Hmmm… I think this may turn out to be Donald’s secret replacement plan for the ACA. Of course, it won’t be black magic. I’m thinkin’ orange magic.
Carry on.
I had a suspected pituitary tumour in October 2015. My endocrinologist put in a request for an MRI a Sunnybrook in Toronto and I was given an appointment for May 2016. I ended up calling http://southtownsradiology.com in Buffalo and had an MRI 3 days later for $600.
I was back at my endocrinologist 10 days later starting treatment.
Not a first world nation, as far as I know. Nations have reformed their systems and even moved between Beveridge, Bismarck and NI types.
A few have tried to move dental services onto the free market. Dental is a bit on the border between medically necessary and cosmetic in many cases. Health care economists warned that this would lead to soaring prices and people being priced out of many services. What actually happened was soaring prices and people being priced out of many services.
The NHS was set up originally as a two tier system because consultants refused to become state employees and wanted to maintain their lucrative private practices. This is pretty much the same today - many (not all) consultants spend part of the week working for the NHS and the rest private.
We have seen the result above, of a totally NHS system in Canada, where the health service loses potential income to it’s neighbour and probably some of the brightest and best consultants too. The UK system is flawed in may ways but it works. Yes, you may have to wait weeks or months for a replacement hip, or an MRI scan, but you will get one and you won’t get a bill. If you don’t want to wait, you can pay and many do. If you are canny, you shop around and find a doctor in Germany who does cataracts for 500 Euros an eye, or a hospital in Spain that will do a replacement hip for half the price a UK hospital will charge.
The news here has been full of stories about 12 hour waits in A&E and the Red Cross said the NHS was "facing a humanitarian crisis" which is arrant nonsense. It’s no coincidence that we are coming up to budget time and everyone wants a bigger pie, or a bigger slice or even better - both.
How does this compare with other contries - USA Canada and Australia?
I am not sure how the Canadian system loses potential income to its neighbour? I can see it losing staff to the much higher salaries in the US, and I know there is a massive net flow of patients from the south across the border to Canada, but income?
As far as I know, there are NHS dentists, and private ones in the UK. The charges you’ve listed are charges from dentists on a Beveridge-type health service. It’d be interesting to see if there are public prices posted for private dentists to compare with.
Ireland has a public/private hybrid. A lot of the time it’s the same doctors involved; you just get to see them faster if you go private. For some things - children’s hospital care, for example - there’s no private option available. I wouldn’t say it works, exactly, but that’s because the public system is weighed down by a truly staggering level of stupidity and incompetence and bureaucracy, so waiting times and overcrowding are beyond shameful. It could work perfectly well, if the people in charge put their minds to it.
There was some talk recently about moving from universal health care to universal insurance, which would have been a clear step towards privatisation, but public opinion was so furiously against it that the (very right-wing, by our standards) government has shut up about it for now.
Wimps. Here we do 72-hour waits.
Not in the Netherlands.
The system did/does get too expensive. Our currently let-the-market-solve-it government has just told all involved to make do with lesser government money. Up until recently, that meant tinkering around with increasingly complex financing systems that were supposed to incentivice cost savings, but that actually made everything more complex and in more need of consultants and systems managers.
One particular, more visible measure, was to increase the self-pay. Everybody had to pay the first 500 dollars of medical costs themselves. This self-pay was the same 500 dollars for everyone, so, for wealthy people it was a pittance and for poor people it was an enormous hurdle that made them avoid medical care, and plunged them into a spiral of debt if they did.
A recent home care developement is Buurtzorg. A real flat, no-management, system of local organizations. it is a ravind success and I predict it will have caused a silent and much needed healthcare revolution in the Netherlands in a decade or so. Googling it, I found the Netherlands is currently exporting the model to the USA. http://www.buurtzorgusa.org/
The World Health Organization (WHO) has France as the #1 health care system in the world. It costs France 11.6% of their GDP (compared to Canada’s 10.9% and #30 ranking according to the WHO). France’s health care systems is <drum roll> government national health insurance.
Italy is #2 and they have a hybrid model.
Spain (#7) is a public system.
Austria (#9) is two-tier.
Japan (#11) is a bit different, but more like a public system than not.
And so on.
I would suggest that the problem with Canada’s healthcare system is not that it is a public system, but something else. What is that something else? I have a perspective, but maybe that would make for a good thread in Great Debates perhaps than continuing the derailment here.
I think my answer to that question was expressed with a great deal of clarity in my concise post.
Interesting, but French doctors will not be heading off to the US for higher pay, as Canadian doctors regularly do. That said, it seems to me that only a little bit of extra money in the system (higher taxes of course) would help a lot. I had an anomalously high PSA about 12 years ago. I could wait for a biopsy at the hospital for weeks or pay $175 at a private clinic. I chose the latter. But the odd thing was that I then had to take the sample myself to the local hospital where it was analyzed immediately (it was benign). I don’t understand this at all. Some say that the private clinics relieve the public system. But they also take doctors and other medical personnel out of the public system. And they were all educated mostly at government expense.
One other thing is that there are doctors driving taxis in Montreal because they are refugees from Syria and elsewhere and not allowed to practice until they have done a Canadian residency, but the numbers permitted to do a residency is tiny. That is the result of lobbying by the Quebec college of physicians and surgeons (of which the premier is one).
Public-ish, lately.
Everybody pays into the national insurance, but there are public suppliers, private-only suppliers and chartered suppliers. Work-related medical services (job-related checkups, control of work injuries) have to be provided by private firms. There is also some vendors of private insurance, both insurance companies offering their own chartered network, and private centers offering a service which is only good in their own center. My own analysis of those insurances is that in the immense majority of cases they make no sense*, but some people think that “since it’s private it’s going to be better” and this particular brand of insurance is growing.
We’ve had several cases of private insurers or providers sending people to the public system and then billing both the client and the public system.
- both the insurance and the public centers are likely to send you to the public hospital if you need something that the public system will cover. And guess how quickly and how well you’ll be treated: either as well as anybody else, or worse, because public-system doctors tend to get pissy if they figure out you’re there to get an expensive covered procedure for free and will later be paying through the nose to someone else to do the much-cheaper rest of the work.
Canada’s UHC system does not cover dental. I know that some provinces have limited coverage for children and possibly people collecting welfare, but I certainly pay the full price for my family. Dental coverage is a fairly standard benefit for employees, usually capped at $1500 or so per family per year.
I must admit to curiosity about this phrase. What is ethical (or unethical for that matter) about getting a bargain price?
should say …and the private centers…
Thanks for the correction Nava.
Dentists in primary care are all self-employed contractors with the NHS (i.e., they may take patients under the NHS contract and also be available at private rates, and dentists and patients may agree to “mix and match” public and private). The NHS contract is based on a blend of capitation fee per patient registered with the dentist and payment per “unit of activity” (i.e., related to the charging bands quoted above), so it’s not easy to say “For treatment X, the NHS pays the dentist £Y”. Here’s an outline (I think the figures are from a couple of years ago, but they won’t have gone up since by more than a few % - very roughly speaking, the dentist gets as much from the NHS per course of treatment as the patient pays):
http://www.mecourse.com/ecourse/pages/page.asp?pid=1375.
rat avatar may have a different reason, but it seems the car owner’s insurance would likely ultimately be responsible for the expenses related to his/her injuries. So even though someone else was probably paying the bills, rat avatar tried to hold down costs by seeking more affordable care at an imaging center.
That is but one drop in an ocean of expenses for medical care paid by insurers nationwide for all car accidents. But cumulatively such cost consciousness could help hold down expenses that ultimately get shared by all.
In a similar vein, I have amazing insurance. It pays 100% from first dollar onward. It will pay from even OTC drugs or vitamins so long as the doctor writes a prescription. But I still pay a bit out of pocket from some basic things like OTC drugs rather than burden the insurance system with it. Easier for me too as I can stock a medicine cabinet and not run to the doctor for every little thing.
Still haven’t explained why a decision by an invading occupying power to end UHC (along with ending the government itself of the occupied country) counts as a decision by the occupied country to end UHC, as asked by the OP.