What are your thoughts on wait times? I was very ill in Barcelona and was told by relatives there wasn't a point in going to the hospital unless I wanted a 6 hour wait for ibuprofen.
Switzerland: if you're ill, you don't go to the hospital. You go the a doctor near you, that already knows your medical history (family doctor), or you call a free hotline (Sanatel), or you just go to a Pharmacy, as the personnel there has medical training and they can also find the nearest doctor and make an appointment for you. And then, bigger public transport stations and airports have doctor stations that are reasonably staffed where you can just walk in ~24hrs.
Hospitals do have walk-in for illness as well, but in relation to other stuff going on in the hospital you don't have a high priority and wait times can be more than you'd expect.
That's if you go to the emergency room - they will keep you waiting (closer to 2 hours than 6), when you have no apparent life threatening condition.
If you have a serious issue, like a heart condition or a broken bone or vomiting etc, you will be processed much faster.
I know that because I've been in both situations - once with pain in my left ear (waited 2 hours, got a prescription to ibuprofen) and another was chest pain and high blood pressure - processed immediately, all blood work done in minutes, etc.
I guess a lot of people go to the emergency room because they just need a doctor to confirm that they're all right.
Same here in Italy. I waited 8 hours to be visited at ER when I had a foot injury while climbing, but in the meanwhile I saw a lot of way more serious patients to go first.
My daughter broke her nose while playing and she had nose surgery and she had to stay a couple of nights in the hospital.
In both cases everything has been completely free (AKA paid by high taxes). Our current system has a lot of issues, but I wouldn't trade for a more private one. For sure I wouldn't trade it for the american system.
> I guess a lot of people go to the emergency room because they just need a doctor to confirm that they're all right.
This is correct and an issue all over the world; without a proper network of local doctors and whatnot (with reasonable waiting times), people will jump to the ER, which is 10x as expensive as a local doctor. But when people have a pressing need for care, they don't have much other options.
Recent UK NHS Scotland experience - went to "Minor Injuries" unit with what I thought was a minor injury (infected cat bite). Was immediately taken to A&E and saw a doctor almost immediately (within 5 minutes) - got an X-ray (which took < 10 mins) and was admitted to a ward where I got multiple intravenous antibiotics. Responded very well so no need for surgery and I was out two days later.
Food was decent, care by staff was very good and WiFi was excellent!
Edit: Turns out that a deep cat bite can be very nasty!
Edit2: This was lunchtime on Wednesday - I know that if I had went at midnight on a Friday it wouldn't be quite so simple...
What makes you think it would be any better in a US hospital? Unless you're literally dying, emergency room treatment is not known for its short wait times.
Side note: does the concept of "urgent care" exist outside the US?
Yes of course 'urgent care' exists outside the US (assuming that you mean A&E).
One of the most baffling things about this whole debate is the assumption by some Americans that socialised medicine is somehow lacking. It really isn't. It's just better and cheaper.
No, I don't think A&E is the same. "Emergency care" in the US is what emergency departments are for. I think this is the equivalent of A&E: go here if you are literally dying. "Urgent care" is for severe cases that don't have risk of imminent death: broken arm would be a great example. An ER will treat your broken arm, just probably not quickly. An urgent care facility is not equipped to handle anything life-threatening.
I'm not saying that the fact these things are separate implies it's worse than the European system, just different.
In the UK there is the distinction between 999 (emergency services) and 111 for "urgent but not life threatening". 111 is staffed by nurses trained to triage and will escalate if necessary and get you an ambulance.
Similarly there tends to be walkin clinics if you don't think you can wait for your GP, but don't think it's something you should go to A&E/ER for. Most of them will not be equipped to handle surgery of any kind, but whatever decisions they do as part of triage will certainly be passed on if they believe you need to be sent to hospital.
I think the big difference is that in most European countries the default is to triage everywhere, unless you pay extra to go private, while Americans seem to be more used to triage being somehow mostly restricted to emergencies.
Triage sucks when you have a minor problem and want quick attention without paying extra for private care, but it's quite great when you have an urgent problem and don't have to wait behind people with much less pressing needs.
Well, some level of triage takes place anywhere you go in the US. If you're at the doctor's office or urgent care for chest pain, you're probably getting a ride to the ER. But, nobody's going to send you away from anywhere because you come in with a broken arm (assuming they're equipped to handle it) or the sniffles. It's just a matter of how long you will wait and how much you will pay.
There's a clue in the name - accident and emergency - that these departments handle urgent but non life threatening care too.
Really, it's a fucking stupid question. Of course Europe's socialised medicine will treat broken arms.
If the question is about the time taken to treat these problems: England is going to through a bit of a scandal at the moment about missed waiting time limits in A&E departments.
The maximum time from arriving at A&E through to either being treated and discharged, or admitted into the hospital for further treatment, is 4 hours. And that time limit must happen for 95% of patients.
And we're currently worried because at the moment it's over 90% (but less than 95%) of patients get treated and discharged or admitted to hospital within 4 hours.
We have the advantage of free or low cost primary care, so most people don't need to leave minor problems to fester until it's turned into a severe problem.
> Really, it's a fucking stupid question. Of course Europe's socialised medicine will treat broken arms.
Seriously, WTF? Where did I ever say broken arms don't get treated? Are you seeing a dumb American in my post because that's what you want to see?
The only thing I even wonder is where the appropriate place to go to get it treated would be. In the US, you can go to an emergency department or an urgent care facility. The urgent care facility is the most appropriate place: you will get seen promptly and they are equipped to handle it, and it will cost less than an ER visit (even after insurance, typically). You will get seen in the ER, but not quickly, and you will probably pay more.
"does the concept of urgent care exist outside the US?", someone else mentions A&E and you say that doesn't count because broken arms.
To answer your point: in England we have:
NHS Choices, a website that provides evidence based advice
NHS 111: a free telephone helpline where health care professionals offer advice, or arrange a call back from a doctor, or recommends a visit to an doctor (and arranged an out of hours doctor if needed), or recommends minor injuries or A&E (and arranges ambulance treatment if needed)
Pharmacy: all pharmacies offer health advice
GP surgeries have GPs but also nurses who can provide a range of treatment including minor surgeries
Minor Injury Units provide treatment for minor Injuries
Accident and Emergency provide treatment for life threatening and other severe accidents - bit they're also misused as walk in treatment centres for a range of mild conditions. Some injuries would mean you get transported to a different hospital after being stabilised -- severe chemical burns would be one example.
I've missed out midwife-led birth units, and all the mental health stuff.
For a broken arm you'd go to A&E. They have to treat it and discharge you within 4 hours. Or you could go to minor injuries, where you'd probably get treated within 4 hours. A&E would have better scanning imaging options.
You're using a bunch of US-specific names and I don't know how they translate. But of course anywhere will have a variety of facilities appropriate to different severity issues; the specifics vary from country to country. And of course if you go to the wrong place you might end up waiting longer, but will still be treated or at worst referred to somewhere that can treat you appropriately, and anything urgent will be treated appropriately quickly.
I was very ill in Barcelona and was told by relatives there wasn't a point in going to the hospital unless I wanted a 6 hour wait for ibuprofen.
Same in USA, unless you still have a knife stuck in your chest. IN USA, that ibuprofen might cost you $250, along with the $XXXX for the doctor's visit. Maybe I'm exaggerating with $250, but having some outrageous bills, I wouldn't be surprised if they bill you separately for the pill AND for opening the bottle and getting one for you.
This attitude silly, it is not always obvious to non-doctors what is an issue. For instance my 2 year old son got his finger caught in a reclining chair, it looked terrible but there was no real issue.
I am sure the opposite may apply to head injuries.
Having lived many years in the US and Europe, wait times in Europe are shorter. This includes emergency room visits, doctor office visits, and physical therapy. Just for example if I was more than 5m late for my physical therapy in the UK, they wouldn't see me. So zero wait time for that. At the doctor I would make a phone appt ahead of time and I usually had to wait 5 or 10m. Also no insurance forms to fill out or any of that annoying extra work.
I live in Madrid and my experience hasn't been even near that bad.
I have only gone to emergency services once, luckily, and it was a very brief wait. For more routine procedures, waiting times are even shorter.
On the other hand. I have had some trouble when I've needed certain specialities which have less available staff. Some relatives of mine have had to wait months for surgeries (not too urgent ones, luckily).
It's an imperfect system. Some hospitals are in terrible shape or overwhelmed, and some services or specialties have long waiting times. Many doctors are overworked and underpaid. But still I think the experience for most people is very positive.
I live in Catalonia, the same region as Barcelona.
If you only need ibuprofen you should not go to the hospital, you must go to a CAP (Centre d'Atenció Primària, Primary Assistance Center). My experience, in a small catalan city, is that sometimes you wait ten minutes, sometimes a couple of hours.
Hospitals can be croweded in Barcelona during flu epidemics or similar, but it is not often the case.
Do you need a prescription for Ibuprofen in Spain? Strange. In Germany, go to the drugstore and buy it yourself. € 10 for 100 400mg pills. And if you are ill, usually you go to a doctor near you. Only in real emergencies, go to the hospital.
In Japan a a normal person will pay a little bit over $100 per month for an insurance card that can be used at any clinic or hospital. People under a certain level of income don't have to pay.
Since a visit to the doctor and medicine is rarely over $10-20 it means basic healthcare is something people don't have to worry about, and keeps people out of the ER (since it costs the same anyway).
Anecdata: Can be at least 15x faster in Europe (NL) than US.
I moved from the US to NL. I've had a (similar) knee operation in both places, on the same knee. Both times involved an ER visit, referral to specialist, planning an MRI, getting a diagnosis, consultation with specialists, surgery, and physical therapy. The Dutch system was approximately 15x faster than the US system (Kaiser): 10 days from ER to OR, vs 5 months in the US. My brother is currently going through a different problem which is following the same trajectory as my knee, when I ask my Dutch doctor friend he is astonished at the hoops my brother has to go through to get action taken.
US:
* ER - unable to straighten knee (incredible pain). Happened before but never for this long. After many hours and extreme pain, it finally clicked into place in the ER.
* Schedule GP visit for referral to specialist (can't go directly!) Took forever.
* Schedule Specialist visit. Took forever.
* Specialist said it happens sometimes, could be several things, best to wait and see.
* 2nd ER visit required. Scheduled a specialist (not available for 30+ days). Talked to a out-of-plan specialist, said the problem was clear: it's the meniscus, you need an MRI to confirm, and will probably need surgery to remove parts or stitch it in place.
* Specialist appointment. Still wanted to delay an MRI. Lots of foot-stomping, finally scheduled an MRI (30 days later).
* In the meantime, another ER visit.
* Quite some time between MRI and specialist consultation. Diagnosis was clear. Surgery scheduled for a month later.
* Operation. Gives me some crutches and tells me to schedule PT for 30 days from operation.
* PT can't be scheduled, 30 days haven't passed! Once 30 days passes, PT can be scheduled. First availability is 30 days in the future (AAAAAAH).
NL:
* ER visit (same issue again out of the blue).
* Specialist sees me the same day. MRI is busy with higher-priority issues, schedules me for 2 days later. No GP approval. Doesn't need or want my info from the US, doesn't want to 'wait and see', just get and MRI and we will probably see the problem clearly!
* MRI. I wait in the hospital, discuss the results with the specialist 2-3 hours later. Plans an operation less than a week away.
* Operation, immediately discusses PT. Two In-plan PT organizations that the surgeon recommends are not available (fully booked), so she schedules me with an (also recommended) out-of-plan PT, and writes a letter to my insurer. They cover it.
> Schedule GP visit for referral to specialist (can't go directly!) Took forever.
I can go to a specialist without referral on my PPO.
> Specialist appointment. Still wanted to delay an MRI. Lots of foot-stomping, finally scheduled an MRI (30 days later).
I got my shoulder MRI within 2 days after doctor visit.
> PT can't be scheduled, 30 days haven't passed! Once 30 days passes, PT can be scheduled. First availability is 30 days in the future (AAAAAAH).
Not sure what this is, I had surgery for my shoulder and was doing PT after 4 days post op. why did you have 30 day restriction?
> doesn't want to 'wait and see', just get and MRI and we will probably see the problem clearly!
MRI's often have high false positives, in my case a torn labrum would be seen in > 70% adults over 45 with no symptoms or pain. Scheduling surgery within a week merely from MRI sounds scary and irresponsible. Why would you want to jump to surgery first when its always available as a last resort. Wouldn't you want to see if something else would do the trick without surgery.
Also, did you research how experienced the doctor is in doing this particular type of surgery, is he upto date with latest techniques, whats his malpractice rate ect. Jumping into surgery with some doctor that you just happen to meet is scary. A botched up surgery is something you have to live with for rest of your life, its irreversible decision.
I'm not sure what the general point is you're trying to make. Mine was to answer, in my experience, whether or not wait times and general 'hassle' is higher in places with more socialized health care than the US. My (limited) experience in NL, and that of those I know here and in the US, is that wait times and hassle are much lower.
It could be that this is due to irresponsible MRI'ing and unneeded operations. If that were true it would be very interesting, since that's the opposite of what people assume when they think of socialized medicine.
It could be that all these super-fast decisions are more expensive, but kill a lot of people sooner, thus saving everyone on healthcare. This also doesn't appear to be the case (life expectancy at birth is higher). https://data.worldbank.org/indicator/SP.DYN.LE00.IN?location...
Anyway, to answer your specific points:
- PPO vs HMO: Nice that you have a PPO. That option wasn't available to me. In the Netherlands, I can pick my insurer freely, my employer has no say in the matter (costs are 100-150 euro a month). Some insurers have in-group agreements, some do not.
- On getting MRIs: I can't tell you when it's correct to order an MRI or not. All I can say is that both MRIs were hits for a torn meniscus, and both operations also bore out evidence of this. Both times it was also a textbook case of a torn meniscus based on my symptoms. Both
- Researching Surgeons: Yes, I researched both surgeons (and hospitals where the surgery was performed). In the US I had fewer options (Kaiser only), in the NL the specialist gave me a list of other specialists who I could get a second opinion from, should I want to.
>I'm not sure what the general point is you're trying to make.
Point I was trying to make is that you are comparing HMO to NL insurance that allowed you to see specialist directly. I don't think thats a fair comparison unless NL requires all insurance to cover self referral to a specialist.
I know nothing about NL healthcare but according to their website
My girlfriend had an emergency while I was in UK and we had to wait around 5 hrs to see the doctor and had to go through series of rooms each getting progressively smaller than the pervious one. First room had hundereds of people. This was a smallish town near london.
Why would you go to a hospital for ibuprofen? Isn't it over the counter there? I've waited at the ER in the US for hours because there was limited staff and more serious cases were handled ahead of mine.
Exactly. Most gov healthcare result in rationing an long wait times and sucks up massive amounts of resources.
We need better private solutions. We need yelp for medical comparative price shopping, with consumer and expert reviews.
Really well executed gov care can be OK but is rare and usually does nor stay good long term.
The current "free market" in healthcare is completely hamstrung by regulation and unspoken anti-competitve practices and broken intermediation via medical aid funds and gov medicare and other programs.
> Most gov healthcare result in rationing an long wait times
Most private health care avoid visible rationing by letting people pay to skip ahead in the queue based on economic means instead of urgency and clinical need. That the rationing and queuing isn't visible doesn't mean it's not there. Only that in the US people sit at home wondering how to afford treatment instead of wait in line based on triage based on urgency.
So yes, the US system is superior if you're one of the lucky ones that can afford to pay your way past those who need treatment more than you.
> and sucks up massive amounts of resources.
US healthcare is vastly more expensive for the users than most socialised options..
Effectively many countries do allow this to some extent.
E.g. a significant portion of private care in the UK is provided in NHS hospitals by NHS staff either outside of their normal shifts arranged by private companies who pay the NHS for access to operating theatres and the like, and by NHS trusts themselves who are allowed to provide private services on top of their socialised care.
A market exception is Norway, which as one of very few countries have very strict limitations on what private services can be provided at all on the basis of an argument that as long as healthcare resources are limited (e.g. there is a practical cap on number of doctors - train too many and they don't get enough experience on real cases to gain the necessary skills), it is seen as immoral to allow people to queue jump.
>> We need yelp for medical comparative price shopping, with consumer and expert reviews.
I'm sorry, this is the stupidest thing I've heard in a long time. What you need is being able to go to any doctor, any hospital, at any time, and knowing you won't pay for it at all, ever, as it is in many countries around the world. Not competitive comparative pricing. If you are in pain you don't want to be shopping around for a good price.