[arjie]

One thing that's surprised me about the US is the general slowness of most things. In India, you can get MRIs and CT Scans same day. Or you could the last time I was there. And it didn't cost very much in comparison.

My doctors have all been good (attested to by my parents who are surgeons themselves) but the healthcare system is wonky.

One thing I didn't expect is that the Indian system where you just drag your health records around paper copy yourself is superior to US EMR systems - which doctors seem to always have trouble with.

But now I have some friends in medicine and I always have them pull my records and keep a copy myself. It's usually a fax but it's better that way. Clearly electronic interop isn't working most of the time.

[evnix]

The general slowness extends to simple things like x-rays and blood tests too. This is not just US but whole of the west seems to have the exact same attitude.

Most of Asia has same day or next day medical tests. In India you can order something like UberEats where in a technician comes home collects your blood samples and the results are emailed within the next 24 hours or so.

Medicine seems to be commoditzed in the east, easily accessible and cheap. West treats it like voodoo magic or rocket science that only a chosen few are capable of partaking in. There is always a long queue to get to your local voodoo practitioner.

[calgoo]

I had some pain in my lungs and they gave me an xray in about 30 minutes here in Spain to confirm that i had pneumonia. I waited 45 min to see the doctor in the emergency room and then another 10min waiting for the doc to check the xrays.

[evnix]

Yeah you need to know the keywords in EU, "pain in chest", "seizures". After which the emergency treatment is quite good.

But for the majority, it isn't great. You go with pain in stomach and it happens to be cancer, you die waiting. I personally have seen so many of these and it's heartbreaking.

[attendant3446]

That is true, but it also varies from country to country. In Sweden I haven't been able to see a doctor in 1.5 years. In Germany, the waiting time is ridiculous, usually 1-3 months, but if you choose your doctors (Google Maps is the best catalogue for almost everything) - you get the results and 99% of it is covered by statutory insurance.

[CaptainZapp]

> The general slowness extends to simple things like x-rays and blood tests too. This is not just US but whole of the west seems to have the exact same attitude.

In Switzerland I get an MRI within 48 hours if my doctor orders it.

Mind you, healthcare is also very expensive comparatively but the quality is very high and coverage is extensive.

[evnix]

Condition is if "your doctor orders it" and how long does it take to get to that doctor if it isn't an emergency. I don't about Switzerland but it is quite bad in majority of EU countries.

And Why can't you just walk in to a clinic to get x-rays and tests done like it is in done elsewhere. Have clinics compete for price.

The other part no one mentions is the utter cheating that goes on in statistics to show that the health care system is doing good. Things like counting the patients who were admitted but not counting the rest 90% who died just waiting for months.

[jorvi]

> And Why can't you just walk in to a clinic to get x-rays and tests done like it is in done elsewhere. Have clinics compete for price.

Because false negatives are a massive problem. People get biopsies or treatments for things that never needed it, which is ultimately worse for their health (on average) than catching the rare time it is something.

[evnix]

There is no stats to what you are speaking. General People not being able to get to doctor in months is a bigger problem than a rare false negative.

This also reduces burden on doctors. If the only thing your doctor does is prescribe antibiotics and orders scans. Why not do it yourself and get treated early.

[CaptainZapp]

You can absolutely walk in an have an MRI made at any time.

It's just not paid for by your health insurance.

[jorvi]

Apologies, I mixed up my terms, I meant false positive.

And no, you are wrong, overtreatment is a huge problem.

[piva00]

> And Why can't you just walk in to a clinic to get x-rays and tests done like it is in done elsewhere. Have clinics compete for price.

I hope you are aware that these also exist in many EU countries, private clinics aren't banned because of public healthcare, you can purchase private health insurance in many countries, I can't say all because I don't know the intricacies of every country's system since this is a national policy and each member-state is free to run their own systems.

Here in Sweden I have private health insurance through my employer, I cannot go directly to a clinic for imaging, etc. since it needs a referral from a doctor but it's quite simple and when I needed I had many choices of private clinics to do a MRI. If you don't have insurance you can definitely pay out of your own pocket, both for a private doctor as for exams.

[autoexec]

You can, but it's not necessarily a good idea.

https://www.newyorker.com/science/annals-of-medicine/will-a-...

https://doi.org/10.1016/j.jacr.2024.08.024

[short_sells_poo]

I feel the seiss system really nails it. Health insurance is mandatory. If you can't afford even the basic level, the government pays for it. The basic level itself covers basically everything from emergency care, hospital stays and gp. The extras you can pay for are things like single rooms in hospitals or access to private clinics. Compared to the local salaries, the basic package is quite cheap - doubly so compared to the UK where National Insurance extracts a very hefty portion of your paycheck and this gets you the dire waiting times of nhs...

[soco]

Maybe because the Swiss didn't let the magical hand of privatization solve it? The healthcare providers might be private but the laws and regulations and conditions under which they are run are very strict and very detailed. Perfect? Of course not, I could give examples heaps. But better that many? Very yes.

Now, is there here anybody from Spain to comment on their system? I've heard good stuff about it.

[sega_sai]

National insurance contributions have nothing to do with the NHS. NI contributions determine your state pension (but because the money from NI just goes to treasury, NI is really just income tax with different name)

[MediumOwl]

Does it? It's also close to last in most categories in the linked study.

[Bayart]

> The general slowness extends to simple things like x-rays and blood tests too. This is not just US but whole of the west seems to have the exact same attitude.

In France I could have a blood test right now, without an appointment, and an X-ray by tomorrow morning (just checked).

But the ER is generally far too slow and some specialists have much too long waiting times.

[nope1000]

I think the problem in the west is just demographics. More older people leads to high demand on the healthcare system and fewer working age people leads to less supply.

[InDubioProRubio]

China, SKorea, Japan.. all aging

[nope1000]

And they all make their citicens work insanely long hours. So they are not sustainable either.

[InDubioProRubio]

Got to keep that Necropolis warm

[tmaly]

I had to visit the ER in Philippines.

In US we sit there for 5-7 hours and see a nurse practitioner.

In Philippines we were in an out in 2 hours and saw two doctors.

[cafard]

My last trip to the ER was in 2010. Probably because I had good health insurance, they saw me quickly (less than half an hour), cleaned me up, maybe glued a cut, and I was done.

This was in the US, just outside Washington, DC.

[angio]

If you're willing to pay out of pocket (~100 euro or so) that service is available in western europe too.

[evnix]

Can you name a few services that do this for that price.

[benterix]

I live in Europe and if I take a blood test at 7 am I can usually check the results online by 1 pm.

[Yizahi]

Blood test yes, MRI - no. In the Ukraine I can go to the M24 center, and yes, 24 means it is literally working 24/7/365. And I don't need doctor's referral to do it. In EU I had to wait 2 months and have doctors referral, and that was lucky window I caught by chance. Other people report waiting much longer.

To get to the specialist doctors is also hard in EU, compared to the Ukraine. Here I had to wait between 1 to 3 months to a lot of specialists. And if any mistake in the referral is made, then wait need to be repeated.

Example - I got a referral for the retinal diag. But to do it 15 mins before the test eye drops are administered (atropine) to dilate pupils. Apparently I have needed to have two referrals - one for the drops, and another for the diag itself, and I got only the second one (made by an eye doctor in the same clinic, so regular staff). So I have waited months, and was denied the procedure, then a spend a week on a phone and visiting clinics in person to sort this out. Then I got proper referral (haha, actually not even then, they simply caved and allowed me to do it with what I had) and had to wait a month again to do a simple check which would take me a hour at any arbitrary day in Ukraine.

[aguaviva]

And in the middle of a full-scale war, in a country not exactly wealthy, no less.

[A_D_E_P_T]

Same. But in Croatia where things are a little bit... well... different. For instance, I don't need a prescription to buy (almost) any drug in the pharmacy. And I don't need a prescription or referral for any medical exams or blood tests; I can order them myself. Asia is like this, but Europe to the north and west of Croatia really isn't.

I believe that things in the UK and Germany might be a lot slower and much more restrictive.

[jq-r]

Well some relatively common things are easy to get in Croatia (bloodwork and meds - GPs like to prescribe those to get rid of you), more serious like exams, treatments, surgeries are absolutely terrible with waiting lists which are years long. People are dying, and/or their condition worsens before they even see a specialist. This is common knowledge for many years now.

Private clinics are opening left and right with the same(!) doctors working in both public and private clinics. Also corruption is rampant allowing doctor's friends to jump lines and that also happens for money/favors. So if you're not rich enough to go to a private clinic your second best option is bribes/corruption/nepotism. And if you don't have the latter, you're frankly fucked.

[A_D_E_P_T]

I've lived in the US where my health insurance had like a $6000 deductible and a $1400/month price-tag. (And, by the way, I really didn't appreciate how American doctors would gatekeep drugs, restrict their availability, and add significantly to their cost.)

Here, you can walk into any private clinic in Croatia, and arrange for even a fairly complicated surgery, and it'll cost you way less than all that. Your annual medical expense bill won't even come close; a very sick person in Croatia, who does everything in private clinics, pays less (annually) than a perfectly healthy person in the US who never sees the inside of a doctor's office.

My wife just gave birth here at an "expensive" private clinic, with a private room of her own, and the total price was cheaper than a few months of medical insurance would have cost in the US.

Ultimately, private clinics are a damn good thing, because price transparency, price competition, and paying out-of-pocket -- they all serve to keep fees reasonable. If a Croatian clinic tried to charge $100 for an aspirin tablet or a bag of saline, there'd be riots with pitchforks and torches.

[jq-r]

I'm not sure if we're talking here about the same things. You may say: "oh it's easy to get meds and it's cheap to do X, medical system is great" while being a medical tourist and/or having a far above average pay, I would accept that. It's great if you have the means. Just like it's great in USA if you're rich, right? But directly comparing two completely different systems and different orders of magnitude of purchasing power and taxes doesn't really paint a good picture of how it's here.

For an average citizen the system is terrible and getting worse by the day. The examples are too numerous to mention.

I'm also not sure if you think that I'm somehow against private clinics. I'm not. They of course won't compete on medications with public services as that's pointless. What I do find apalling is that doctors are working in both public and private clinics completely legally. Moreover, that practice makes the public services worse by removing the availability of the doctors and makes taxpayers being double charged for the same service.

There would be riots with pitchforks if most needed some non-basic ("take these pills") medical help. When you're young you probably don't need much. But as you get older you actually might need some procedure or a treatment. But by that time you are actually older, sicker, and there aren't too many of you to actually riot. And many jump the lines by having friends (of friends) working in hospitals. It's bleak and grim and I don't see it getting better.

[InsideOutSanta]

"This is not just US but whole of the west seems to have the exact same attitude"

The slowness you describe has not been my experience in many European countries. It really depends on how the healthcare system is designed to work.

I was pretty surprised when I went to China and I could just go to a doctor's office without an appointment, stand in a queue, stick out my tongue, get a diagnosis within ten seconds, and be sent out with a handful of random colorful pills wrapped in paper. Yes, this was, in fact, a real doctor's office, and I did take the pills. I have no idea what they were or did, if anything at all.

I also did enjoy the phone-ordered house visits from nurses in Indonesia when I got Bali belly, although that is probably a result of low labor cost more than anything else. And the poop tests I received a few hours later weren't all that helpful. Oh, I have "amoebas," that's very useful, thanks.

All told, I'm happy I usually live in Western Europe. Relatively expensive, but high-quality, fast healthcare without the constant risk of going bankrupt when something unfortunate happens.

[pitkali]

Out of the Western Europe, I lived in Sweden and Germany, and I have not been impressed with the health care so far. I hear it's different when you're having a heart attack, but if you "just" tore some knee ligaments, for example, getting good care in a timely manner is a struggle.

[askonomm]

In Estonia all of our records (incl. Health) are digitized and online in a central system that both doctors and you can access. It works wonders. Every doctor I go to can see my entire medical history with a press of a button, and I don't have to deal with any of that. Likewise when they prescribe new things, I can see my prescriptions right there, and so forth. We're a 100% online nation now, and clearly when done well it's remarkably good.

[fire_lake]

Does one big digital system make a cyber attack more damaging?

[jillesvangurp]

In theory yes. But having accurate & complete information in the hands of nurses and doctors saves lives on a daily basis as well.

[willvarfar]

Estonia is frequently targeted by massive coordinated and sophisticated cyber attacks. So far it has proved very resilient and secure.

[llm_trw]

Efficiency and resiliency are usually orthogonal.

[HPsquared]

Like a physical structure made of one large component is often the strongest and lightest, most rigid etc. But it's the most vulnerable to cracking or other failures.

[inglor_cz]

Well, they are engaged in constant low-level conflict with Russia, so their systems must be pretty hardened against hostile incursions already.

If there is one EU region where digital security must be taken as a life-and-death matter, it is the Baltics. In case of weakening of NATO, they are the foremost candidates for the next Special Military Operation.

[benterix]

> In case of weakening of NATO, they are the foremost candidates for the next Special Military Operation.

I guess the odds of Trump winning are much lower than a couple of months ago. And even if he wins, if he follows with his stupid plan of giving Ukraine to Putin, he will be criticized by all sides. So losing a Baltic state would be another bitter blow and he probably would want to avoid that as he wants to appear "strong".

Also, NATO is not just the USA. The remaining countries had no choice but to increase their military spending and will continue to support Ukraine until the last dime knowing that the fall of this country will just make Putin more aggressive. We can't just let this happen, with the next American administration or without.

[inglor_cz]

It is not really just about Trump. It is quite obvious at least since Obama that US strategic interests are reorienting towards Southeast Asia, which is understandable as half of humanity lives there.

And even with a friendly administration, it can feasibly happen that there will be more crises unfolding at the same time than the US is capable of efficiently addressing. (Say, Ukraine and Israel and Taiwan.)

I wonder how much of a choice the other countries have. Being a European and observing European political patterns, I am very sure that Finland, Sweden, Denmark and most of the former Soviet satellites will continue to support Ukraine because they know what is at stake for them. The UK may as well, given that the dislike between England and Russia goes a long way back.

But there are influential people in Germany (and I am not talking about the AfD here, but about the industrial lobby) constantly pushing in the back rooms for reconciliation with Russia at any cost, because high energy costs have made a mess of the German economy, and I can see something like a repeat of the Munich betrayal of 1938 in the future. At this phase of the war, Putin would be open to such an agreement with Germany. Not even his wildest plans foresee a re-subjugation of the former GDR, so Germany risks "nothing" (well, a lot of goodwill east of the Oder, but that may be an acceptable tradeoff for the businesspeople).

And the more distant countries such as Spain or the Netherlands or Belgium aren't really that much interested in Eastern European affairs, all the verbal proclamations notwithstanding. Although NL has some unsettled business against Russia with regards to that shot down airliner.

[anal_reactor]

While I can see populist parties pushing for an agreement with Russia, it would be a ridiculous move because it would completely split EU into two parts: Russia-lovers (countries that don't border Russia) and Russia-haters (countries that do border Russia).

[28304283409234]

Or any other attack. I remember we had such a centralized registration system. It was used to great effect by the German Nazis when they occupied our country. Of course, occupation by foreign aggressors is highly unlikely in Estonia. Unless history repeats itself as it has (in Estonia) dozens of times.

[askonomm]

Do you want to advance your society and make life more convenient for the people or do you want to live in constant fear and create unnecessary complexities for the people? We put a lot of effort in creating secure systems, we audit them constantly, and we get a plethora of cyber attacks from Russians on a constant basis, but they haven't gotten through yet.

We believe in living the best life we can, through the means of making life as convenient as we can, and we're very happy our government thinks the same. I've lived abroad many times, in many countries, and every single time was miserable because of the unnecessary complexity every basic thing involved. I very much doubt that complexity was for security reasons, more like the incompetence of the government bureaucrats to create a cohesive system that interoperates with all the different parts.

[atoav]

Why does this need to be framed as a ditochomy?

I want my health system to be both resilient and efficient. Why? Because generally when unforeseen black-swan-type catastrophic events produce high demand in the health system, chances are other infrastructure is also affected by whatever that event was.

If the last pandemic has shown anything it is that if great minds come together and cast aside their corporations strategic or financial incentives for a moment, we can have the nice things — so for example tools that excell in multiple dimensions at once that many described as incompatible with each other: convenience, resilience, privacy, ...

If we want to move things forward, we should do our level best to not fall into the trap of false dichotomies. What is often framed as a fundamental dichotomy is usually just a tension that people with vested interests abuse to get a solution that suits them. That is not where real innovation or good engineering happens.

[wkat4242]

Are there safeguards in place to prevent the wrong people looking up your data with the touch of a button though? I'm aware of Estonia's digital prowess but for me privacy is a top concern and I'm glad we're not so all-in here.

[askonomm]

In the FAQ section of our health portal (https://www.terviseportaal.ee/en/kontaktid-ja-kkk/) it states:

> In Estonia, health information is gathered to the Health Information System, where your prescriptions and medical records are accessible to the health care professionals that provide services to you. The Health Portal enables you to view your data in the Health Information System, submit additional information, and change your personal data. You may restrict your health data if you wish. In that case, health care professionals no longer have access to your health information and the quality of medical care may be impaired, especially in emergency situations.

We take privacy very seriously. We can also see exactly who looked at our data, as there is a log of every person or institute who has done so. A little more is written here: https://e-estonia.com/i-spy-with-my-little-eyeprivacy/

[xtracto]

I understand where you are coming from. But for ME I have personally ever wondered why are people afraid of others knowing their medical history.

This I know is a very unpopular opinion, but for my specific case, I've got plenty of medical record that may be considered "shameful"? Got several colonoscopies, endoscopies, I lost a finger, I had a LIS (anal operation) , etc, etc, etc haha. Yet, I kind of don't really care if people knew about it.

Maybe I have never truly suffered discrimination (I'm what we call "whitexican" here in Mexico, so I'm privileged. And that's why I think like this.

[wkat4242]

In countries where healthcare can exclude preexisting conditions this can be a major problem.

And it's not just about shame. It's just about it being nobody's business. I'm not afraid of people knowing my history (though I imagine my mental health history may raise some eyebrows, I don't feel bad about it) but it's just none of anyone else's business and I would certainly be pissed if someone knew that I didn't confide in.

[mattclarkdotnet]

Australia checking in and agreeing, usually same day or even within a few hours for MRI, x-ray and ultrasound. Next day for CAT. Centralised records so each practitioner can see the full history.

Oh and blood tests done with max 30 minute wait and then results in 48h

[iteria]

Same and I'm American.

Although as an American, I always struggle with blanket statements because we have wildly different standards for literally everything depending on where you are. I live in a major city that isn't LA or NYC or something like that. all of my medical records are digitized too. All my doctors can look at everything an urgent care, hospital, regular doctor did. But also my sister who lives in nowhere, USA has to deal with paper everything and long delays. The US is both 1st and 3rd world depending on what area you're talking about.

[faangguyindia]

MRI and CT scans done in India vs US will have vastly different quality.

Basically, for equal quality in india you'll always end up paying 2x-5x of what you'll pay in any developed nation.

This is the primary reason, if you are rich and want quality - you will overpay in india.

[gregjor]

I doubt this. I don’t have experience in India, but I have had lots of medical care in Thailand. Twice now Thai hospitals have found things that my US doctor and US imaging/diagnostic clinics missed. I can get MRI & CT immediately in Thailand, in the same places the doctor works. In the US I have to go to a separate clinic and wait weeks or even months. Cost in Thailand, at the most expensive private hospital (Bumrungrad) typically 1/5 or less US prices.

I also had great experience at public hospital in Taiwan, just walked in and asked for a test. Price was less than 10% for the same procedure in US, with no waiting.

And don’t even start on cost of prescription meds. Americans get scammed.

[gsa]

Electronic interop, in my experience talking to my GP (not US), is tricky not because of technical challenges but very strict privacy implications.

[renewiltord]

I wish I could pre-select an "I don't care. I'm informed and choose an open docs policy" box once after writing a 1 h exam and call it quits. My genome is on the Internet. I bet nothing bad will come of it by the time I die.

[HPsquared]

There's safety in numbers.

[xvector]

Classic example of government overregulation fucking over the regular citizen.

I go to two hospitals and am dealing with a medical condition and it's a total nightmare. Each hospital uses the same backend but I have to go through a lengthy and convoluted process to let them share information with each other after every single appointment.

I'm getting really sick of this affecting my treatment in the name of "privacy." I have a medical condition, for god's sake. Privacy is completely irrelevant if my doctors cannot even efficiently communicate to treat me.

Every week I curse whoever it was that thought this would be a great idea. I'm sure it sounded great in their heads, as regulations tend to do for most bureaucrats.

I am a security engineer btw, I have worked on privacy and security featuresets for products that billions of people use every day. I am 100% confident that it is doing more harm than good in the medical-information-sharing space.

[xtracto]

In Mexico my experience was this:

* 8am arrive to the emergency room in a private hospital

* 8:10am get seen by an internist doctor and after initial review, tell the doctor that I would like to get an MRI.

8.20 get a doctor prescribed mri ans take it to the radiology department

8:40 get the MRI

9:30 Get the results of the MRI, and pay for the whole thing: No more than $1500 USD. Without insurance .

10:00am take mri to doctor and get appropriate prescription.

That was an amazing experience. We have these incredible technologies that could be used to detect illness waaaay before . Like, allow everyone to have an MRI every 6 months. Regardless of illnes, after.say you are 30.

[HDThoreaun]

Plenty of urgent care places in the US will give you an mri if you walk in. It’s just expensive because labor here is crazy expensive compared to Mexico.

[tester89]

Can the median income Indian citizen get such service? Chances are no. This report is about the average case. Extremely rich Americans, just like extremely rich Indians can probably get faster service.

[rscho]

Electronic health records have dismal ergonomy, usually. They're profiled for billing performance instead of care performance.

[fnordpiglet]

This changed about 15 years ago. Prior to that you would often just go same visit to imaging or whatever.

[betaby]

> One thing that's surprised me about the US is the general slowness of most things.

... and there is Canada

[heraldgeezer]

But did you get to redeem?