pretty much hypothetical since we Australians are a tough and hardy bunch, and usually don't bother to see a doctor for anything less serious than decapitation or multiple snakebites. If someone went to hospital for something wussy like "shark bit off leg" the rest of us would point and laugh and call them a whinging shiela

[David Mosley]

In Australia, if you had gone to a public hospital, you would have been admited and treated, and the cost would have been absorbed by the public health system. Any non-critical surgery you get placed on a waiting list, and when your turn comes, you are admitted and treated, and the cost is absorbed by the public health system.

That's pretty much the same in the UK as well. Turn up, get triaged, wait your turn, pay nowt.

Our local NHS Trust operates a 'walk-in' centre which you can use rather than A&E if you've got a less serious ailment, like a sprained wrist, so you don't have to wait for the guy with the metal pole sticking out of his head to be seen first. The amount of times we've had to take our daughter to the walk-in centre we should get a season ticket! (Poor child takes after her father.)

[J-Sun]

Ive no idea. I cant afford to get sick.

The guy I buy insurance through doesnt have insurance himself; he cant afford it. How sad is that?

My mother had a stroke, and Mom and Dad will never in their life pay that mess off, even with insurance. In fairness, their insurance hasnt been too bad to them, but the thing is pricey.

What astounds me is that, in an effort to get out of lawsuits etc, here in the US most doctors are now considered independant contractors, and thus many insurance companies wont pay for anything a doctor at a hospital does. How weird is that?

I think I am just resigned to the idea that somewhere around 50 I will become indebted for life to some hospital and will make payments till I croak. Seems to be the American way.

[Rothgo]

What astounds me is that, in an effort to get out of lawsuits etc, here in the US most doctors are now considered independant contractors, and thus many insurance companies wont pay for anything a doctor at a hospital does. How weird is that?

The threat of litigation is also the reason that doctors in the USA are often advised not to respond to any "Is there a doctor in the house/plane/train/etc?" questions. Fortunately for many, most choose not to heed that warning.

On a strangly ironic note, it's nearly impossible for lawyers to get medical insurance, due to the higher probablity of claims being made.

[Nathaniel]

one of my lectureres swears he was at a conference where someone collapsed... the "Is there a doctor in the house" question was asked, he, along with 90% of the audience stood up "Of Medicine?" said the speaker, and everyone sat down.

[L'Etranger]

Mad Scientist,
there's a good overview of the systems on Wikipedia. It also includes that of Germany which has two main options. http://en.wikipedia.org/wiki/Health_...ystems#Germany Most striking perhaps is that the State Health Insurance cannot reject anyone. So there's noone uninsured. People up to a certain higher income are obliged to be member of the state insurance, one pays about half of up to 15% of the income (the other half is paid by the employer), if you are an artist, writer, journalist and have no employer another organisation pays the other half. You get a little chip card that entitles you to all medical services, for the medicine prescribed by a doctor you pay a percentage, unless you have a "lowest income status".
German docters generally feel they earn too little in this system which is why many move to Uk or Norway every year.
There are flaws, but where aren't?

[Lankar Shrae]

What astounds me is that, in an effort to get out of lawsuits etc, here in the US most doctors are now considered independant contractors, and thus many insurance companies wont pay for anything a doctor at a hospital does. How weird is that?

The threat of litigation is also the reason that doctors in the USA are often advised not to respond to any "Is there a doctor in the house/plane/train/etc?" questions. Fortunately for many, most choose not to heed that warning.

On a strangly ironic note, it's nearly impossible for lawyers to get medical insurance, due to the higher probablity of claims being made.

Hmmm smacks of a taste of higher justice there!!

[Livebrain]

What astounds me is that, in an effort to get out of lawsuits etc, here in the US most doctors are now considered independant contractors, and thus many insurance companies wont pay for anything a doctor at a hospital does. How weird is that?

The threat of litigation is also the reason that doctors in the USA are often advised not to respond to any "Is there a doctor in the house/plane/train/etc?" questions. Fortunately for many, most choose not to heed that warning.

On a strangly ironic note, it's nearly impossible for lawyers to get medical insurance, due to the higher probablity of claims being made.

First, in the States, in most cases there are laws that will protect the good samaritan, under most circumstances. They are, funnily enough, called "Good Samaritan Laws". ;)

I would love to see your source for the lawyer/insurance comment. Being a lawyer with health insurance, mind you. :)

[Jolanthus Trel]

There is still a lot of beurocratic red tape involved. A friend of mine from England was telling me how she needed an MRI scan but they wouldn't send her for an MRI until she'd had an x-ray. BUT they wouldn't give her an x-ray because they were worried it might affect her childbaring. You'd think at this point that they'd just send her for an MRI but nooo, she has to fly to the US to get one.

[valerian]

There is still a lot of beurocratic red tape involved. A friend of mine from England was telling me how she needed an MRI scan but they wouldn't send her for an MRI until she'd had an x-ray. BUT they wouldn't give her an x-ray because they were worried it might affect her childbaring. You'd think at this point that they'd just send her for an MRI but nooo, she has to fly to the US to get one.

My experience in the British Health Service was anything but bureaucratic. I had a stroke April 2009 and was in hosptial for a week and the only bureaucracy I saw was the patient notes at the end of my bed. I never saw an administrator. I never had to fill in a form or anything. Just answered a few questions is all. The wards were not that modern but I had access my own personal telly (so I could watch the Champions League Semi Final) and the treatment from doctors, nurses etc was absolutely first class. And the follow up stuff since has been pretty cool too though I haven't need much help since. I just wish I didn't have to take these pills for the rest of my life ...

[thingfish]

Agree totally Valerian.
I stay periodically in the local hospital as im being treated for Huntingtons Disease and the doctors and nurses and other staff are completely professional.
They are always under pressure but just put their lip against it and get on with the job.
We are fortunate to have such an amazing health service.

[Morgan Kane]

I gues every where in any western country is the same except USA ..... I remeber Mike Moore moovie on the subjct.

But from what i read everywhere also health and care spendings are more and more important and governements try to limit public insurance costs. In France our health system from reform to reform is going downhill.

French hospitals receive patients from UK who cannot bear to wait for urgent dideases but recently a personnadmitted in an emergency service died because there was no place in time in any public or private intitution ....

Governement explains that come not from a lack of places but from bad organisation.

What's true is that roughly from 1946 to 1976, with public welfare, health professionals benefited from an infinite market seen as infinitely solvable. Result is that health spending grew and prevention plumeted.

One can add that general public health and prevention plumeted also. Governements for instance, never did anything against junk food .... Industrials produce deliberately junk food studied to make betters sales and profits adding sugar and fats and salt ....

[MalikTous]

Medic!

What I've seen so far is, in the USA, a good capitalist medical system in teh 60s go down in flames when the government stepped in and granted a bunch of phony, fraudulent, and frivolous malpractise suits, thus driving the overall cost of medicine way up. When I served in the Navy, I was unimpressed with the military medical system; 'free' care was often second rate and one of my friends died from poor quality care. Military care was adequate as battlefield medicine, but in port the capitalist hospitals were much better. Now these silly bugger Socialists -er, Democrats want to wreck the whole thing with their socialist medical program, and I consider it unacceptable and refuse to participate.

In my observations overseas while riding boats out of Spain, Scotland, Italy, and other ports, I saw how the socialist systems ranged from 'adequate' down past atrocious. I'd not want to go to a hospital in most nations featuring state-run medicine. Capitalism offers incentive - why else would the Canadians line up to use USA hospitals rather than wait for long times to use second-rate Canadian socialist 'free' care? I'd frankly rather use a Native shaman than Obamacare. The whole problem was caused by government intrusion, and it's going to fall apart at current rates. Will they draft people to play doctor? Will USA medical practise become a distant memory? Time will tell...