Let’s say that I took advantage of one of those offers in my inbox, and got a degree in Doctorology. (Or even, I completed a accredited medical program in Britain (or any European nation with socialized healthcare), could I ‘opt out’ of the system and just setup a private practice? Or are all practicing medical doctors compelled to be part of the system?
Obviously this could vary from country to country. Pretty well everywhere, I imagine, you will need to be licensed to practice medicine – i.e. have a qualification from a recognised medical school, or go through some procedure to have your qualification from an unrecognised school (e.g. one in another country) assessed and accepted, and then put your name on a register and keep it there.
After that, the system will vary from country to country. If you want to work in a hospital, you’ll need to get a hospital appointment. Some hospitals are state-run; others are not. Most countries will have a mix of the two. Either way, you’ll be paid a salary by the hospital. The terms of yoru appointment may or may not allow you to accept patients privately in your own time, and charge them fees. This is true regardless of whether you are appointed to a public or a private hospital.
If you work in a private hospital, you may still find yourself treating public patients. The public health authorities may well buy services from privately owned and operated hospitals.
If you want to work in your own GP practice, the system in any country with which I am familiar is that GPs are self-employed; they are not employed by the state. The state may pay the fees of the patients, or the fees of some of the patients, or some of the fees of some or all of the patients . . . you get the picture. By and large, however, the state buys GP services for some or all of the population; it doesn’t directly provide them itself. Typically there will be negotiations between the state and the medical representative organisations about the level of fees to be paid. Fees may be on a per service basis (fee for every consultation) or on a per capita basis (fee for having a patient on your books and being available to him) or some combination of the two.
GPs are free to accept patients who are paying their own fees; why not? Equally they are free (within the constraints of professional ethics, of course) to decline patients whose fees are paid by the state. From time to time they threaten to do so, usually as part of the bargaining process mentioned above. In practice most GPs could not survive without the income from treating public patients.
In some places there may also be a network of GP clinics where the doctors are employed and paid by the state, no fees are paid by or in respect of the patients, and the doctors are not free to accept patients privately (or their commitment to the clinic means that they have no time to do this). I don’t think that any Western European country depends primarily on such a network of clinics.
Does that answer your question?
Certainly does. Thanks!
I assume the conditions would widely from one country to another. Here in France (assuming that you’re licensed to practice medecine in France):
You can perfectly set up a private practice. Actually, outside of public hospitals and some public health organizations, all doctors in France are private practitionners. Then, you would have to choose between being “conventionné”, which mean that you’ll have to charge your patients an amount fixed by the social security, and would get some benefits (tax breaks, I believe), or not being “conventionné” and charge whatever you want (then you won’t get the benefits, and your patients won’t be reimbursed by the social security for the part above the fixed prices). Actually, this is innacurate, because I know there’s a third category in-between, but I can’t remember the specifics.
Most specialists will charge more than the fixed amounts (sometimes by a very wide margin, especially when they’re well known) , while most GP tend to follow them.
Now, I don’t think you could really “opt out” of the system, which would mean, I suppose, refusing to handle your patients the documents necessary for them to be reimbursed for their medical expenses. But I believe that it wasn’t what you meant, but rather believed that you had to “opt out” in order to set up a private practice.
There are also private hospitals throughout Europe.