Question for those living in countries other than the U.S....

[dang]

If you live in a country that has a nationalized health care system, I'm curious about how well you think it works? Cost, wait times at hospitals and doctors offices, medications, etc. I don't know very much about this stuff but I'm fairly certain that most other industrialized countries have a government run, or nationalized system.

As you may have heard, the U.S. is again trying to go toward nationalized health care and its really hard to know what to believe in today's media/propaganda. This is a HUGE issue to deal with and has been looked at for years. It would be nice to get some insight from others who live it.

Dan

 

[decoupe]

Universal Health Care VS Private

Where to start?

It boggles my mind that the country that has created such hope and expectations for the world in terms of advances in the quality of life through medicine and the sciences can be so close minded to the responsibility of ensuring that all of it's citizens have access to those services. I don't understand the problem of delivering good health care to the same people you ask to fight your battles, work at the bottom of the economic grid and vote in your elections. It must really suck to be poor and sick.

We don't have a perfect system. There is no perfect system. There is no right answer. Our perspective on what the role of society and the individual is different and our health care system reflects this. There are alternatives to either/or public or private systems that we are slowly moving towards. The battle is to provide the best care to everyone without bankrupting either the individual or the country. The definition of basic health care is changing and the emphasis is on prevention rather than cure - a healthier individual will result in a healthier society.

So what is the Canadian health care system all about? The theory is that everyone has the same level of service and rights to access. The taxes we pay contribute to the cost of operating the system. If you don't earn enough to pay taxes you're still entitled to coverage at the same level. The quality is supposed to be equal across the whole country. In practice it does well but certainly isn't perfect. It's at it's best when dealing with emergencies, trauma and critical care. Scary life threatening stuff like my father's stroke or mother in law's cardiac incident gets attention and treatment RFN (right F...ing now). If you want prompt first class care - come in bleeding, develop Stage 3 Lymphoma or faint and fall over at the grocery store. If you have a cold or sprained ankle and someone is hemorrhaging, you come second. A simple surgery to reconstruct a ligament in my left thumb is a 6 month wait.

I'm sure there are horror stories (I don't know of any) with examples of long waits, poor physician assessments and insensitive nurses in public health care. But, the big scare tactics being used by the HMO's and opponents of any publicly funded health care in the US - even if true as individual cases - are not representative of the system or how it performs in general. The horror stories get your attention but as a percentage of cases - what is that?

Make your choices but understand the alternatives.

 

[timt]

Dan, you ask a question that is constantly debated in the UK and has many answers given from different "positions". I believe Canada modelled their system on the NHS (National Health Service) and decoupe's answer could have been written for the UK. Answers can be very long, I'll try and keep this reasonably short! On reviewing, much of what I have written is in the link which will take you to other information if you are so minded.

Our system is a "free" service "open to all at the point of need", it's funded by taxation and used to be delivered wholly by the state owned organisation. For some years elements have been subcontracted to "private" enterprises but they deliver on behalf of the NHS and theoretically it matters not who delivers ... There are prescription charges for drugs but only a minority are liable and there are charges for some (most?) dental and optical services.

At the moment the government operates targets for a wide range of things such as wait times, accessability etc. There are inumerable measurements applied that appear as a nightmare to practioners but are intended to manage costs (of operations, drugs, etc) and track performance (eg, surgery "survival" rates) to provide an attempt at ensuring that the service is broadly equitable across the country. There are bad stories in the press, how else would the press survive (?), and sometimes there are good stories. There are regional and even sub-regional differences in service because the Service is organised and funded/budgeted to a local level on various parameters and so logically there are differences in local performance.

Major acute surgery usually gets the best press, plus A&E, chronic illness management frequently gets the worst press and there are reoccurring issues over the funding and availability of new drugs.

The bullet that noone so far seems prepared to bite is that health care costs will continue to rise as expectation rises driven by current success and every new capability or drug discovery ... someone has to pay and/or a limit has to be imposed. When the NHS was introduced 60 years ago
http://www.nhs.uk/nhsengland/aboutnhs/pages/About.aspx capability, expections and intent were somewhat different. To some it is an essential part of a modern egalitarian society, to others we have a tiger by the tail. On balance I would say our system is very successful in delivery (acknowledging that one can't please all the people all of the time) but woefully out of control on cost and over administered.

Some argue that the French system is now better than ours, I have little to no knowledge of their system so leave that one to others.

 

[gmad]

Canada vs US.

From the perspective of a US citizen living in Canada, I offer the following views on Canadian health-care.
The good:
As above, if you are in dire straits, there is no discussion, you go straight to the head of the line. There is world class trauma care, cancer care, etc., especially in the major cities.
A medical emergency is not a financial disaster.
The bad:
It is an ideologically run system,an overly bureauracratized mess. beholden to the large health care unions who put their own welfare ahead of the patients. The dogmatic term, "public health care", insinuates that this is the only system that works and offers egalitarian treatment.
Patient care in all but the biggest cities is hit or miss and you can wait for ever. Witness my father, a retired MD, on a waiting list for over a year for a simple MRI to facilitate hip replacement.
A chronic shortage of Family doc's due to ridiculous policy making in the 70's and 80's.
A lax immigration system that floods Canada with 'medical immigrants', who take advantage of the generous benefits at little or no cost. (education also)
Since goverment's job is to be re-elected, the long term planning necessary to make sure the system is sustained is absent. We now have a serious shortage of long-term beds for older patients. It is a common occurrence for hospitals to announce there is no room at the inn.
I could go on. It seems to me, the most effective systems combine a publicly funded system with some form of private delivery, ie France. The Canadian and US systems are two ends of spectrum. The solution, is somewhere in the middle.

now, back to cars

 

[abe3.0CSi]

The biggest problem I see in the US is that how the heck are they going to manage national health care when they can't manage the Veterans Administration health care system, they do a poor job with mediaid for the poor ( yes in this country the poor get health care), they poorly run medicare (for the elderly), UPS/FEDEX does a better job than the post office, and finally look at our great public education...hahaha. So, now the government in its ultiimate wisdom thinks they can run healthcare! You guys forgot to mention that many in Canada have private insurance and when it gets tough...they run across the border to get their hips replaced and cardiac surgery because by the time they get around to doing it in Canada...it may be too late!. Finally, when the Belinda Stronach former cabinet minister in Canada runs to California to get breast cancer treatment...that tells it all!
The 40 million in the US without health care includes about 15-20 million making over 65k a year in their 20s and 30s who do not want to pay several thousand a year because they think they will never get sick. Also add to the statistics the millions of illegal alliens who will also get "free healthcare"...This plan will kill small business in the US who is the backbone of new source of employement....they are struggling now and when they get taxed to death to pay for this you will see unemployment go further up.
They need to fix what is wrong with our system...not eliminate it and replace it with a system that could be worse than what we have. If their are flaws with the Canadian/UKs system, the US will be 10 times worse. Our government is more wasteful, too big, and less efficient than the europeans/Canada. Not to mention that their is no tort reform or free medical education with the US proposals. In Europe the average medical student is not $300k in debt like the US and physicians get sued 10x vs Europe...they need to change that too.
Please, I am not trying to be critical of Canada/or Europe...in fact I am critical of the US. Americans want to have the same disposable income (how many in europe get a car at 16 years of age..its the rule not the exception in the US), they are demanding and sue if they don't get their way, they are impatient and will not put up with waiting in lines, they are less forgiving, they expectations are higher...yet they want "free healthcare". In other words, they want their cake and eat it too!
I wonder how many women in the US will put up with three mammograms in their life time. According to the UK...breast cancer in the younger woman is too agressive and costly to treat..therefore why look for it. In older women...well they are going to die of something else...so why look for it. So, you get three mammograms...will see how women in the US will like that.
BTW, one of the first thing in Obamacares 1000 page report is that "we the federal employees will be excluded.." Boy, if its good enough for the citizens of the US...it should be good enough for the feds...they don't want to give up their private insurance but expect us to give ours up! They sent their kids to private schools...but the politicians tells up that public schools are good for us...they are against vouchers for the poor to send their kids to private schools!
One last thing for interesting stats... look up NCPA (national center for policy analysis) http://www.ncpa.org/pub/ba649 it compares US vs...lots of myths about americans not getting health care. Breast cancer mortality is 52% in Germany, 88% higher in UK vs US. Prostate cancer mortality in Canada is 184% higher in Canada. More US women get screened for PAP, mammograms, colonoscopy, PSA for prostate than in Canada. Actually, more people in UK, Canada, Germany, NZealand, Australia think they need healthcare reform than in the US!
Average waiting time in Canada (according to Canadian Ministry of Health) knee replacement 290days, hip 210d,
breast cancer treatment 168d, cataract 141d, prostate cancer 96d, cardiac bypass 65d..that is why the border states are full of Canadians with private insurance! But, they all do get equal care...are we Americans become patient like the Canadians...we may have to go to Mexico to get our care. In fact, I predict that if Obamacare happens that within 10years we will be traveling to Canada and Mexico for specialty care.
And my favorite...in the US if you are going to get a hip replaced you will probably get the best available on the market at that time. In many european countries the system will offer you a hip or knee or eye lense..but if you want the better one...you must pay the doctor/hospital lots of $$$$ for the upgrades! We will see how far that will get in the US!

abe

 

[dang]

Abe, I'm looking for opinions about OTHER countries health care systems, not the U.S. I can go to just about any online or hardcopy source and find all kinds of opinions about our own system, the pros and cons, who benefits, who doesn't, blah blah blah. I want to hear from people who actually deal with it. If you live in another country then I'm way off base here, but my assumption is that you live in the U.S.

Dan

 

[Orangener]

In Austria we have a combined system of social insurance, it enfolds the health care (Krankenversicherung), unemployment insurance (Arbeitslosenversicherung), accident insurance (Unfallversicherung) and pension insurance (Pensionsversicherung).

English is not my native language, therefore it is very difficult to explain, but maybe this link gives you some informations:

In english: http://www.help.gv.at/Content.Node/HELP-FC.html

In german, maybe you can find a translation program : http://de.wikipedia.org/wiki/Sozialversicherung_(Österreich)

I pay monthly approximately 33% for social insurance (40%) and taxes (60%) !

I was born into this system and wont miss it !

 

[decoupe]

One of the obvious problems with any health care system is to rate at which medical technology progresses and how the system adapts to it. The Canadian system was one of the crown jewels of the social net that we counted as basic to all and the system was designed to be unchanging and tamper proof politically. All of those amazing advances in joint repair and replacement, cancer screening and treatment, organ replacement, neonatal care etc etc etc have produced huge issues of funding that translate into wait times and capacity for delivery. This has forced the advocates for and against ANY private service providers and clinics into battle and increasingly polarized the debate.

This is further complicated by the inherent structure of regulation and funding the delivery of services. The system is regulated under the Canada Health Act but delivered by and at the Provincial level which has some autonomy and ability to further enhance or restrict based on the relative wealth of the Province. In effect their are 10 different variations of the same universal health care. The same cooperation or bickering (depending on the issue) goes on between the Canadian federal and provincial governments as with your US federal and state governments.

Gmad is exactly right that the politicians are a huge part of the problem with how the the issue of access, funding, level of service and provision of services will be handled. I don't see much difference between the indifference to the patient of the entitlement of the unions and the profit motive of the HMO industry but a fundamental component won't change and that is the role of the Federal government in regulating standards of care and monitoring delivery of care by private providers to a degree that Americans wold find intrusive. Canadians generally demand that oversight role of government in essential services such as health care and finance/banking.

Our system does not allow (in theory) anyone to queue jump and buy their way to the front of the line. Medical treatment in the States is in some sense a commodity to be purchased if you have the cash and the Canadians that go south for treatment are typically not working for minimum wage - they are sufficiently wealthy to shop for a new hip, cardiac bypass or whatever. Having those private for profit services in Canada would, to a degree (we have a shortage of doctors because so many go south to make more money working for HMO's doing hip replacements on Canadians), increase the availability of the not for profit to treat everyone else. This is a bitter pill for some of the health care advocates to swallow as it not stereotypically Canadian egalitarian. But it is happening - private MRI clinics are common and readily available.

So our system has huge issues, resists change, is ideologically delusional, full of holes, bureaucratic at all levels, incredibly expensive to fund and cash strapped to the point of destitution. It also provides a very broad level of generally very good service across a country 20% larger than the US with about 10% of the population (which is a huge problem in itself). It is changing very slowly and will be forced to change and allow more private "industrial" health care services - that is already happening. One province (BC) has what is effectively a small hospital and private owned clinics that provide specialty services are more commonplace but they all operate under the Canada Health Act and will probably bill for services through it as well as directly to the patient.

We have a flawed health care system that is very much behind that 8 ball and struggling to catch up with out losing it's core values of universal access and delivery. It has treated me and my extended family extremely well through cancer treatments, strokes, heart issues and joint replacements (sister in law waited two years for the first hip and one for the second). My 5 trips under the knife wielded by one of the best in orthopods in Canada have been with waits of less than 1 week and as much as 6 months. All of the above has not cost anyone a dime for any of the treatment - all covered by the system (that is actually part of the problem - there should be a user charge based on a means test).

Our system wouldn't work in the US because - well because you aren't Canadians. Hell, there are clearly examples that it doesn't work here for everybody, everywhere, all the time anyway. It can't.

Politically, we are different. What we expect - you probably wouldn't accept. We have had many services that were once delivered by government privatized with no cost benefit and a decline of service but we also fully understand how waste seems to be inherent in anything government touches. But there is a lot both of us can learn from how health care is delivered in each country.

If Canada were to attempt to start all over and create a Canada Health Act today it wold never happen. When this was passed in the 1966 it was an incredibly difficult process in which many doctors were in open rebellion and left for the US. If I had any advice worth giving it is to set up an independent non governmental body that reports and makes recommendation to your federal government. To approach this from an ideological point of view is to doom it to failure.

Good luck. Have to go bleed my brakes.

Wordy bastard, eh?