| I'm not saying to exclude doctors :) , I'm saying that primary care and triage could be done by individuals with less extensive studies. Having more medical services does drive the cost down and I live in a country with firsthand experience. Here in Uruguay, we have several tiers of care, the first one being an equivalent to a walk-in clinic plus doctor-to-home services. If your child has a fever, or you're feeling unwell for some reason, or you have a rash, you go to those and get immediate service. Here they're manned by actual doctors because we have a lot of them (4 per 1000 inhabitants, highest in the world). These doctors usually only did the standard training (which is 6 years) and not the specializations (which are 4 more years). These services are not free but they're available with a ridiculously cheap subscription (about 35 dollars/month) which includes free ambulance services in case of heart attack or similar. These are the ones I'd man with nurses or equivalents in the U.S. They know better than to treat complicated cases - if they triage and understand your diagnosis might be more serious (let's say they suspect the abdominal pain is an appendicitis), they immediately transfer you to your primary care center. As mentioned, if your injury or symptoms are more serious, then you can go to your primary health provider. These are under a "mutualism system", which is basically equivalent to being a state-provided healthcare system. Those are paid from your paycheck (4.5% to 6% of gross salary) and free for those under some sort of state subsidy or pension or equivalent. Here you have access to all specialists, if you're on a standard service, you'll have to be referred by a general practitioner or have a wait time of a few months. There are also private insurance companies that provide a service on top of this, which for an extra monthly premium (200 dollars in my case) you can get same-day appointments to any specialist. Many doctors here are among the 1%, but a lot of them (those in the primary care centers I mentioned) don't make much above a standard wage. |