While on vacation in Japan some years ago, my two-year-old daughter fell off a playground slide and cut her head badly. We took her to the local (large city) hospital, where they had to sedate her before stitching her up because she was hysterical. The hospital was very modern and efficient, with robotic trams traversing the ceilings carrying forms and check-in kiosks in the lobby. Everyone was as polite and kind to us as they could be (esp. considering the language barrier), and the doctor was very conscientious about leaving as small a scar as possible. They didn’t take our insurance, of course: we had to pay in cash, on the spot for services rendered. I got the impression, however, that was the norm (at least at that time). The clerk remarked to our interpreter that not many people had insurance. The bill was considerably less than it would have been in a US hospital: something like $600 for an operating room, anasthesia, and all that came with it.
I still have the hospital card, embossed with my daughter’s name, birthdate and other info, in Japanese. Most expensive souvenir we brought home.
I share your sentiment but I’ll probably be dead before (or if) it ever happens.
Spain normally doesn’t, you’re asked to get travel insurance when going outside the EU (travel packages normally include it), but I had a fellowship from my local government which included insurance covering the following:
- reimbursement of any non-elective expenses. The policy stated that you should try to look for a relatively cheap option pretty please; if you went to the Mayo Clinic for a flu shot they reserved the right to give you hell about it and pay less than you had (the policy also indicated how this payment would be calculated).
- transportation back home in case of a long-term (over 30 days) condition which would not allow me to continue studying while it was treated,
- repatriation of cadaver.
I still had to take insurance locally, as the university did not accept that policy because it didn’t include a list of conditions covered, copays/no copays, etc. I simply had no idea where to get all the legislation and protocols defining what is considered elective under Spanish laws, plus they requred official translations and that would have cost more than the American insurance. The copays from my American insurance were covered by my Spanish one.
It was mostly said that not many visitors have insurance. The vast majority of Japanese are part of the national heath system.
For routine matters, Japanese health care if fine, and inexpensive, especially when compared to the States.
There is much less wait time to get appointments here than what my mother has in the States, even with her full coverage insurance policy.
Almost all medical care for infants and small children is completely covered, so that’s nice.
Counseling is not covered, it’s all out of pocket.
Some areas are behind the States. I’ve got a friend who has a son with autism, and the level of diagnosis and care is much behind the States. Likewise for another friend whose little boy has cerebral palsy.
Other areas seem OK. My mother was an NIC nurse and was impressed with the medical team which treated Pough-chan, and said the team was a good an any she had seen in the States.
In addition to the US, my family and I have received medical care in the Federated States of Micronesia, Indonesia, South Africa, Egypt, and Singapore. (As a literal matter, we have also received medical care in Mozambique, but the care we received was not representative of what ordinary citizens could get, as we relied on either a service provided by Sweden for aid workers, or a very expensive clinic that was too costly except for rich foreigners.)
Needless to say, with 6 countries to compare I could write for hours on this topic. Let me cut to the chase: Singaporean and South African medical care is world class.
Indonesia and Egypt are hit-or-miss, but if you are reasonably well off and are able to advocate for your own interests, you’ll be all right for routine care.
The facilities were limited but the quality of human resources in the FSM was excellent because the hospital was primarily staffed with US physicians working off their student loans, a la Indian reservation postings (I don’t know if this is still done or not; my experience was over 20 years ago).
In all countries, the accessibility of care was/is MUCH higher than we have experienced in the US. Evening and Saturday appointments, appointments with specialists, appointments with the doctor YOU choose, and appointments on short notice, are very easy to come by. Costs are of course much lower.
The care itself that my family and I have received in the US has been world class, but getting access to it has been nearly impossible. At one point the only reason we were able to secure appointments with a good pediatrician in the Boston area was because my husband worked with somebody extremely influential (you’d know his name if I said it) whose wife was in pediatrics, and she recommended us to her friend and fellow physician.
On the Big Island, which is where we now “live” in the US, only my son has a regular doctor, and the reason he was able to get into that doctor’s practice is because once he got sick and ended up in the hospital emergency room (for which we paid $800 out of pocket, no insurance coverage) - the hospital recommended him to a local physician for follow-up care, and our son has been followed by that physician for all his immunizations and check-ups every since.
I always say that the $800 we spent was not really for the emergency room care, it was buying a slot in the local health care system. I realize that Hawaii state law and the reality of island geography mean that our American experience is not entirely typical, but still, it makes me fear for anyone who needs health care in the US.
US - UK here.
In 1988 I had knee surgery in the US. It was probably about a month between the injury and the surgery, so pretty good. I was working for an insurance company at the time and one of the benefits was complete coverage and no paperwork hassles. The only thing I paid for was half the cost of having a custom knee brace made. The insurance covered everything else including about 6 weeks of physiotherapy. Total cost was over $15000.
I haven’t been under the knife in the UK but have been to the hospital a few times for ECGs and for seeing the cardiologist. An interesting thing is that a fair bit of the staff are army. It’s close to Aldershot (home of the British Army) so I guess it makes sense, but it was strange getting an ultrasound from a guy in camo.
Nobody’s mentioned dentistry yet.
In the US the dentist I had in Houston was very high tech but seemed very overstaffed. There was a dedicated receptionist, a tech that did x-rays, a hygienist, her assistant, the dentist, and his assistant. I think there may have been only 3 treatment rooms. You check in with the receptionist then wait. Go see the x-ray tech (there were always x-rays) then wait. Go see the floss nazis to get cleaned, then wait. The dentist would sweep in, poke around for a couple minutes. If you needed something filled then you make another appointment for the work. The whole process always took at least an hour.
My dentist in the UK is set up in an old converted 2 story house. Reception is on the ground floor, upstairs is a room for the dentist and one for the hygienist. The receptionist is also a tech who can run the big x-ray machine. The dentist pokes around and the assistant takes notes. If something like a simple filling needs done he does it then and there. My record for a checkup plus two fillings was 20 minutes.
I think it’s worth pointing out that, generally speaking, being treated in hospital by military personnel is about as common in the UK as it is in the US — ie not very, unless you happen to be a soldier yourself.
I’m English so I’m familiar with the NHS but I did need to see a doctor once on a trip to the States. Main difference:
NHS - First question “what seems to be the problem”
US clinic - “how will you be paying”
When you are used to free healthcare it comes as a bit of a shock that the clinic’s first concern is getting paid but once you accept that it’s a business it becomes understandable.
I’m a great fan of the NHS but also believe people should have the choice to go private if they have the means to do so. This seems to infuriate socialists who presumably can’t stand the thought of one person being better off than another. It makes perfect sense to me - everyone in the UK pays for the NHS through their taxes so if someone elects to go private they pay for it themselves and relieve the burden on the NHS at the same time.
I had my vasectomy done privately - you think I was going to let some overstressed, underpaid NHS intern just coming off an eighteen hour shift get busy down there with a scalpel? Not a fucking chance. 
A (fortunately) limited experience, but a decent comparison between US and Japanese care from the mid-90’s:
I spent a year teaching English in Japan, and during that time I got romantically involved with a native teacher at the same school. One Sunday morning I told her, “I hate to bother you, but my stomach is killing me. Can you set up a doctor’s appointment for tomorrow?”
Instead, my girlfriend drove me immediately to the local (small city) clinic, which was open and fully staffed. I waited all of ten minutes before seeing a doctor. While getting my vitals, the doctor asked me questions, which my girlfriend translated. I answered in broken Japanese, then succumbed to using my girlfriend as a translator as well. The doctor told my girlfriend I had a-koo-to ko-rai-ta-su and, when I asked what that meant in English, neither could figure out a better answer. There was a brief pause while I pondered the sound, then realized, “Oh! Acute Colitis! What causes that?”
The doctor couldn’t tell me exactly what caused it [there are, apparently, various causes and nobody is really sure but it’s related to IBS], but said I could get medicine to treat it. She wrote a prescription, my girlfriend took me and the note to the pharmacy, then five minutes later led me and the drugs to the car.
A week or two later, when my head was clearer, I asked my girlfriend how much I owed her for covering my clinic and drug payments. She said I shouldn’t worry about it but, when I insisted, finally told me there was never a charge. Since I was a foreign resident with a work visa, the national health care system covered me 100%.
Differences:
In San Diego (i.e. not small-town treatment), I was accustomed to a minimum half-hour wait in an emergency-room’s or even my own doctor’s waiting room. At the universities where I got help when I was a student, I waited even longer amongst packed waiting rooms.In Japan, there was a waiting room, but it was empty and I waited 5 minutes while they processed my green card (it really was a green plastic card).
In San Diego I never even thought about seeing a doctor on a weekend. The clinics near where I lived were either closed on weekends or charged extra for Sunday/Holiday visits. Up here in Ventura county, they even charge more at the clinics for night visits. (I’m sorry, I forgot to schedule my accident on a weekday; I should have known better than to repair my kitchen cabinets on the weekend.) My colitis visit occurred on a Sunday and was treated as it would have been on any other day.
American pharmacies, for whatever reason, require at least 20 minutes to fill a prescription. When all of my information is right there in the nationwide database that the pharmacy can access, why does it take so long? When I was an unknown foreigner getting a week’s worth of powder in a Japanese clinical pharmacy, why did it only take 5 minutes?
A bit of a weird subtle difference: Japanese medicine is typically powders in tiny envelopes or syrups in tiny vials or bottles and quite often it tastes horrible. At the time, I asked my girlfriend why Japan didn’t use capsules or pills and she said they just didn’t [I don’t think she knew, regardless of whether or not there’s a policy]. I asked one of my best English students, who was an abdominal surgeon in the big city nearby and he explained that medicine is typically prescribed according to the patient’s weight. Pills are easier to take and can keep the tongue from tasting the content, but powder or syrups can be more accurately pre-measured. Years later, when my mother was struggling with Thyroid problems, her US doctor had a hell of a time trying to balance her medicine dosage because in the US it only comes in a pill.
I don’t understand where the example comes from. So far, I haven’t seen any respondent complaining about interminable waits in any non-US medical facilities. Is this just a myth perpetuated by the entities opposed to universal health care?
The common complaint seems to be the prioritization of money over patient care.
—G?
It feels so good it ought to be illegal
I got my vaccination from a phonograph needle
. --Jon Bon Jovi (Bon Jovi)
. Blame it on the Love of Rock ‘n’ Roll
. Keep the Faith
Japanese pharmacies are great. I hobbled into a neighbourhood pharmacy while roaming around Tokyo with a sore back (and no Japanese) and they gave me some little adhesive pad things soaked in linament. And they were awesome, far better than pills IMHO. Can’t remember how much it cost me, (so it was obviously reasonable).
UK and Canada as well as the US. I don’t have much to add to other peoples’ experiences other than to say that I never experienced long waiting lists in either country (indeed, I wait far longer for care here).
The biggest difference to me that I haven’t seen yet is that if you need to see a primary physician, you go and see one. There’s no dance of “OK, this GP is under your insurance but has no new openings, this GP has openings but isn’t covered by your insurance, and this GP you can go to but his first appointment opening is in six months so do you want morning or evening six months from now?” There’s no endless fighting over “well, your insurance covers surgery on your elbow, but although the form we have here says you had surgery for ‘tennis elbow’ the doctor didn’t fill in the site of surgery, so we’re going to charge you until you inevitably appeal.” The bureaucracy was far less onerous, to put it mildly.
I have used health services in Georgia, Tunisia, Iran, Czech Rep, UAE, Yemen, Thailand, Australia, Cambodia and the US.
The only thing I noticed about the US is that it is vastly more expensive. The best quality hospitals I found were in Thailand, US and Yemen.
US medical care is of course very good. But it’s very expensive. ER waits can also be nightmarish–I’ve waited as long as 5 hours before getting treated in an ER before in the US. I don’t think I’ve ever waited more than 20-30 minutes to see a doctor in a foreign ER.
I tore ligaments in my ankle playing soccer while on study abroad in Germany in the early 90s and had my ankle surgically repaired. The surgeon did an excellent job, and the total cost (surgery, anesthesia, hospital stay, etc.) was a little over $1000, which was cheap even for back then. First-rate.
In Beirut, I tore my ACL and had that surgically repaired, also pretty cheaply (although I had insurance to cover it).
Specialist care here in Doha is not so great, though; we find ourselves seeing specialists in the States when we are there, rather than relying on the rather mediocre care available here.
My impression from watching my dad go through medical procedures is that in the US, there is a lot more reliance on expensive devices and technology, much of which may produce better results at the margins, but which certainly drives up costs.
It’s reassuring me to see people talking about long waits in the US - that’s pretty much the only complaint I have with the Calgary medical system (I can’t say the Canadian system, because I think Calgary is a particularly bad example at this point in time, thanks to a politician who thought a city of over a million people should only have three hospitals).
We travel to the US regularly, and we don’t set foot across the border without travelling health insurance. Anything else would be extremely foolish.
And on that basis it kind of makes me wonder how those that wish to argue the superiority of the US system really say things, with a straight face, like “in socialised systems, sure you don’t have to pay anything, but the care is rationed because there isn’t enough to go around. You could die before you get treatment, or have to go miles to have access to an xray machine, whereas in the US you’re always seen immediately and all the facilities are available”.
I’ve actually read that argument on here before.
Well, I’ll admit that if you live in any of the villages in my medical district (other than the one I live in), you do have to go miles for an X-ray.
10 miles tops, but hey…
I’ve had GP and hospital care in the US and UK and can honestly say that I’ve had excellent and awful care in both. Much of the variance had to do with the individual doctors involved so doesn’t pertain to a systemic comparison.
On a very anecdotal basis I’d rate the US hospital experience slightly better (with the caveat that I had very good insurance and still paid them a lot of money for the marginal improvement) but UK GP care much better. That said, the newer facilities in the UK are very good indeed; I had to take the child to the A&E recently for a head wound and the place was amazing (Royal London in Whitechapel, if you’re wondering). The next time I need emergency care I’m going to see if I can go to the Children’s A&E instead.
And I can’t stress enough the value of the pre- and post-natal support system in the UK. Free antenatal classes, a midwife coming to your house the day after you get home with the baby to make sure you and he/she/they are okay, followup visits by a health visitor, free baby clinics and helplines - it was a freaking godsend. Oh, and capped prescription costs (free for children and pregnant women) helped a lot too, especially as the child needed special milk-free formula for about six months.
On the whole, the NHS rocks. Quality of healthcare is good and while there are things that could be better and a percentage of underpaid, overworked and/or inexperienced doofuses in the system, that’s true of any healthcare system. I’m quite happy to pay the tax if this is what I get for it.
There are ways around our horrendous wait times, too - I can drive half an hour to the local emergency room and wait eight hours to be seen, or I can drive an hour and a half to a small town outside of Calgary and probably be seen immediately. The same applies to elective surgeries; universal health care means that there are any number of small hospitals that have surgical suites that are more available than the Calgary ones.
Of course everyone should keep in mind that a better experience under national health care systems isn’t a complete argument for those systems over theUS model. There are lots od other things to take into account. For one, the increased taxes necessary fornatiknal health care leads tohigher permanent unemployment through slower economic growth. So, when you were enjoying that national system, maybe think about the unemployed guy sitting around who’s paying theprice for it.
You’re right. I can’t think why Canada and New Zealand haven’t traced their economic collapse to just this phenomenon. But since this isn’t that kind of debate, I’ll refrain from showing how brilliant your argument is.
When I moved to Canada, I was shocked that you could just walk in and see the doctor whenever you needed to. I had Kaiser in the US, and their favourite thing to do was take blood. I had some blood taken here last week, and the facilities were a bit smaller and shabbier, but exactly the same as far as professionalism and cleanliness.
I haven’t had anything complicated done here, but my experience in the US was that they were very quick to test, especially with expensive machines. I had an ultrasound to diagnose a problem that could have been diagnosed by reading my case history and wikipedia (steatosis, or foie gras if you’re a goose).