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by furyg3 3214 days ago
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.

So yeah, socialized medicine rocks.

1 comments

> 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.

I would also assume that it would be more expensive per capita, which it doesn't appear to be: https://data.worldbank.org/indicator/SH.XPD.PCAP?end=2014&lo...

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

https://www.govt.nz/browse/health-system/gps-and-prescriptio...

" In most cases, you need to visit your General Practitioner (GP) first so they can refer you."

What kind of insurance did you have that allowed you to self refer ?

You seem to have compared apples and oranges and came to the conclusion that oranges rock.