Countries with Government Health Schemes: Talk About Your Health Insurance/Health Care Here

[liz_marcs]

This is Part 2 of my project, which I'm calling, "It's time for a little truth, baby."

To all people who live in countries with some form of government health insurance/health care, talk about it in the comments below.

I also invite all Americans who are on some form of government/state plan to also comment.

All of you, talk about the good, the bad, the beautiful, and the ugly.

I go by the simple credo: light scares the cockroaches.

Americans need to know the truth about what other countries do and how they do it with respect to health care. Facts, figures, and personal experience. Talk about it, warts and all.

All of you, please comment here.

Commenting is set to allow for anonymous comments and comments left by people using OpenID.

As I explained in the "home post," I will not be responding to any comments. I am just collecting stories for other people to read and make up their minds about Health Care Reform in the U.S.

The only thing I'll be doing is monitoring to make sure no one threatens the use of violence against anyone else posting.

Once again, pass the link to the post around to friend and foe alike. And keep in mind that all comments are public, so with that in mind be judicious about your personal details.

Have at it.

Comments

Canadian

[medie]

My mother has an aeortic aneurysm. She's required to have an ultrasound every six months to ensure it doesn't grow. Occasionally, paperwork gets lost, sometimes there are busier periods than others, but she always gets the test.

She never pays a dime.

Same goes for her regular mammograms, visits to the doctor to check on her meds, check up, such and sundry.

My mother, by the way, is in her mid seventies. Her sisters are nearing eighty. The only people who have a say in what kind of treatment she gets re: surgeries and such? Are my Mom and her doctor.

No government official gets a say. The day to day care of patients is NOT a concern beyond the paperwork required.

I myself have gone through testing for a heart condition. Someday in the near future I will under go a DNA test to see if I carry the marker for said condition. If I do, it will mean the same round of tests every three years for the rest of my life to ensure I don't develop symptoms.

The only costs I'll ever incur for said tests will be gas money to travel to the city where my cardiologist works (it's worth noting I live in a very rural area, which means some services have longer wait times due to difficulty in keeping personnel. Doctors likes the urban areas they does. Though we did just get a surgeon that left Manhattan. He likes the life here better.) but he's a researcher so it's not the average.

Likewise, with that kind of travel, there is the cost of staying places, but a lot of support organizations have sprung up (not for profit groups) that help out. IE The Ronald McDonald houses, or Daffodil Place in St. Johns (for cancer patients) the hospital in St. Johns also has a hostel for families who have patients in care.

It's hard to get a doctor sometimes, yes, but that's nothing new anywhere. The government has been fairly open and honest about the difficulty in recruiting doctors and nurses. Less being trained, more wanting to go elsewhere and work with the big cities and big money, but the process is already changing and growing to accomodate this.

It's not perfect, shit happens, but if I am worried about my health or my mother's, we call a doctor. If it's an emergency, they'll rush us in. If it's not, we might have a wait. If it's a real emergency, we go to the ER.

I have never in my life ever had to go without treatment because I couldn't afford the cost. I have a friend in Indiana. A few years ago she lost her job and her health insurance with it. Around the same time her health deteriorated a little. I would urge her to see a doctor when she'd describe symptoms to me and, almost always, her answer was the same.

"I can't afford it right now." which meant it got worse.

I've never had to do that. I know that, sometimes, I might have to wait a few months for something (and I have) but I also know that, inevitably, I will get that treatment.

If I can't get it here and there's an option elsewhere the government will pay to take me there.

Like I said, it's not perfect, and we do like to bitch about it at times, but more often than not, it works and I am damn lucky to live under it.

Re: Canadian

[kurukami.livejournal.com]

One of the comments I heard from a co-worker at work (I brought up the topic today, to see what other people thought) was the question of wait times. Specifically, and this is hearsay (a friend of hers was from Canada, or somesuch), that the wait period for an appendectomy was in her case in the months.

Is there any truth to that, or is it a bit of misinformation? I would think that an appendectomy would be considered fairly vital surgery, and not optional given the potentially life-threatening consequences of a burst appendix.

So: what kind of delays, if any, have you experienced with the universal Canadian health system?

Australian

[deird1]

My doctor doesn't do bulk-billing, so a regular visit to the GP costs me about $60.
But then, I drive straight from the doctor to the nearest Medicare office, hand them my receipt from the doctor, and promptly get handed back $45...


I've had to go to hospital twice. Once was for excessive nose-bleeds (extremely minor and non-life threatening) and took several weeks to get an appointment.
The other time was for severe back pain (very painful, but not at all life-threatening) and took half an hour in the ER before they got to me.

The nose-bleeds visit cost me $50, the back pain included lots of pills and x-rays, and cost me under $300 overall.

Re: Australian

[clownfishdesign.livejournal.com]

You can arrange it so that the GP's office sends the receipt electronically to Medicare, who then pay the refund directly back into your bank account.

[kerri]

Canadian, here :)

This is the way it works when I go to the doctor: I walk in, I show them my card, I get treated. Sometimes there are forms to fill out, waits in waiting rooms, but the treatment is always there.

My grandmother had a minor heart attack a couple of years ago. Even though she lives in a small rural town, she got pretty immediate attention, was rushed to the hospital, she got treatment, she had surgery within a couple of days. When she came home she had at-home care provided that she didn't have to worry about paying for.

My grandfather has had a couple of strokes, he's also had a lot of support at home and in hospital without any cost to our family. This is vital, because my grandparents live on pensions - they wouldn't be able to afford anything more. Their decisions revolve around whether or not they want to take the treatment, not cost.

There are wait times for some procedures, yes. But one thing I would like to say is that from what I have seen, one difference that comes with our healthcare system is the lack of stress. I hate to pull in stories that I've heard from the US, but I have to to illustrate a point - I don't know anyone in Canada who doesn't want an ambulance called because of the cost associated. In fact, my grandmother has had to resort to calling one when my grandfather has had trouble, because she doesn't drive - if she'd had to pay, she probably wouldn't have, and who knows how that would have affected things. I also don't know anyone who's had to choose to not have life saving surgery because their insurance said they wouldn't pay for it.

There are downsides, but the benefits seem immense in comparison. And when everyone is contributing a little through taxes, etc, the depth of the burden is on the shoulders of the government, not the sick and their loved ones.

[ryca.livejournal.com]

I know that this belongs on the "Americans" post, but it rang a bell for me - when I was in high school, a bunch of my friends went to the beach to party. I'll say in advance that they all survived the night. However, one of them got THROWN OFF A CLIFF and fell nearly twenty feet before landing on a small ledge (after the ledge was a *very* long drop to rocks and ocean, so we're all extremely grateful for that ledge).
Now, my friends were drunk and underage, so we weren't big on calling the police very often, but these were special circumstances. Someone went running to call 911. She had several broken ribs, lots of smaller injuries, and that was just what they could tell from talking to her.
Her mom knew that she was out drinking and wouldn't care about that part - the problem was that my friend *begged* everyone to not call an ambulance because she knew they couldn't afford it. Girl falls off a *cliff* and breaks her ribs and god knows what else, and says "nope, I can't afford a doctor, please please please don't call". And back then, we thought that was *normal*.
(They did call the ambulance, she was taken to the hospital, and she was fine, although her mother was *livid* that she'd had to pay for the ambulance ride - we didn't like her mother very much).

Australian

[crossoverman.livejournal.com]

I am covered by our government healthcare system, Medicare, which means when I go to see a doctor, I do not pay for the consult/examination. I do have to pay for any prescriptions that are fulfilled or drugs administered, but under Medicare I can claim some of that money back. That's dependant on what the drugs are, ie. last time I actually went to the doctor was for immunisation when I traveled to SE Asia which is not covered under Medicare.

I also have private health insurance. This covers any hospital visits and most procedures. I have never actually needed to claim under my own health insurance. The last time I was actually in hospital I was still covered under my family's health insurance policy (which I believe lasts until someone is 21 and living under the same roof as their parents).

I watch private health insurance rates climb every year and I am now paying around $90 a month compared to $50/month six or seven years ago. Since I have basically had health insurance my entire life - I went straight onto my own personal cover after I couldn't be covered by the family policy - I never have to worry about a company claiming a pre-existing condition. My policy continues as long as I continue payments.

As to the dreaded pre-existing condition that seems to keep some Americans uninsured, I don't think that would be the case in Australia. Certainly a pre-existing condition would warrant a premium higher than someone without the condition. And if you were already diagnosed with something critical, it might make you uninsurable here - but there's still the government Medicare service to fall back on if you are unable to afford private health insurance.

There is also a Medicare rebate available at the end of the financial year, if you have private health insurance. This is all worked out with the tax return and I'm not all that clear about it - but it counts somewhat toward the cheque I get from the Tax Office every year; ie. we pay the equivalent of 1.5% of our gross income toward Medicare, but if we can prove we have private health insurance, we get some (or all) of that counted as a claim against our gross income.

I know the people without private health insurance here sometimes have to wait weeks or months or years for surgeries that I could have next week under private health insurance - and there's some good arguments against our government as to why certain procedures are considered "elective" but overall, people are covered here. No one is completely uninsured.

Re: Australian - private health insurance

[lilacsigil.livejournal.com]

Certainly a pre-existing condition would warrant a premium higher than someone without the condition. And if you were already diagnosed with something critical, it might make you uninsurable here

Not usually! I have several medical conditions, including having a rare and possibly recurrent cancer at a young age, and I'm pretty fat, but the only difference between my private premium and anyone else's is that I wouldn't have been able to use the private system for a pre-existing serious condition for the first two years I had the insurance (six months for some less serious stuff). Apart from that, no restrictions. In fact, I was diagnosed with an unrelated condition during that waiting period, and the out-of-pocket costs of the minor and elective surgery were covered. Americans thinner and healthier than me have found themselves uninsurable.

Basically, private health insurance buys you out of the public system if you don't want to wait. It also helps with the cost of things that are not covered by Medicare, like massage or chiropracty. As for the Medicare rebate for people with private health insurance - families who earn more than $75000/year are charged an extra 1.5% of their income in tax. If they have private health insurance, they get that extra 1.5% back every year. I earn less than this, so I don't pay the extra tax and don't get a rebate.

[midnightsjane.livejournal.com]

Canadian here.
I can speak as someone who has been on both sides of the Canadian health care system, as a nurse and a patient. I work in the ICU of a large teaching hospital near the core of the city; many of the people who end up in our ICU are what we refer to as Downtown Eastsiders: many are homeless, drug addicted, HIV positive men and women who are among the most disadvantaged of our community. These people get exactly the same treatment that someone from the more affluent part of society do. Our health care provides for all of our citizens through the provincial health insurance programme. I have never known anyone who defers treatment because they can't afford it.
Yes, our system has problems, and yes, we taxpayers do pay for the privilege of universal health care, but I believe most Canadians feel that our system is part of what makes our country a good place to live. In fact, when the CBC did a survey to find the one person we feel is the greatest Canadian, the man who was chosen by an overwhelming majority of Canadians was Tommy Douglas, the man who is known as the father of Medicare.
I am currently retired, on a pension. I pay exactly $27 per month for my health insurance. I choose my own doctor; if I need emergency care, I go to the ER, and present my Care Card. I have never had to pay for any of my health care beyond the monthly premium, even when I needed a stress test and a nuclear scan to rule out a cardiac problem.
There are waiting times for elective surgeries, certainly; because we all have equal access to the system, there is inevitably some form of queue. However, anything life threatening is dealt with promptly, in my experience. No one is ever

[midnightsjane.livejournal.com]

Whoops, lost part of my comment.
No one is ever denied treatment that is medically necessary because their insurance provider says it isn't necessary; those decisions are made by the doctors and their patients.
I for one would not trade the Canadian health care system for the American version.

New Zealand

[annella.livejournal.com]

I don't have any health insurance. Why would I need health insurance? I'm only 27.

I am currently a student, which means I am eligble for a community services card and student health. This means doctor visits cost me $6.50 and prescriptions cost me $3 each. When I'm not a student or on a community services card it becomes a little more difficult because doctor visits jump up to $50.

My father is fully insured, so when he got cancer a few years ago, he decided to go to a private hospital. His insurance covered absolutely everything.

When my mother got cancer she went through the public health system and it was free. She didn't have to pay anything. If I get sick enough to have to go to the hospital, the same applies - I get treated, and the most I might have to pay for is a follow-up appointment to my GP and a few prescriptions.

If I have an accident, I get treated for free and I get 80% of my salary while I am unable to work. My rehab will be paid for (unless the Accident Compensation Corporation decides not to pay, which it does on rare occasions) and I will have assistance going back to work without being crippled by medical bills.

New Zealand

[phaetonschariot.livejournal.com]

lol I was about to ask where you got $6.50 doctor appointments but duh, student. My doctors visits have crept up from $30 to nearly $40 over the last couple of years.

(Note for Americans on NZ money - halve it for US dollars.)

Australia, Canada, USA

[damned-colonial.livejournal.com]

I was born in and lived in Australia til age 25, then moved to Canada for 4 years, back to Australia for a bit, and now over to the US where I live in San Francisco.

Basic health care, what's covered, what's not

In Australia, you have a Medicare card. It has the form factor of a credit card, a magnetic strip on the back, and your name and a number on the front. When you go to a doctor or to the hospital, they swipe it, and that's it. However, it doesn't work for dentists or therapists/counsellors or podiatrists or dermatologists or other such specialists except in special circumstances. Many people supplement Medicare by having private health insurance, which *does* cover these things. At one point I had top of the line private insurance with all the "extras" in Australia, and paid around $100/month for it. This would get me in to just about any specialist very quickly, and covered dental, vision, etc. It even gave me a discount on gym membership and massage. Private insurance also gets you things like a private room in a hospital and your choice of doctor; if you are on Medicare only, you will be in a shared ward and will have whatever doctor the hospital assigns to you.

In Canada the situation was similar. I was there on a temporary work visa for 4 years, and lived in Ontario. I had an OHIP card that had my photo and basic information on it (similar to a driver's license) and would get it swiped at the doctor's office and pay nothing. I only went to ER once in Canada (for a respiratory thing, basically asthma attack at 3am) and it cost me nothing. Again, dental and vision and therapy/counselling and similar things weren't covered, but in this case my work paid for the private insurance to cover that gap. I never used it much, though, so I can't really speak to it in detail.

Prescription drugs

In both Canada and Australia, prescription drugs seem cheaper than in the US. Example: at various times I have been on the contraceptive pill. In Australia I get a 3 month prescription for around $20 under PBS (a scheme where the govt negotiates the prices of drugs with the suppliers, and they are standard everywhere). If I hit (I think) $500 in the course of the year, prescriptions start being around $3 a hit. I can get a long term supply of regular drugs (like the Pill) at any time.

Various times I have had minor infections, the cost for antibiotics has been around the $10-$20 mark. A Ventolin inhaler for asthma would be around $8. My private health insurance would reimburse either of those in full; they don't reimburse the Pill though, even when used for health reasons (not contraceptive), because they are sexist fuckwads. Ahem. Again, the $500(?) annual limit applies -- if I went over that, they would start being very very cheap.

In Canada, the prices for prescriptions seemed similar to the above, but I didn't have so many prescriptions in the time I was there, so that's just a general impression.

In the US I can only get one month of the Pill at a time, and my *co-pay* is $10. That's $30 for 3 months WITH private insurance. Antibiotics, again, are $10, but they would be much more without the insurance I have.

Re: Australia, Canada, USA

[damned-colonial.livejournal.com]

General practitioner/family doctor availability and wait times

In Australia, the most common kind of doctor for everyday stuff is called a GP (general practitioner) and they mostly work in clinics with a few docs sharing space. Clinics roughly divide into three categories:

* bulk billing, walk in
* bull billing, appointment
* not bulk billing, appointment

Let me explain bulk billing. Basically BB is when they swipe your Medicare card and magic happens and the government pays. They bill the government in bulk, saying "We saw 100 patients today, give us money."

Non-bulk-billing works like this: the doc's office charges you some amount (commonly around $40) for a consultation and gives you a receipt. You either take that receipt to a Medicare office (they're all over the place, in shopping malls and things, like post offices) or else mail it in, and you get reimbursed. I forget the reimbursement but it might be $30. Usually the doc's fee is a bit higher than the reimbursed amount, maybe $40 or $50. The sort of docs who do this tend to be more old-fashioned, like something from the 50s, you know? I kind of like them, and can afford the $10-$20 extra, so I go to them when I can.

Anyway: Australian waiting times for GPs are the best I've ever known in the three countries I've lived in. I can *always* get a same-day appointment, even for trivial non-urgent stuff. Walk-in clinics have fairly short waiting times (usually around 30 mins). Places with appointments can usually fit you in same day, or next day at worst. If, for example, I needed a repeat on my BCP prescription, or felt like I had a bout of bronchitis and wanted it checked out and maybe antibiotics -- in short, anything that didn't really need continuity of care -- I would just pop into a walk-in clinic near my office. I could do it on my lunch hour if I took a late lunch to avoid the rush.

In Canada, everywhere is bulk billing, though they don't call it that. I believe it's illegal(?) for them to do what the Australian doctors do and over-charge then you get reimbursed for some lesser amount. Perhaps a Canadian can clarify. Anyway.

In Canada, ideally, you have a "family doctor". This is the doctor you see all the time, and who provides continuity of care, and is *your* doctor. Sometimes it is hard to find one who's taking patients, and switching from one to another too often is frowned upon. People complain about this quite a bit, but I guess I got lucky with it. I found quite a good clinic a short bus ride from where I lived, on personal recommendation from a friend, and was fairly happy with it.

If you don't have a family doctor, or need to see someone at short notice or odd hours, or don't care about continuity of care, you can go to a walk-in clinic. I only did this once or twice, but it seemed similar to Australia in that the waits were reasonably short and the service was good. One time when I did this, it was before I got my OHIP card, and the cost to me as an uninsured person was about $40.

NB: the above is all based on living in major urban areas; I can't speak for rural areas.

New Zealand

[phaetonschariot.livejournal.com]

We have public healthcare here, and I'm not sure of the specifics for non-citizens, but for citizens everyone is covered by ACC, which is accident compensation, and if you get an injury that causes you to miss work you can file a claim with them and get up to I believe 80% of your income back, as well as compensation for the cost of treatment. (The most expensive and drastic things, I assume, are not as well covered, but I can't say for sure.)

My personal situation is that I'm living on the government sickness benefit ("disability allowance" I think they call it now) which is a short term benefit that gives you about NZ$150 a week and you have to reapply for it every three months. If you have a disability that will cause you to be unable to work for more than two years, or you're expected to die within two years, you can get the disability benefit which is more like NZ$230 a week.

Obviously I go back to the doctors every three months to renew my benefit, and also to get my medication. My medication, without which I would most likely be dead, is covered by the healthcare system so I don't have to pay the full amount of the prescription. Off the top of my head I remember that one of my medications costs about NZ$150 for three months. I pay $3 per prescription. (I recall hearing a lot about how much birth control costs in America - I get it to handle my periods, and that's also $3 for I think six months.)

I have my own health insurance, which I can choose how intensive it is/how much it covers, and each level has different pricing. My plan doesn't cover my doctor's appointments, but if anything worse happens I could get them to pay for treatment for most things. As well, I have life insurance. My health insurance is about NZ$30 a month, and I can't remember how much my life insurance is, but it's yearly. Both of those are private insurance, but they're affordable even though my income is extremely low.

New Zealand

[phaetonschariot.livejournal.com]

Oh, additional information - treatment at the ER is free, however if you need an ambulance they request a donation of NZ$50 to the St Johns who run the ambulance system to cover costs.

[lilacsigil.livejournal.com]

I had cancer. I was extremely sick, needed a lot of expensive tests, couldn't work, had to have surgery, and will need medication and regular check-ups for the rest of my life. The whole experience cost me about $260 over 18 months, plus about $40 every three months for the medication. Going to the doctor costs me $50, and I get $36 back. Because I live in a rural area, access to specialised medical equipment isn't as good - I have to travel 50km for an ultrasound, for example - but this is an issue of distance and population density rather than public vs private. The further away from major cities you go, the worse the healthcare gets, especially in Central Australia - Canada seems to be doing better than us on this issue. But private insurance wouldn't bring the ultrasound closer!

Most medication costs a maximum of $32.90/month (up to $7 more if you want particular brands, in a few cases) or $5.30/month if you are on a pension of any sort or below a certain income level. Once you've spent a certain amount on prescriptions per family in a year (about 60 scripts this year) you get concession rate prescriptions for the rest of the year. If you were already getting them at the concession rate, you then get them free. This year, "family" includes same sex couples and their kids, finally!

Not all medications are covered. Some stronger doses of the Pill (the ones used to control acne but also endometriosis and PCOS) are not covered. Most of the medications trans people use are not covered. Some very new medications that have not yet gone through government revieew are not covered - this is not usually an issue except that some of them are late-stage cancer drugs and obviously people who are suffering late-stage cancer can't really wait up to a year for their medication to be reviewed, and lobby the government to go faster.

There are separate schemes covering people injured in traffic accidents or injured at work which are more generous with ancillary services such as physiotherapy and pay for all medications. These also provide income support.

No-one is thrown out for not being able to pay. No-one misses out on care because it's too expensive. No-one goes bankrupt due to medical bills. There may be a wait, but you will get treated.

[damned-colonial.livejournal.com]

This year, "family" includes same sex couples and their kids, finally!

I am delighted to hear this!

[lilacsigil.livejournal.com]

Yep! We still can't get married, but there's few differences between "de facto" and "married" here anyway, so now my girlfriend and I can share our medical costs, taxes, superannuation, etc. automatically! Hooray!

Canadian

[(Anonymous)]

There's good and bad things about our system, but generally speaking, it does okay. There's a per month fee you pay that varies by Province, and if you are low income or a senior, this gets pro-rated down to as low as zero. For people with low income, there's also a program (at least in BC) that provides assistance with the cost of perscriptions. Kids are covered with the parent's plan to I think age 18, longer if the child is disabled (or in full-time college, I think)

Personally, I've had two surgical procedures (wisdom teeth and gall bladder), both were done within a very reasonable amount of time after someone realized I needed them. I don't actually remember a period of time between 'you need surgery' and surgery. A co-worker recently went to a walk-in clinic with recurring stomach pain, and they had her inflamed appendix out within 12 hours.

There are usage fees for some things, and extended hospital stays are not often covered. Dental and optometric services aren't covered, but I think there may be some programs in place to assist low income families. There's a set number of partly-subsidized alternative treatments covered (Chiropractic, massage therapy, accupuncture) as long as they are recommended by a physician. I forget the details, but if you Google Medical services BC, you can get all the details and the low-down on programs that are in place. Also, medical expenses above 3% of net income (expenses accumulated for the family, income of the individual) can be claimed for a tax deduction, and that includes a very broad range of expenses, from perscriptions to hearing aids and insulin pumps to special food required for gluten-free diets (with proof).

The only problem I've had is finding a family doctor, but felt I didn't need one because walk-in clinics functioned quite well in lieu. I live in an area with a high rate of older retirees, and the per capita rate of family doctors is still catching up with demand. However, once I decided I needed one, I found a really good doctor in town after a few phone calls, some research and networking. Took about a month to get in for the first appointment, but that was because it was a low priority check-up. Had I been having medical problems an appointment would have been scheduled within two days, or I could have gone to a walk-in and done a follow-up with the family doctor.

Premiums are based solely on income level, age (reduces premiums), and number of people in the family (larger the family, the further the income needs to go, so usually reduces as well). As a single, non-senior, non-low-income person with no kids, I pay $54 a month. That's the max for a single person in my province. "Pre-existing conditions" don't exist, because you are covered by your parent or guardian's policy as soon as you are born. If a person develops a chronic illness, the premiums do not go up. If anything, they would go down if the person is less able to earn income and has their premiums subsidized.

Re: Canadian

[lynnenne]

There's a per month fee you pay that varies by Province, and if you are low income or a senior, this gets pro-rated down to as low as zero.

Really? I've lived in Nova Scotia, New Brunswick and Ontario, and I've never paid a monthly fee for health care. It's all covered through our taxes.

[thorfinn]

I live in Australia. If I happen to injure myself and require emergency treatment, I can arrive at any hospital with an Emergency Department, and get immediate attention by the triage nurse. There is no question of requiring private health insurance, simply confirmation of whether I actually have a medical issue requiring immediate treatment. If I do, then it's straight into the hospital for treatment. I don't pay anything (apart from taxes) to get this.

Australia: taxes

[freyaw.livejournal.com]

And if you pay >AU$1500 out-of-pocket (that is, have more than $1500 worth of expenses that you had to pay for after Medicare and private health insurance have finished with it, 20% of those out-of-pocket expenses get rebated on your tax (http://www.ato.gov.au/individuals/content.asp?doc=/content/19181.htm). Also, because I lodge my tax electronically, I can have eTax look up my Medicare records for me (should I choose) which includes a record of how much I claimed that they didn't cover.

Italy

[laura-iskra.livejournal.com]

We have public health care here in Italy and we pay for it through our taxes and well, despite all the things I despise about my country I have to say it works pretty well. It covers everything, from the family doctor (long waiting times there because they have many patients each) to emergency treatments to any kind of operations. We have to pay small fees (about 30-50$ most) for blood texts (even if there are many exemptions for many kind of pathologies) and for specific exams like magnetic resonance or mammography or ultrasound scans, and if we go to the ER with something not requiring an immediate treatment or something not really serious (i.e. something we could have visited our family doctor about) we still have to pay a small fee. Of course there are long waiting lines but you can manage buy calling different hospitals to find the way to do the exams in reasonably short terms (if there are emergencies, like cancer suspects, that require immediate treatment you get given a green card to have immediate attention). What does not work is the dental care, almost everybody has a private dentist and then you have to choose quite carefully. Children do not pay for any exams, until they are 13 or something (not sure about the exact age). Summing it up, a lot of my relatives have had to do cancer related operations, and I've given birth to mu son without paying an euro more than the taxes, hospitals are not perfect, some are quite old fashioned but all in all nobody is denied health care.

of course you can always avail yourself of private doctors, paying their fees and so on..

(hope it make sense, I just woke up and my english is not the best anyway)

Re: Italy

[(Anonymous)]

(American here) Years ago after a canceled, non-insured IVF cycle on which I spent over $5,000 just for the drugs, I then ordered IVF drugs from Italy for less than 1/5 of what I'd paid in the U.S. My son is now 7.

Canadian, eh

[(Anonymous)]

I keep hearing stories about horrible wait times in Canadian hospitals. This is true. I once waited 4 hours at a local hospital known for it's slow service. Of course this was a wait for test results after I'd been examined, told that my pain was from kidney stones, and given some groovy pain medication. The cost was several hours of my summer vacation that I'll never get back.

I have seen reports of people have to wait months for some forms of surgery. These individual cases are national news. It's been at least five years since I've even heard of such a report. Except, of course, in American health debates.

What I'd like to ask is how long does an American without health insurance have to wait? Why does nobody ever ask that question? It would seem that even if the horror stories are true and we have months of waiting, it would still be better than never getting treated. Or maybe that's just me.

Dave

Re: Canadian, eh

[orwhoeveriam.livejournal.com]

My sister waited like 8 hours in the ER when she hurt her arm in a car accident. She wasn't badly hurt, just some soft tissue damage. She had insurance, and half the time we were there, we were the only people there. I have no idea why it took so long. But whenever anyone from my family has gone to the ER, there's been a huge amount of waiting. And we just had (well, within the past year or so) a couple of news stories about people dying while waiting in ER's.

As far as waiting for surgeries.... I know that wisdom tooth removal surgery appointments have to be made way in advance, and it's expensive even with decent insurance. I think mine is gonna cost like $2000 out of pocket. But other than that, I don't know about surgery wait times.

U.K.

[innerbrat]

I have never - touch wood - had a serious health issue, but:

If I am ill enough to be concerned, I check the NHS Direct website. The information there is sparse, so if I'm worried I can phone a helpline (local rates) and talk to someone. If I want to go to see a doctor, I phone my General Practitioner's office in the morning and arrange an appointment; walk ins are hard to come by and GPs are often pushed for time, so it's important I keep that appointment and come in, but then the experience depends on the doctor themselves.

I never ever have to pay for any contraception (though I haven't used any for a while), and any other prescriptions are about £6 ($12) each time, no matter what the drug.

When I asked for a referral to a psychiatrist, I was on the waiting list for a year, but when my name came up, she was patient, understanding and a very good therapist.

I'd say in general the problems with the NHS are underfunding and understaffing - there just aren't enough manhours to deal with the etire population of the country, and a lot of medical professionals have found it better to go private, which takes people away from the NHS.

The conflict between private and NHS is demonstrated by dentistry; dentists take both NHS and private patients and often try to push patients into becoming private. I missed an appointment once and they refused to keep me as an NHS patient.

Waiting lists are often cited as a complaint, but no one wants to pay more for the service, and it's over-administrated, presumably because of its public status.

Re: U.K.

[chaletian.livejournal.com]

...a lot of medical professionals have found it better to go private, which takes people away from the NHS.

I'm not sure this is as widespread as people suppose. The private sector does not pay *that* well for allied health professionals (nurses, physios etc). It does lure away a lot of consultants (senior doctors), but mostly they tend to have private practices on the side - the majority of consultants like to keep at least one foot in the NHS.

Britain/Sweden

[smhwpf.livejournal.com]

No really serious health issues, but have always found the UK NHS quick and effective when I have had various things to check up on, etc. And of course never had to pay a penny. (We do have to pay for dental, and a fairly small prescription charge for prescribed medicines, which those on means-tested benefits, children and the elderly are exempt from). Generally very satisfied. The big problems of waiting lists for treatment seem to have been greatly ameliorated under the current government (one of the few good things it's done) by large cash injections - and we still pay a lot less in total than in the US!

Sweden (where I now live) works somewhat differently in that we make a nominal payment to our healthcare costs (about $20 for a trip to the doctor for example), up to a yearly maximum of about $120. (I don't know if certain groups are exempt). I've had a couple of minor issues, and had quite an extensive set of check-ups for sleep apneoa, and was very impressed by how quickly I got treated for something that is very far from life-threatening.

In short, socialized health-care FTW!

UK

[chaletian.livejournal.com]

Apparently, my flat mate was ranting at me last night, some random (white, well-off, male) British MEP was having a cozy bitchfest with some random (white, well-off, male) American talk show host or something about how shit the NHS was, and that just made my blood boil.

The National Health Service, set up immediately after the Second World War, is a universal health care service with medical care free at the point of delivery (it is funded by the taxpayer). GP services, district nurse services, outpatient services, inpatient services – it’s all free at the point of delivery. The NHS will provide prosthetics, pace makers, hearing aids, all that jazz. You pay a flat rate for prescriptions (£6/7; I’m not quite sure how much), and you also pay flat rates for NHS dentists. The NHS will also contribute to eye tests and glasses etc if you are a child/pregnant/diabetic/unemployed etc.

It’s far from a perfect system. It’s underfunded, understaffed in some areas, overmanaged and overpoliticised. Personally, I do believe (and I know it’s not always a popular opinion), that those who can afford health insurance and ‘go private’, should do. The waiting lists for some clinics and operations can be very long. It can be difficult to get to see your GP. And sometimes it’s very easy. I live in London, and I can get a GP appointment whenever I want. The one time I needed to go to an outpatient appointment, I was given one within a month or so. If it’s urgent; if it’s life-threatening, you WILL be seen promptly. (For example, there is a ‘Two Week Wait’ protocol in place for any patient with suspected cancer; this is strictly audited.)

I’ve worked in the NHS and in private practice over the last nine years, and though the NHS has it flaws, it is, I think principally sound.

Re: UK

[wendymr.livejournal.com]

Oh, and something I haven't seen anyone clarify yet with regard to the NHS: there is no prescription charge for contraceptives, and pregnant women and the elderly don't pay either. (Lived in the UK for 16 years).

UK

[concernedlily.livejournal.com]

About thirteen years ago, my mother had cancer of the neck. Her surgery and several weeks of radiotherapy and follow-up appointments were free and she paid only the prescription charge for the expensive medicines she needed afterwards. Years on, the radiotherapy has had a terrible effect on her teeth: she's currently getting about £20,000 worth of free dentistry to repair them, as part of a clinical trial, because radiotherapy caused it.

The beginning of this year, my father was diagnosed with a very similar to cancer to what my mother had. He went three or four weeks between the first appointment to diagnosis, was seen by oncology within two weeks, had surgery within six weeks of the diagnosis, and six weeks of radiotherapy after that - all free. He doesn't pay prescription charges because he's over 60, but the NHS is now paying for all prescriptions arising from cancer treatment anyway. Neither of them have to worry that having had this treatment/spent on this treatment will damage their chances of getting treatment for anything else that happens to them, ever.

I've worked in the NHS as well and I agree with the above commenter that there's a lot of administration, because it is public funds and that means paper trails and targets. However, I wonder whether the administration generated by insurance companies checking into whether they're going to pay claims isn't comparable. I would certainly not argue that the NHS is perfect, but it is a system that makes a lot of people better without them having to consider finances.

Re: UK

[stormwreath.livejournal.com]

I wonder whether the administration generated by insurance companies checking into whether they're going to pay claims isn't comparable.

As far as I gather, it's not comparable at all:
The US private insurance based system requires twice as many bureaucrats and costs twice as much to administer as the centralised UK system...

[st-aurafina.livejournal.com]

Australian community pharmacist here - I deal daily with Medicare (http://www.medicareaustralia.gov.au/), the administrating body for the provision of health care in Australia. I wanted to talk about what medication costs in Australia, from the point of view of prescriptions that you would have filled at your local pharmacy.

When you get a prescription on the National Health Service (NHS), you pay up to a maximum of $32.90 or $5.30 if you're on income support. That's generally around the cost for a month's worth of medication. You may pay more if you choose not to have the generic brand, most surcharges are around the $2 mark, but a few can be up to $8 - Lexapro (escitalopram), for example, has the highest surcharge at an extra $8 per month. When your family has paid a maximum of $1264.90 in a year, your prescriptions decrease in price to $5.30 each until the end of the year. If you're on income support, when your family has paid $318 or had sixty prescriptions filled, your prescriptions are free until the end of the year.

Medicare covers a lot of medications, but not all of them. Some medications require that you have certain medical conditions before you are entitled to a subsidised price - for example, if you take Lyrica (pregabalin) for epilepsy, it's subsidised. If you take it for chronic pain, or as a mood stabiliser, it's currently not subsidised.

You can see a list of covered medications here (http://www.pbs.gov.au/html/consumer/browseby/product).

If you're overweight, you still receive all the same access to treatment that a person who is not overweight would receive - this includes treatment for hypertension, diabetes, high cholesterol. If you're a smoker, you still receive exactly the same treatment that a non-smoker receives for chronic obstructive pulmonary disease, asthma and emphysema. No matter your lifestye, your prior health history, your body type, your genetic misfortune, you will not be denied treatment or medication for your conditions.

There are always medications which should be covered that aren't. For example, they just took all the HRT off the NHS - that doesn't mean much to post-menopausal women who were already paying $30 per month for their Premarin, but it does mean a lot to the people on income support who were paying $5.30 per month and now have to find an extra $25 to cover their menopausal symptom control.

It's not a perfect system - it can't cover every single person, but it does cover a lot of people. It's constantly reviewed, it's constantly under public scrutiny, and every year many more medications are added than are removed. And no matter what your pre-existing conditions are, you're going to be treated.

[lizbee.livejournal.com]

Lexapro (escitalopram), for example, has the highest surcharge at an extra $8 per month.

I KNOW. I have a list in my diary of the pharmacies that "forget" to ask if I want a generic brand.

Scotland

[pmoodie.livejournal.com]

I'm a 39 year old Scotsman, and there have been countless instances throughout my life where the National Health Service has been a huge help to me, my family and my friends.

Off the top of my head:

They kept my Dad alive for about 15 years after his first heart-attack. They helped my Mum get through the menopause. They fixed my hand when I broke it. They saved me from a potentially fatal asthma attack when I was a teen. They repaired my friend's leg when he smashed it in a motorcycle accident. They provided my Uncle with the care and assistance he needed during his long fight with cancer, which he eventually lost. They assisted in the delivery of myself, and pretty much everyone else I know.

Beyond what we pay in taxes and National Insurance, none of us ever got billed for any of this treatment.

And that is a very reassuring thought to know that if we need medical treatment, it's there. We don't have to worry about how much money we have in the bank.

Anyone who can serously claim that our country would be better off without the NHS is either lying to serve their own political agenda, or has no idea what they're talking about.

Denmark

[lakrids404.livejournal.com]

I think that most Danes, think that their puplic health system are function very well, not perfect but good enough where it counts. All medical expenses are free or heavily subsidies including transport medicine an retraining.

It can be hard to see ones system god/bad from so here is a link to article by Brittany Shoot an American living in Denmark

UK resident

[(Anonymous)]

I'm on some medication for Polycystic Ovarian Syndrome. I don't have mega symptoms, but without it I have Oh-dear-GOD heavy periods. (I do apologise for the TMI here!)

For this, I've had to go to my GP (appointment either a couple of days ahead, or a turn-up-and-wait deal - this varies by the particular surgery (Practice in the US I think). I then got referred to a Gynaecologist at the hospital, had an ultrasound, blood test, and consultation or two, and then got prescribed tablets. The ONLY cost for this is the £7.20 prescription charge, which for me covers 2 months of tablets because I asked the doc to do more than one month!

My mum is on so many pills she practically rattles ;) and she gets a pre-payment certificate, which is effectively a discount if you need either 4 items in 3 months, or 14 items in 12 months. There's information here, for any UK residents who don't know about this: http://www.nhs.uk/chq/Pages/2422.aspx?CategoryID=73&SubCategoryID=108

If you want personal opinions on this, the lack of healthcare in the US (and elsewhere) is something that seems so antediluvian that I just don't understand it. I did once have a wait of approx 2 and a half hours at the hospital, because they were overbooked for the outpatients clinic. I would much rather have this than the thought looming over me that, if I got cancer, say, I might not be able to pay to have treatment and therefore die. But that's just IMHO ;)

Obviously, the NHS isn't perfect. As others have said, it does have long waits. There's no guarantee that every doctor that you see is fabulous, and mistakes are made. But that is the case everywhere - people are people, after all; human error is always going to be with us. I do dislike the fact that in some senses the NHS isn't, in fact, National - the policies can change depending where in the country you live, as you'll be subject to a different Primary Care Trust, who may decide that you don't meet their criteria for a certain medication when if you moved down the road to the next Trust area you would. I'd like to see that fixed. But I wouldn't want the NHS abolished and replaced with insurance. That way lies madness (again, only my opinion)

And good lord, who knew I had this much to say about the NHS? I do apologise for rambling on.

Debbie

Re: UK resident

[chaletian.livejournal.com]

If you want personal opinions on this, the lack of healthcare in the US (and elsewhere) is something that seems so antediluvian that I just don't understand it.

Word. All my grandparents have had various cancer/heart type problems in the last few years and have been looked after beautifully by the NHS, and it's great that you always know there is that healthcare system in place, so you basically never have to worry about going to the doctor's and how to pay for it. I mean, really - it's never crossed my mind to worry about having enough money to stay healthy, if that makes sense. I may blench everytime I open my payslip and see how much tax and national insurance I've paid, but honestly I would rather be taxed more and live in a country with the NHS than have more money month to month and have to worry about paying to see the GP.

ETA: My grandfather actually died earlier this year of complications to prostate cancer. He was in a specialised cancer hospital in Sheffield for a while, but they discharged once there was nothing they could do and he wanted to come home. Local services then provided district nurses and all sorts of people, with the GP popping along every so often, to look after him for the last few months. (A lot of them even came to his funeral.) They performed an amazing service, and I know my entire family is grateful for it. My grandparents didn't have to pay for anything (but they, in their turn, had helped support it with the old taxeroony when Grandad was working).

Heigh ho. NHS YAY! basically. *g*

[kattahj.livejournal.com]

Swede, and I haven't gone to the doctor all that often, but here's what I do know (based on various Swedish healthcare sites I checked, as well as my own experience):

A trip to the doctor costs between 25-50 USD, depending on what we're talking about - specialist care is more expensive than GP unless you have a letter of referral. A general health check is comparatively expensive, at 70 USD. The maximum cost is 125 USD/year - after that you get a card that gives you free healthcare for a year (counting from the date of your first visit). This also covers physical therapy etc. (Unless you miss an appointment, which I did, in which case you still have to pay.)

Healthcare for children under 20 is free. A visit to the local nurse during her drop-in hours is free. Testing of and treatment for STD is free. Pregnancy checkups are free, though a pregnancy test costs about 15 USD, as do pap smeears and mammograms.

Dental care is more expensive, and may costs several hundred or even thousand USD for adults if there's much work to be done. (It's still free for children.) The prices also vary a lot. Roughly, it's probably 50-70 USD for a general checkup.

As for waiting lists and so forth, as I understand it that can sometimes be a problem. The waiting list for a non-emergency surgery can be up to three months. As for general doctor's trips I've mostly had scheduled meetings, which can be anything from the same day (for a nurse or a doctor on duty) to several weeks (for a specialist). Last time I went to the emergency room, with a twisted knee, I waited for maybe an hour or so. Dentists usually just book you in and you have to say if you can't come, though emergency dentistry can be called in the same day or (if you're unlucky) the day before your meeting.

The worst that I can say about the health care I've received is that doctors/nurses on duty sometimes seem a bit stressed and can miss stuff. (The emergency doctor that examined my knee made a different diagnosis than the physiotherapist ten days later - and the latter was right.) This isn't a general thing, though.

And yeah, sure, it all comes from the taxes... but I can think of few things more worthy to spend the taxes on.

[beer-good-foamy.livejournal.com]

Swede here too; I'd just add that while we do have private practices and even hospitals alongside the government-run ones, many of them work under the same payment scheme; that is, the private company provides the care, the government picks up the tab.

There's a list here - in Swedish, unfortunately - of the charges that apply in Stockholm (they may vary from province to province, but not much). For instance, one day in the hospital? About $11 US.

UK

[nineveh-uk.livejournal.com]

For me, the existence of the NHS is the symbol of a modern society worth living in. There are alternative effective universal healthcare systems, but considering the limited amount we spend, and the considerable social disparities in the UK, the NHS does an absolutely brilliant job. For “Free at the point of delivery” Nye Bevan should be a secular saint.

I hope to spend my life putting far more in tax into the NHS than I get out (something one would presumably not hope with insurance) and even so I still benefit enormously, because I am safe from catastrophe, it is cheaper to keep someone with chronic illness in work than to pay them invalidity benefit, and because I think I benefit from being part of a society in which taking care of others in this way is part of the social compact.

*

Re. “government between you and your doctor”, I have recently had isotretinoin (Roaccutane) on the NHS. (Cost, about £22 total for prescriptions over 6 months, plus bus fares to hospital.) It's fantastic stuff, but because (among other potentially serious side-effects) the drug is highly teratogenic it is heavily controlled in most countries. In the UK this means you need to get it via a consultant, who will tell you not to give blood, talk about the risks and give guidance on any necessary contraceptive use. In New Zealand, I think GPs can get a licence to prescribe it, and give the same advice.

In the USA, it means the iPledge programme, which involves both doctor and patient giving the patient’s medical details to a government agency and thus breaking patient confidentiality on areas including sexual activity and reproductive health, and intrusive questioning on these subjects every month via a government phoneline. Until 2006, it also involved men (and this could include teenage boys severely depressed due to scarring acne) waiting 23 days before getting their drugs to make sure they weren’t pregnant. It _still_ involves women and teenage girls waiting random menstrual cycle days whilst severely depressed due to scarring acne, whilst their later life employment prospects diminish because of it. People are worried about the govt having their medical records? It already demands them for access to a safe, lifesaving drug. It knows about sexual activity, past pregnancy, and STDs. Oh, and it doesn’t work – because the people who perhaps really need the advice don’t want the stress, humiliation, and unnecessary treatment delays and so get the stuff from Mexico and online instead.

Dermatology appts in the U.S.

[(Anonymous)]

If I want to see a dermatologist in the U.S., I have to make my appointment 3 months out for someone not in high demand. 6 months to a year for a highly-sought dermatologist. Not quite as long for allergists and rhinologists, but very close.

Germany

[yvi (from livejournal.com)]

I haven't yet discovered the 'bad' or the 'ugly' of my country's system. I am a student right now and since I turned 25, I pay 55€ a month in health insurance. Before that I was insured by my father's insurance. I have never had to wait more than 4 weeks for non-essential appointments, never more than a week for essentials appointments and never longer than a few hours for an emergency.

I had a lot of joint problems in the last year and I could see various specialists about it and have very extensive and frequent bloodwork and other tests done without having to consider whether I could afford it. I can get my hypothyroidism treated without having to weigh the benefits against the costs.

I also have Vasomotor rhinitis, which is just an annoyance. I can get the more invasive surgery for that paid for by insurance, if I want to - or I can have the non-invase surgery done for 300€ out of my pocket. These are pretty much the only things you need to pay for - medication doesn't cost a lot, even my non-medically needed birth control pills are only 30€ for 6 months.

If I ever make a lot of money, I will pay more than in other countries, maybe, but I don't mind that. At that point, I will be able to do that. Right now, I wouldn't be able to afford private insurance.

It's not free. The cost goes directly out of your paycheck. But it's affordable because everyone has to have it. per person and per year, German health care costs about a third less than that in the US - that's due to a) less bureaucracy, and b) more preventive measures being taken because people can afford them, as I understand it.

Re: Germany

[yvi (from livejournal.com)]

And oh, reading the comments: I don't need to be referred to a specialist. When I know I need to see an ENT, a dermatologist, or a rheumatologist, I just go and make an appointment with whatever doctor I want. I have only been turned down once because they couldn't fit in new patients.