USA Healthcare bill (question for those living outside the USA)

[mattgreenecomposer]

Goodness,
In case you've been living under a rock for six months, the USA is trying to do a major overhaul on our current healthcare system.  After looking at the bill, I've discovered half of it has nothing to do with healthcare at all.  I don't want to get into the people's opinions or the pro's or cons of the bill but I had a serious question for those living in Canada, and the UK:

We have a shortage of doctors and nurses already in the USA.  I'm wondering if anyone out there has had a serious illness and has had to get health care from their countries plan, what the wait was (or if there was any wait at all to get the treatment.)  By serious, I mean you needed a specialist. You had cancer, heart surgery, a disease for example.  I'm wondering what people's real life experiences were and wanted to cut through the media bull.
thanks
M

[alessandro]

I'm working in a private medical insurance company, in Belgium.

The 'healthcare system' is something really complex and a matter of probably 'endless' discussion.   Every system has its pros en contras.  To stay on topic, I don't know specifically for Canada (besides that it sounds like a wise place to live, beautiful too, modern etcetera...) in the UK (which 'invented' in some way (at least their own) healthcare system in the beginning of the 20th century, there is a waiting period for 'serious' operations (heart, prostheses (leg, hip, vertebre)...), patients often fly to the Netherlands and Belgium to get treated well an quickly.  But that's mainly the case in public healthcare.  There is a huge gap what concerns service and prizes between public and private healthcare.   I think - it is a sad thing to say - that it is the same thing all over the world, the more money you have, the better the treatment.

Now, what is also worthwile to think over (if one likes thinking once in a while) is what actually "health" means, or is supposed to mean these days.   It is such a complex matter.  Imagine all the money that circulates in pharmacy, the prices of doctor's fees, the population which grows older and bigger, the treatments that advance in quality but also in price (now I start to write without structure, sorry), you can these days get very good and immediate cure for cancer here in Belgium, but it is expensive.   I'll make a huge approximation, it is worth the price of a house, here in Belgium.   And then we have not spoken yet about the amount of 'preventive medicine' (in how far should that be backed with tax money), and all the implants that make life longer (pacemakers etcetera), that are sometimes implanted by cardiologists in nearly dead bodies.  And all the people that sell an organ (a kidney, a lung) for a bit of money in order to have a some living, oh my...  there's is so much to say.
It is wiser to focus (even as a government) on how to stay healthy than how to cure illnesses.   If everybody could grow and eat decent food, low fat, low sugar, a good walk every day and an good humoured, positive attitude in life, that is a small step for man and...
I wish everybody in this forum and everywhere a very good health !
Kindly

[rc]

My experience in Canada:  For minor things we can sit around waiting a while, and sometimes they will rush us through.  Stepped on a nail once when I was young, my mom got worried and took me down to check out that it wasn't infected.  Doc looks at it from across the room and says "come back if it hurts in a few days".  A few days later it's hurting, but I just limped it off for a few weeks until it went away.  Not serious (just a worrying mother )

BUT, when they thought my brain might be bleeding I got right in there for tests, no time wasted.  So I'm thinking that they're overworked and wind up having to prioritize...  Though sometimes they screw up - I read in the paper a few months back that some guy died after sitting in the waiting room for hours.

Healthcare is still somewhat controversial up here.  It's very expensive, and like many huge tax pools seems to get very top-heavy with layers of management and various paper pushers.  At least, that's the impression I've gotten.

I've heard that in Alberta they used to charge people $10 to go to the ER.  Not a lot of money, but enough to dissuade people from clogging it up for every cut and scrape.  Seems like a great idea, but the federal government put a stop to it for some reason.  (Healthcare used to be up to the provinces, but somewhere along the way the federal government cleverly comandeered it)

[richard black]

It's enormously variable here in the UK. Variable by disease type, your geographical location, all sorts of things. My wife had some annoying and worrying symptoms - they turned out to be symptoms of nothing much, but obviously before assuming that one wants to get a few tests done to eliminate all the nasty possible causes that one can all too easily imagine. She went to her local doctor's surgery (this is all on the National Health Service, i.e. free state healthcare) and saw various individual doctors on various individual occasions, describing pretty much the same symptoms to each one: about the 6th one she saw referred her as an urgent case for some scans that the others hadn't even considered, apparently. Other referrals took between 3 days and some months. Mind you, in the past the local hospital (a large and highly-regarded one) has looked after her very well with specific and obvious stuff.

But would the situation necessarily have been so much better with private healthcare? On the one hand, one might imagine that private doctors would take more care: on the other, they might send needless referrals and prescribe unnecessary medicines to keep their colleagues in business. Anyway, most private healthcare is paid for out of insurance, and the grade of insurance you have is at least as important as the particular doctor or hospital you visit.

Healthcare is controversial pretty much everywhere. Fact is, medical science can do so much stuff but a lot of it is astronomically expensive and where do you draw the line? And what happens when money isn't an object? Well, a very rich friend (now late friend, sadly) of mine recently went to India from the UK, after exhausting the best treatments that the UK, the USA and Switzerland could offer. Why? Because there was reckoned to be a doctor there who simply knew more than the ones here, fancy equipment or no fancy equipment.

[mattgreenecomposer]

Thanks everyone for the feed back.  I liked the comment about preventative medicine and the lifestyle you lead.  I have a friend form Vietnam and she said before she came to the USA she had not even heard of cancer.  That is just mind boggling to me.  But goes to show, diet and exercise is a huge part of it.

[rc]

Here's a spot where more people are giving their experiences:

https://www.cbc.ca/news/citizenbytes/2009/07/us_health_care_debate_canadian.html

[oxy60]

A question for the Belgian.

You mention public and private in your country. What does private actually mean? Can a Belgian just go to a medical/doctor/facility and pay cash? Are there such facilities doctors/hospitals/out-patient services available? In other words could one get a CAT scan or complicated blood analysis done on an "over the counter" basis for cash without being part of the system?

[alessandro]

A question for the Belgian.

You mention public and private in your country. What does private actually mean? Can a Belgian just go to a medical/doctor/facility and pay cash? Are there such facilities doctors/hospitals/out-patient services available? In other words could one get a CAT scan or complicated blood analysis done on an "over the counter" basis for cash without being part of the system?

First I want to thank for the interest that you have in this matter.  And to answer your last question ; Yes, one can get treatment and buy medicine and medical material without "being part of the system".  (Even people without "official papers" (i.e. homeless, refugees waiting to be 'regularised', etcetera come into consideration for medical treatment)...  In fact, right now, there's is even this group of benevolent people, nursing people, that look pro-actively for this "sans-papiers" in order to see if they are in any need of urgent medical help.   Also in hard winters for example, police working together with medical personal, pick up sick (dying) homeless people from the streets, at least, the one that are willing to get medical help because that is not always the case, there are a lot of people that want to be left alone.
So yes, there is a rather positive (though in my eyes a little to commercial) vibe in the health system here in Belgium.  I heard, and it wouldn't surprise me that it were true, that our medical (public) health system is the best in the world.   I heard it already from Americans, UK-citizens, Portugese, Korean, American...
Every working person in Belgium, and everybody that contributes through taxes taken directly by an employer from the salary and transferred into the "pot" what is called freely translated "Social Security" can get a great deal of his medical costs reimbursed by the 'State'.  I give two "commom" examples.  A visit to your local doctor costs approximately 25 euros of which you get 21 euros 50 cent reimbursed.  You pay cash to your doctor and can get the reimbursement already a week later.  (Little footnote, there is a organisation "Geneeskunde voor het volk" (freely translated "Medicine for the People") where you pay your consultation the way it suits you best.  You can give a little money, you can pay later and even if you don't have any money at that moment, the service is the same.)
Giving birth in the hospital can cost approximately 2000 euros of which you can get back approximately 70 % back.  One usually pays this bill (+/- the 550 euros (since the participation of the national 'social security' is directly dealt between hospital and public health and deducted from the total bill, so you only have to pay the difference) by bank transfer.
Of the approximately 11 million people that are living in Belgium, one can state that 95 procent of those people can claim this standard public service.  
For the remaining five procent, that are people that are just travelling here, diplomats, business-men and persons that do note have as their "main-residence" a place in Belgium, those people, well, you cannot know for sure how they are insured agains illness since they're not officially registered, but they often are fully privately insured.  They pay the total bill when they go to a doctor or to a hospital (which is the 25 euros and the 2000 euros in the examples mentioned above) and eventually try to claim it back at their private insurance.  I don't think that hospitals tend to accept cash as you put it "over-the-counter" but I think they rather prefer a payment by creditcard (thought it must technically be possible and tolerable to accept 'in the absolute' a payment in cash).
Public health insurance is very broad but does not offer always neither indefinite neither total coverage.   I you lose your teeth when you're old you have to pay as good as everything yourself at the dentist.   If you have for example a severe type of bloodcancer, the reimbursement will not be optimal if you only have coverage by this public health insurance.   That is why it can be useful to insure yourself also privately, (which costs approximately 60 euros a month for a coverage for hospitalisation, out-patient and dental costs for a 30 year old that contributes to the 'public health'-pot and it is approximately worth a 140 euros a month for the 30 year old that wants to be 'fully' insured without contributing to the 'public health' pot).
Let's state that public combined with a private insurance covers approximately 90 procent of the costs of 95 procent of the existing treatments.
Another nice illustrating fact is that for example since half a year, the total bill is reimbursed by the public health system for dental care for the less than 16 year old.
Kindly.
Patrick

[oxy60]

Thank you Patrick for your rather complete answer. The reason for the question is that several years ago there was a new treatment for macular degeneration. In Holland the waiting list was six months long to get that treatment. People went blind waiting and waiting. It turns out that there wern't enough qualified doctors. People who could afford it went to CH where the serum was made (with pigs blood from Holland) and got treated.

Does Belgium have a limit on the number of doctors in any speciality?

[alessandro]

The reason for the question is that several years ago there was a new treatment for macular degeneration. In Holland the waiting list was six months long to get that treatment. People went blind waiting and waiting. It turns out that there wern't enough qualified doctors. People who could afford it went to CH where the serum was made (with pigs blood from Holland) and got treated.

Does Belgium have a limit on the number of doctors in any speciality?

Degeneration and by extense (macular) degeneration is rather 'common'.  It is an example that is like many things in medicine mind-boggling.   It is I think something revolting that one has to live with 'general' degeneration, in fact even the fact of aging is on a cellular base and genetically regulated, there are cells identified that are active in this process of ageing, so one could say that ageing (degeneration) is also evolution and development.   Macular degeneration is a terrible thing, slowly losing the view must be a very frustrating process.  In general, there are a few forms of macular degeration that are indeed hard to treat, but in most cases there is some treatment that "restaures" to a certain level the view, for example, "one can read again" (which is for me one of the essentials in my life, I don't underestimate the fact that seeing shapes and colours can be most enjoyable, but I fear the eventual day that I will lose the capacity of reading.)  These often laser, retina and 'fluid' treatments can be done rather quickly in Belgium.
But you point out some extremely interesting, actual and one of the important future concerns in Medicine.   You don't use the word for it, but I think that you're implying "gen" treatments.  These are, if you look at if from a certain distance and as an 'amateur' like me, rather "new" in medicine.  I remember the big worldnews of the 'complete mapping of the human gen' as if it were yesterday.   I think that since the nineties, lots of scientist could focus their attention on looking for this type of gen-treatments in lots of areas of medecine.   And as you know, before a type of medication is officially admitted, it takes a tremendous lot of time, it sometimes (often ?) takes more time to get them 'legalized' and accepted for reimbursement in 'public health service' and other authorities, than the design, development and the testing together.   And Switzerland is from what I see the epicentre of development of really sophisticated and effective drugs and medication.   And that, dear OXY60, together with the fact that it takes for governments years to give a 'green' light to the latest newest medication, brings us back to the remark I made in my first reply 'the one that has the money is more likely to get the best treatment'.

Now an answer to your question, in short.

Here in Belgium, government and authorities try to regulate the numbers of doctors, not only in comparison to density of inhabitants per region, but also per discipline.
I heard of for example a lack of psychiatrists in Holland, in particalur 'youth' psychiatrists.   But this particular lack for instance has a strong link with politics and social organisation.  One could also state that this lack is mainly a concern to look for solutions for the phenomenon of an increasing number of youngsters that don't go to school, hang around and finally (could) become 'criminals' or a burden in the eye.  It could even be seen positively in the sense that it has probably no sense at all to put youngsters for a long time in jail.
Another parameter in neighbourn countrys is the 'emigration'.   Dutch doctors, psychiatrists, dentists etcetera earn more money than in Belgium.   So, a lot of doctors leave Belgium and start practicing in Holland.
But, a very strange thing is the 'maximum' of student-doctors that are allowed to... go from the first grade in University to the second ! Imagine, you study a year medicine, you're brilliant, feel good and than, for no reason at all except some kind of lottery, you're not allowed to continue ! That must really be horrible except for those who can see life as purely a hobby (which it probably is, but to some extend).
And finally, dear OXY60, one of the biggest challenges is probably the future lack of nurses and 'aids' in order to maintain a certain standard and comfort of life for the population growing much older, and not much births.

Kind greetings.  

[oxy60]

Once again a wonderful answer. It is important that all of our US members read these posts carefully and consider the implications of inplimenting such a system in the US. Belgium and Holland have excellent systems even with the hiccups that have been illustrated by these posts. There are of course horror stories to balance the heroic efforts in both countries. But we also have plenty of illustrations of our own.

Now let's from our other US members..

[ted]

By and large, we have found that the New Zealand public system is very good indeed for really serious things. My wife, for instance had a gangrenous appendix and prior to that a benign but dangerous tumour on her spine. Both were treated in exemplary fashion in the public system. Years ago, I had to get my mother into hospital with heart attacks and my father with septicaemia. I cannot fault the public system personally and it is completely free to citizens.

Where the situation gets complicated here is with non-critical but perhaps painful or very uncomfortable things - hernias, knee and hip replacements, hundreds of other complaints which are not normally fatal but can make life a trial. The free public system is very slow for these things and even with elective surgery using health insurance you end up paying quite a bit.

Our accident compensation system is excellent. All treatment of accidental injury is free regardless of circumstance or liability. In addition to knowing you will be treated, the nature of the law makes the frequent lawsuits seen in other countries pointless. That's pretty good.

Of course mistakes do happen, and a few of them will be serious, but mostly I am still very glad I live where I do.