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Old 04-30-2020, 02:30 PM
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Is the US health system really this bad?


From here:

'At a time when medical professionals are putting their lives at risk, tens of thousands of doctors in the United States are taking large pay cuts.
And even as some parts of the US are talking of desperate shortages in nursing staff, elsewhere in the country many nurses are being told to stay at home without pay.
That is because American healthcare companies are looking to cut costs as they struggle to generate revenue during the coronavirus crisis.'

(Bolding mine)

With Universal Health Care, people's health comes first.
Apparently with the US system, it's just about the money.
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Old 04-30-2020, 02:39 PM
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Why do you hate Freedom?




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Old 04-30-2020, 02:44 PM
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Reading only the thread title, I'm guessing yes. Yes, it probably is.
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Old 04-30-2020, 02:47 PM
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40 years of voodoo economics...
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Old 04-30-2020, 02:50 PM
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You're missing most of the story. 1) Non-necessary medical treatments are being postponed by order of the governments. and 2) Many people, even if they have some sort of medical necessity, are not going to hospitals out of fear of catching COVID-19 there. So there's not enough work for nursing staff. Just like restaurant employees have been terminated, unneeded nursing staff are being terminated.

It's not about people's health coming first or not. There's just not enough demand for the services these nurses perform.
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Old 04-30-2020, 02:50 PM
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Hospitals in the US are heavily supported by elective surgery. So yes, it is all about that money.
With less elective surgery, a lot of nurses have little to no work. (on preview, see above)

It might take decades to achieve real UHC in the USA. We have a sizable population against it and many embedded interests, especially our giant insurance industry with legions of lobbyist with loads of money to spread around.

My sister is caught in a horrible gray area, she's averaged 2 days a week work so losing 3/5th of her pay but isn't eligible for unemployment. She's an Endo Nurse.

Last edited by What Exit?; 04-30-2020 at 02:53 PM.
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Old 04-30-2020, 02:51 PM
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Some hospitals have cancelled or postponed elective surgeries and procedures, so the only inpatients are ones with COVID-19 or those whose surgeries or procedures could not be cancelled. As a result, these hospitals are emptier than they would be in normal times. So some staff, like the surgical scrub nurses, surgeons, physical therapists, radiology technicians, etc have been sent home.
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Old 04-30-2020, 02:57 PM
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The U.S healthcare system is terrible for many reasons, but I'm not really sure of the relevance of what you're citing to UHC vs the US system.

Right now for obvious reasons nobody wants to go near a hospital unless they are dying. So in places that don't have many cases of the virus to deal with, hospitals and medical staff have nothing to do, just as many people have nothing to do with the lockdown and social distancing. This has nothing to do with it being "just about the money" or denying people medical care. Nobody wants medical care right now unless they absolutely need it.

There are questions about whether furloughed staff should still be paid by large corporations who can afford it, but that applies to all large corporations, not just those in healthcare.

Last edited by Riemann; 04-30-2020 at 02:59 PM.
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Old 04-30-2020, 03:16 PM
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I agree with Riemann; much of this is not unique to America's admittedly fucked up healthcare system. I assume other countries have cancelled or postponed elective procedures, so that their scrub nurses and such were sent home. (In theory, you can retrain scrub nurses as floor nurses, but that would take a while.)
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Old 04-30-2020, 03:19 PM
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Originally Posted by Llama Llogophile View Post
Reading only the thread title, I'm guessing yes. Yes, it probably is.
You're wrong. It's much worse.
  #11  
Old 04-30-2020, 05:16 PM
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I agree with Riemann; much of this is not unique to America's admittedly fucked up healthcare system. I assume other countries have cancelled or postponed elective procedures, so that their scrub nurses and such were sent home. (In theory, you can retrain scrub nurses as floor nurses, but that would take a while.)
Never actually worked in a hospital setting, but isn't floor nurse closer to an entry-level position than scrub nurse? Or are they both entry level (or higher-than-entry-level tier, but on different tracks)?
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Old 04-30-2020, 05:24 PM
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I'm not qualified to answer that but I'm sure others here are. My sense is that they are different specialties within nursing, not necessarily that one is a higher-level position.
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Old 04-30-2020, 05:29 PM
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I'm not qualified to answer that but I'm sure others here are. My sense is that they are different specialties within nursing, not necessarily that one is a higher-level position.
I suppose that's possible, but don't nursing school graduates complete roughly the same curriculum, and have their specialized training after they get placed?
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Old 04-30-2020, 05:31 PM
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So what do you think is happening in UHC countries? Here in the Netherlands the insurance companies are paying the hospitals in advance for elective surgery that will now happen later in the year... this is the whole point of UHC systems, they are based on cooperation rather than competition (both between care provider and insurance company and insurance company and client.

I've not heard about any hospital personel being fired. There are issues with some health care providers (dentists, physios) having liquidity issues, but they get government support.

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Last edited by polar bear; 04-30-2020 at 05:32 PM.
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Old 04-30-2020, 05:44 PM
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So wouldn't the hospitals in the Netherlands have the same problem? The money they are getting now for surgeries later could be used to pay salaries today to the scrub nurses and others associated with the surgical departments even though the surgeries aren't happening. But then later in the year, when the surgeries do happen, the hospital won't be getting any money because they were already paid. So there's still a gap.
  #16  
Old 04-30-2020, 05:52 PM
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My sister is caught in a horrible gray area, she's averaged 2 days a week work so losing 3/5th of her pay but isn't eligible for unemployment. She's an Endo Nurse.
My BFF's sister is in the same situation. They've cancelled non-emergency scopes, so they've gone from averaging 30 procedures daily to maybe 5 or 6, so she has volunteered to work in the nearby hospital if needed. Fortunately for them, their kids are grown and her husband makes adequate money to support them, but it's just a big unexpected shock that nobody had planned for.
  #17  
Old 04-30-2020, 06:07 PM
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Why are elective surgeries being cancelled when there are available resources?

Is it simply to keep patients out of facilities that have COVID patients? Can they not just make sure these procedures are done in separate facilities?

Or do elective surgeries share some scarce resource with ICU patients?

Or is there some risk management that says for every X number of elective surgeries, there must be Y spare capacity of ICU in case it goes wrong?
  #18  
Old 04-30-2020, 06:45 PM
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Hospitals in the US are heavily supported by elective surgery. So yes, it is all about that money.
With less elective surgery, a lot of nurses have little to no work. (on preview, see above)
My brother is a visiting nurse. A lot of his cases are providing follow-up care changing dressings for people who have gone home after surgery. He says he has many fewer cases because a lot of surgeries have been postponed. I'm not sure how that affects his income.

Ironically, he was supposed to have a hip replacement in June that he thinks will be postponed.
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Old 04-30-2020, 07:04 PM
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Why are elective surgeries being cancelled when there are available resources?

Is it simply to keep patients out of facilities that have COVID patients? Can they not just make sure these procedures are done in separate facilities?

Or do elective surgeries share some scarce resource with ICU patients?

Or is there some risk management that says for every X number of elective surgeries, there must be Y spare capacity of ICU in case it goes wrong?
There's lots of reasons, any of which are going to apply to different hospitals to different degrees:
1) stay at home orders are real, and the hospitals shouldn't be the ones breaking them
2) if you're bringing in patients for elective surgeries, then you've got waiting rooms full of people, staff to check them in, staff for the surgeries, etc - any of these people could be asymptomatic carriers spreading disease to any/all of the others
3) your own staff are both the ones at highest risk (contact with the most patients) and the ones who present the highest risk to the public if they are carriers. As a medical professional, you definitely don't want to be the cause of the next hotspot
4) you're diverting PPE, sedatives, surgical supplies, etc from where they are most urgently needed
5) yes, you want to keep medical pros in reserve as spare capacity, because you don't know when the next wave will hit or a bunch of hospital staff will get exposed and need to self-quarantine. You definitely don't want all of the elective surgery staff in self quarantine because some idiot who wanted a mole removed didn't mention that he was coughing and running a fever.
6) even well-managed elective surgery has a complication rate, and so you need to do follow-up and sometimes admit patients. You can't just stop treatment because the ER suddenly got slammed, and you don't want to be admitting your basically healthy patients with minor complications into a contagion zone.
7) your patient population is probably also wary of coming in to a hospital. There's lots and lots of cases of people coming for childbirth, for headaches, for whatever, who turned out several days later to also be COVID positive. There isn't really a "safe" side of the hospital, and even if you're in the supposedly safe area, you need to park in the same parking lots, touch the same door handles, and ride the same elevators as the people who have a contagious disease.

I'm one of the people impatiently awaiting an "elective" procedure - one which is technically optional but badly needed for long term health and quality of life. I'm 100% willing to wait until the risks involved in going into surgery are lower than the risks involved in waiting.
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Old 04-30-2020, 07:12 PM
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never mind, thoroughly answered above.

Damn shame we have idle hands that can't be used, but I get it.

Last edited by HMS Irruncible; 04-30-2020 at 07:16 PM.
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Old 04-30-2020, 07:44 PM
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My uncle just had a surgery that the doctors deemed shouldn't wait. He had to have a coronavirus test a couple of days before the surgery (it came back negative). Presumably, if it had been positive, they'd have re-evaluated how urgent it was. But if you test everyone before they go into the hospital, I'm not sure what the problem would be. I guess they still just don't have enough tests?
  #22  
Old 04-30-2020, 11:19 PM
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Originally Posted by HMS Irruncible View Post
Why are elective surgeries being cancelled when there are available resources?

Is it simply to keep patients out of facilities that have COVID patients? Can they not just make sure these procedures are done in separate facilities?

Or do elective surgeries share some scarce resource with ICU patients?

Or is there some risk management that says for every X number of elective surgeries, there must be Y spare capacity of ICU in case it goes wrong?
Pretty much all of the above. Your second paragraph is the biggest concern.
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Old 05-01-2020, 03:23 AM
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It seems to me that many posters are ignoring the bolded line of glee's post. I'll highlight specifically the words that are being ignored:

Quote:
That is because American healthcare companies are looking to cut costs as they struggle to generate revenue during the coronavirus crisis.
That's not about people not having a job due to no elective surgeries. The quote specifically says that they're cutting doctors because they can't make enough money. So, if this is happening in UHC countries, that means that they are also losing funding from COVID-19. But seeing as they don't get paid from the people, why would they be losing money? Why would the national allotment for services go down?

It seems unlikely to me that the bolded section, clearly the focus of the post since it was in bold, is going on in countries with UHC, unless you guys are so bad that your government is running out of money and can't increase its deficit to cover it.
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Old 05-01-2020, 03:31 AM
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So wouldn't the hospitals in the Netherlands have the same problem? The money they are getting now for surgeries later could be used to pay salaries today to the scrub nurses and others associated with the surgical departments even though the surgeries aren't happening. But then later in the year, when the surgeries do happen, the hospital won't be getting any money because they were already paid. So there's still a gap.
I guess the idea is that most postponed procedures will be done in addition to the ones you would normally expect. So in total it wouldn't be much lower than in a normal year...of course hospitals get money for covid cases as well.

Money just hasn't been much of an issue, as far as I can tell from watching the news. And pretty much every industry that is suffering has been all over the news, so if hospitals were in the same boat...I think I would have heard.

A lack of ICU beds was, but it turns out we managed. Lack of protective materials is still an issue. Former ICU nurses returning to help out was happening, weeks ago we were told to please see our GP if you don't feel well... cardiologists and neurologists saw a big drop in consultations and were afraid of the consequences.



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Old 05-01-2020, 06:28 AM
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Actually, yes, there are a few ways it can be different in UHC.

A lot of staff in the UK NHS are absolutely being cross-trained to work with COVID patients. A friend of mine spent a few weeks, as it was becoming obvious how serious this was going to get, training surgical staff, who were called off elective surgery, on some of the procedures that were likely to be needed if her normal specialist team gets overwhelmed. Sure, they're not going to be immediate experts, but a few weeks of training in one or two specific procedures is enough to be at least competent at those, given the background they already have. Also not everything involved in patient care is specialised, some of it just involves an understanding of good hygiene practice. She did say most of the surgeons were kinda being arseholes about it, because they don't like not being the boss of the room, but still... She did mention that one of their most experienced surgeons requested a badge without his job title on it, because he didn't want people to assume he was the expert in the room rather than the qualified nurses, while he was basically going to be acting as a nursing assistant.

Staff are also being loaned from my local area - which currently has a low number of cases - to places with a nursing shortage and lots of patients. The fact that the whole payment system is different, with central funding and staff on salary, rather than paid by procedure, also means that staff and aren't being sent home without pay and can just be moved between departments- or even between regions- without many problems. There is just a general principle of cooperation here.

I'm not going to pretend the way the government has been handling the situation here is perfect, very far from it, and the PPE shortages do appear to have been worsened by politicians playing politics rather than making decisions on medical grounds, but the flexibility within the NHS is pretty damn good.
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Old 05-01-2020, 07:13 AM
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It's a YMMV type of thing. My daughter (nurse in maternity-delivery) and her fiancé (MD) work in the same hospital and are swamped with work. They are working 12 hour shifts and making excellent money. They're closing on a home purchase they had previously planned to wait a few years on. It's just a question of how long they can handle working long shifts before their patients suffer.
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Old 05-01-2020, 08:55 AM
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I'm going to duck for cover after making this comment, but...

...there's a part of me that the whole fucking thing would just collapse so we could start over, so that people would be so outraged that they would demand something better that services the collective need. Yes, the healthcare system is run by corporate scam artists, but we put up with it because of this "I've got mine, so I don't give a shit about you" attitude among so many people in this country. Take a fair chunk of union members, for example, which is ironic when you hear them complain about low wages and workplace safety and expect everyone else to join their chorus.

The privately-run health system is best at doing one thing in particular: reinforcing inequality in our society, and providing inequities in health care. Beyond that, it's pretty much average in terms of the results, average in terms of innovation, and downright shitty when you start looking at it in terms of real value. No country on earth pays so much for mixed results.

So yeah, burn the whole thing down. Let's feel the pain together, and let's collectively demand something better that provides equal access to people.
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Old 05-01-2020, 10:11 AM
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That's not about people not having a job due to no elective surgeries. The quote specifically says that they're cutting doctors because they can't make enough money. So, if this is happening in UHC countries, that means that they are also losing funding from COVID-19. But seeing as they don't get paid from the people, why would they be losing money? Why would the national allotment for services go down?

It seems unlikely to me that the bolded section, clearly the focus of the post since it was in bold, is going on in countries with UHC, unless you guys are so bad that your government is running out of money and can't increase its deficit to cover it.
The thing is that UHC isn't just one thing- it's not always that every doctor/healthcare provider is a government employee and every hospital is run by the government or even that doctors are funded a certain amount per person enrolled as a patient and hospitals are funded to serve a given catchment area. There are absolutely UHC systems where doctors are in private practice that function in many ways like the US system , with the main difference being that all residents have "insurance" in which all doctors participate * - but it's still fee-for-service , so the doctor still has to see enough patients to bring in enough revenue to pay the rent and the staff. Seeing fewer patients means bringing in less revenue even though everyone has coverage and there aren't insurance companies involved.





*from the patient side , you don't have any issues of being unable to afford medical care or being unable to find a doctor who participates in your network
*
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Old 05-01-2020, 11:13 AM
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In Norway at least Covid will have thrown a wrench into the hospital funding system. It is all public money, but it's funneled to hospitals based on procedures performed, so a Norwegian hospital would have similar revenue stream issues in a lockdown.

It would have completely different solutions to those issues though. They are government owned and can run deficits and borrow money in a way a private entity cannot.

And of course our whole labor system is different, so that even for private health service companies, of which there are many, and that the health care system relies on for a lot of tests, lab work and outpatient procedures, you could furlough or fire your employees, without it being as much of a hit to them as in the US (furloughing would smart for your company though).
  #30  
Old 05-01-2020, 11:46 AM
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Look, the ONLY purpose of a for-profit company is to make money. No other. In fact, if it is publicly held, it could be considered malfeasance to behave any other way.

So the real question is: Do we want a healthcare system in the United States that is for-profit? Answer that and your questions will be answered.
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Old 05-01-2020, 12:07 PM
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Note that only a minority of the hospitals in the United States are owned by for-profit companies. More than half are owned by not-for-profit organizations (although some owner groups are truly massive) and a bunch more are government-owned. See here for numbers.
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Old 05-01-2020, 01:28 PM
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Look, the ONLY purpose of a for-profit company is to make money. No other. In fact, if it is publicly held, it could be considered malfeasance to behave any other way.
I agree, but it could be run with a long term view as opposed to next Q's earnings. Sort of the possibly apocryphal Henry Ford story about paying his workers enough to be able to afford his cars.

Not exactly sure how that works for a hospital, but perhaps giving up some short term profit to build good will? Because at some level, it is good for a hospital's revenue stream to encourage people to be sick - this is of course not ideal for society as a whole.
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Old 05-01-2020, 02:00 PM
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The Netherlands is one of the countries with both UHC and insurance companies that charge premiums and pay health care providers (well regulated of course).

I just saw the latest news about the insurance companies having aproved a support package for small health care providers worth several bilion euro's. Exactly for what we are talking about here: care providers that cannot provide care because of corona restrictions. This is to allow these companies to pay salaries and other bills while they wait before they can start up again.

No system is perfect, and ours certainly isn't, but it is possible to have a system where the actors have a more cooperative attitude... even when they are all for profit companies.



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Old 05-03-2020, 11:48 AM
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I agree with Riemann; much of this is not unique to America's admittedly fucked up healthcare system. I assume other countries have cancelled or postponed elective procedures, so that their scrub nurses and such were sent home. (In theory, you can retrain scrub nurses as floor nurses, but that would take a while.)
Most countries don't have as many types and levels of nurses as the US do. The idea of having a "scrub nurse" vs a "floor nurse", for example... nope.
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Old 05-03-2020, 11:58 AM
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Most countries don't have as many types and levels of nurses as the US do. The idea of having a "scrub nurse" vs a "floor nurse", for example... nope.
I'm not sure what you mean by this - do you mean that in most countries a nurse might be assisting in surgery on Tuesday, working on an inpatient floor on Wednesday and working in the ER on Thursday or do you mean something else?
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Old 05-03-2020, 01:32 PM
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So, if this is happening in UHC countries, that means that they are also losing funding from COVID-19. But seeing as they don't get paid from the people, why would they be losing money? Why would the national allotment for services go down?
Some UHC countries nationalize health care providers. Many don't. They get paid for services provided to patients. Getting a check from the government to pay is not different for their bottom line than getting one from an insurance company. Many UHC systems are not even single payer. Whether they offer tiered services or allowing supplemental insurance to cover things like deductibles and copays, providers do not get all of their funding from the government. In many UHC countries private providers still get paid for service by some combination of the government, insurance companies, and the patient.

Single payer with nationalized health care providers is more the exception than the rule in countries with UHC systems. That model is simply not a universal part of what we call UHC. You seem to be assuming that it is.

Last edited by DinoR; 05-03-2020 at 01:35 PM.
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