Health care in your part of the world?

In My Humble Opinion
1

It seems health care for citizens of various countries is a hot-topic these days, so just wanting folks to chime in with their experiences and how much it costs them, with/without insurance, and out-of-pocket (deductible) expenses.

I’m Australian, female, 56 years old. I do not have private health insurance, but rely upon Medicare, the universal health coverage. As a low-income earner, I pay approximately $500 per year in insurance, which entitles me to see a GP whenever I need to and to be referred to a specialist centre for more complex med issues (on the proviso that the GP and specialist ‘bulk-bill’…means there are no out of pocket charges for me).

Now mostly this will mean being referred to a PUBLIC hospital for specialist treatment. Depending upon how ‘urgent’ the GP deems the referral will determine whether I wait three weeks or three months for a consultation. If it is an emergency situation of course, I will be admitted to a world-class hospital for world-class treatment immediately, at no cost…no matter how long that treatment takes.

So just some examples, I gave birth to four children, all covered by our public health system (pre and antenatal care included). Any illnesses that my kids had were all covered by our public health system (including hospitalisations). In my years I have had various illnesses diagnosed (most non-urgent) but in every single case was able to get specialist care within a max of one month…again at some of the very best teaching hospitals in the western world, and again, at no out-of-pocket cost to me.

In a nutshell, I am very satisfied with the Australian medical insurance system. My only gripe is that Medicare doesn’t cover dental treatment (and I would be more than happy to pay an increased premium for that) but at this stage it is not looking at being covered on a national level.

Yours?

2

And just to add that people who are on government benefits (unemployment, disabled, aged pensions etc) do not have to pay the Medicare premium. Their health-care is totally covered without cost.

3

Well, as someone said, the NHS is the closest thing the UK has to a national religion. It’s not as overt as that, it’s not something you’re aware of in your daily life, but it is always there - a phone call away, for you, your family, your loved ones, for generations. It’s bonkers and beautiful, and so are the staff.

4

What a wonderful write-up! :wink:

5

Following the OP’s style:
I’m an American, 60 years old, private health insurance through my employer. High income earner (97th percentile), I pay about $12,000 per year for my portion. The rest is covered by the company. There are copays and percentages after X visits, but in normal situations I can see my GP whenever. There are some out of pocket charges for me if I exceed certain limits (I cover 20% up to some maximum). I also pay a small charge (usually less than $1.00) for monthly prescriptions. The coverage also includes long-term disability, life insurance, dental, and vision.

Physicians are provided onsite (at work) free of charge and they handle minor stuff (colds, bronchitis, etc.) and the prescription meds there are free. The same coverage is provided to me in retirement, including continued coverage of my <26 year old children. It is deducted from my pension check, as it was with my paycheck. One downside is that my portion of the total increases. The upside is, should I pass away, the pension and coverage continue for my family with no change. Like most, when I reach 65 I must change to Medicare and the company coverage of insurance ends.

The births of both children were covered entirely with no copays from us. This was 20+ years ago, so I don’t know if that’s still true. Like the OP, we’ve had a few medically urgent occasions resulting in surgeries, these were covered with a small copay, and received specialist care within a week. While recovering, my income is also covered, and continues uninterrupted. I don’t know what the limit is, but I’ve been “out” for a month several times, and on one occasion was out for 8 weeks.

Like the OP, I am extremely satisfied with my medical insurance.

6

In short, the USA Medicare plan may be the best “universal” system in the world. I’ve been covered by Medicare for 27 years, and I have absolutely no issue with it whatsoever. It exists in three plans, for hospitalization, medical and drugs. Every medical need I have ever had has been attended to with efficiency and professionalism, with no cost to me other than an occasional copay and annual deductible. It isn’t even mandatory, any Social Security beneficiary can opt out. The enrollment and coverage cost is about $1500 a year, and low-income retirees have that paid by Medicaid.

For people not eligible for Medicare, of course, the story is quite different.

7

I’m an American female, 47 years old. I have excellent coverage through my employer. I also live in Massachusetts, so if I lose my job and insurance, I would have coverage through MassCare (our Medicaid) due to a medical disability.

For my employer plan, I pay $300 a month toward my premiums. My employer pays $600 a month. Our plan is self-insured, meaning the employer pays the cost of our care out of pocket.

Copays are reasonable ($25 for an office visit). Medications are $10-$25-$50 copays if on the list. Out of pocket in network max is $1500 a year. I met that with medication copays alone.

Because I live in the metro-Boston-ish area, I have access to world-class hospitals and doctors if I need them. My neurologist is a Harvard professor and set up the migraine/headache department for one of those world-class hospitals. Most of my care takes place at Lahey Clinic, which uses electronic medical records and such to be sure that docs are able to easily coordinate care, and to help avoid duplicative tests and such.

The other side of the US insurance divide is this: I spent over a year without any coverage before the ACA; I could not work due to chronic migraine, and COBRA was more than my monthly rent. I also had hard-to-treat asthma. It was terrifying. Medicaid would have only been an option in that state if I were pregnant. The high-risk pool had been full for 14 years. I had literally no options.

8

Living in Alberta, Canada I am covered by our free UHC (before anyone gets to argue, I am using “free” in the sense of not paying doctors, hospitals, etc. directly for services rendered; I know it’s not free in terms of taxes ultimately paying for it). I go into a doctor’s office or Emergency department, they do their thing, and I leave without any mention of payment.

There are things that our UHC does not cover, like prescription drugs, and ambulance (there are others, but those two are what I am concerned about for myself). So, I voluntarily pay Cdn$190.50 every three months for the cheapest supplementary health insurance I could find, covering 75% of my prescriptions as well as any ambulance rides I might need (and other stuff I ignore).

9

Just to add to what Canadjun posted above about UHC in Canada, the system in Canada is particularly easy to describe because it’s so simple. There are actually multiple systems, administered by the provinces, but they’re all substantially the same in the basics. Everyone has access to the same services, and there is no private insurance for medically necessary services and therefore no restricted tiers of service. There are also no deductibles and no co-pays. The universal-service model means that any doctor, any hospital, any facility is available to anyone for medically necessary services – there are no “networks” that anyone is in or out of, and no concept of something being out of bounds because you don’t have the right coverage.

I’ve always been very satisfied with my health care services under this model. I recently had – for the first time in my life – a medical emergency that resulted in an extended hospital stay and surgery and a bill that I never saw but that I’m sure would have been well into the six digits, at least in the US. It cost me not one dime.

On the prescription drugs and ambulance services that Canadjun mentions, most folks would have such costs covered by their employer’s supplemental insurance. I’m retired so prescription drugs are covered under the free provincial drug plan, and here in Ontario ambulance costs are not a concern as they are capped at $45, the rest is covered by the public plan.

10

This could turn into a long and complicated post, but I’ll try to make it brief by hitting on the high points (or lows, depending on your viewpoint)

For many years my spouse and I were covered by Healthy Indiana Plan, which is a form of expanded Medicaid that pre-dates the ACA but is now folded into it. I spent a certain amount of my time and effort on the phone to keep our care coordinated and coming, but overall I had no real complaints about the system, and it kept my disabled, diabetic, aging spouse out of the hospital.

Until he got cancer, but even then, I felt we had proper standard of care (confirmed by talking to doctors I know in real life like my sister and others) and we were able to see him through that illness until his death without being financially broken.

However, his approval for hospice care came a week AFTER he died - it’s like the system worked fine until we reached the point where we wanted comfort care and not aggressive try-to-kill-the-cancer care. It took both myself and my sister (an MD who specialized in end-of-life care) to browbeat the system into keeping him in a setting where his pain could be properly controlled. But we did it.

Due to the way the funding is set up, though the day my husband died is also the day I lost my health insurance. As a single-person household I no longer qualified for the coverage due to my income being unchanged but having fewer people in the household. Stop and think about that: ** your spouse of 30 years dies, AND you lose your health insurance**.

Fortunately, I wasn’t entirely unprepared for the situation and I have coverage again through my employer. Yippee. However, the doctor I’ve been going to for most of a decade is not on their plan so I am forced to change doctors, and where I seek medical care, at a time when I really did not need more disruption in my life. I am having to learn to navigate a new “health care plan” and my own care of my asthma and allergies (which flared up due to the inevitable stress and less than wonderful care of my own self that accompanies something like a spouse dying of cancer) has been interrupted. I can not, at present, get my own prescriptions filled although I am not out of them yet and I am working on the problem. I also have significantly higher copays and deductibles (which yes, I can afford to pay although it pinches).

So while in one sense I have been happy with the care I have received, and I’m happy I can access care when I need it, I am NOT happy with having the rug yanked out from under me and all the change and disruption. Sure, maybe I’ll like my future yet-to-be-chosen doc even more than my current one, but at the moment my continuity of care is non-existent, and it comes at a bad time in my life. I’ll get through it, but is this sort of thing really necessary? Isn’t there a better way to do this?

11

up the junction has already said the essentials about the NHS, but just to clarify; the current situation is that the only charges a person would be personally liable for here are prescription costs, which are the flat price of £8.60 an item.

If you are getting certain income based benefits, pregnant, under 16, [del]you need to reevaluate your life[/del] have a long term disability, are over 60, or are under 18 and still in full time education, then you are exempt from that as well.

If that’s still too expensive, there is a prepayment card which is valid for all medicines for 3 months for £29.10 or 12 months for £104.

You don’t pay out of pocket to see a doctor, you don’t pay for your ambulance.

Even things like the much complained about waiting lists can be misleading; I know I’ve posted this on here before, but I had surgery a while back. I saw the specialist a few days after being referred urgently, and (I swear he just got a kick out of saying this) he told me: "OK, looking at your scan, we are going to recommend surgery for you. The current waiting list is 6-8 weeks.

pause

You’re the worst case on it, would you rather stay tonight and we’ll try and fit you in, or come back tomorrow morning?"

Nothing’s perfect, and you may have to wait a while to see a specialist sometimes (though there are private options as well, if you really don’t want to wait, so it is an option to pay to see a specialist sooner, the either get private treatment as well or you can be referred back to the NHS for treatment), but there aren’t a whole lot of gaps to fall through.

12

American, college degree and work for a company that is in the fortune 500. My insurance has a $3000 deductible and no out of network coverage. Due to the fact that a major medical visit will cost as much as a years rent when out of network charges and deductibles are combined, I avoid the doctor and just diagnose/treat most illnesses myself at home using google.

American health care isn’t all bad. A dental visit for cleaning/xray/exam is about $100, and fillings are about $50 each. Most Rx drugs are off patent and many are $20/month or less. An uncomplicated primary care visit to a walk in clinic is usually $100 or less. We have good public health here. Clean water, vaccines, etc.

But if you need anything more complex than that (major medical care), god help you in America.

13

Another Canuck. I would just add two points to the posts above.

Our healthcare is fully portable across the country. Each province pays for its own residents, wherever they are in Canada. If I’m travelling in another province and need medical care, i present my Sask health card and I’m good. The other province then bills Saskatchewan Medicare for the treatment. I never see a bill.

Getting a specialist appointment can involve waiting, sometimes for months, but then the two cases where I’ve needed a specialist weren’t urgent or major health risks. There’s a triage function there: people who have higher medical urgency get to see specialists faster.

I’ve never had to wait long to see a GP for regular matters. Seeing my own GP may take up to a week, but I can always just go to a walk-in clinic, wait for a while, and see a GP.

14

Last month I was in Guyana and Suriname, and I talked to several people in each country about health care. Suriname is about twice as rich as Guyana, PPP, but health care is a contentious political issue in Suriname. People are disappointed that there is no national health care assistance, and all medical costs are out of pocket or private insurance. Government corruption is blamed for that (and everything else, of course).

Many Surinamese cross over into Guyana, for an even better standard of health care. Guyana’s health care is fully universaslly nationalized, and people are quite proud ot it. There is only a small annual subscription, but by Guyanesse standards, it may be costly. A hotel houssemaid makes only about 65c an hour in Georgetown.

15

One further comment, to add to what’s already been said. I think the fact that there is a single tier of health care in Canada for everyone, including the wealthy, is a very positive thing and although it poses challenges, it does tend to hold the entire system accountable to providing the highest level of quality. This imperative starts to deteriorate when there are multiple tiers of service quality associated with insurance of different cost levels or direct out-of-pocket payments, and the ultimate example of that goes beyond even the multiple different levels of insurance coverage – it’s the recent emergence of red-carpet boutique health care in the US. This is not merely theoretical; my family in the US just had their GP move to one of these, and are faced with either finding a new doctor who is willing to endure the everyday hassles of ordinary insurance, or pay thousands of dollars out of pocket to simply retain their existing doctor in his new reduced-load boutique practice.

16

I would love to know where dental is that cheap. My daughter has to take the day off work and sit at the dental college for hours to get treatment. Even there it’s 100 for a filling and the cleaning seems to take several visits at 80 bucks a trip. Cleanings one trip/xrays another trip/some sort of coating another trip.

I’m in TN. My daughter works 35 hours a week and goes to college full-time. She doesn’t qualify for any sort of Tenncare medicaid. She was told if she got pregnant she would qualify. So being responsible means no health care coverage. I took her to the ER a couple months ago because we thought she might have a kidney infection. She was very ill or I’d have just taken her to a Walgreens walk-in clinic. The bills coming in so far have reached two thousand dollars for ten minutes in the ER (after the understandably long waiting room time, of course). She never saw a doctor, just a nurse, and that was just for about 30 seconds for the nurse to say “You have a UTI. Here’s your prescription”. I knew there would be a bill but not this big, and one is from a private doctor who still bills for a doctor when you only see the nurse. And while she MAY have had a UTI it’s not what was causing her the issues. We are worried it’s her contraceptive implant. We really really wish she could get it removed, but the program that pays for you to get it inserted will not pay to remove it even if you’re suffering bad side effects. That I believe they said costs 400 dollars. And that’s about 399 more than we can afford. I’m seriously thinking of starting one of those “go fund me” deals to help her get it removed.

Tenncare I think does a pretty good job with children’s health. My 12 year old is autistic and all her therapies are covered, as well as dental and vision. BUT she didn’t qualify for braces. She has really crooked teeth but braces are only covered if it causes a medical issue.

As for me, I have nothing and it’s scary. I have applied for disability because I have a list of diagnoses, but apparently they’re not severe enough even though I haven’t been able to work or drive because I have a history of dissociative episodes while driving. I want to work, I just haven’t found a job where I can get to work AND be available to get my daughter to her three appointments every week. I COULD just say fuck it and not take her but I’d really rather not, considering how many issues she has. She doesn’t qualify for any disability assistance either though. BUT at least she does have Tenncare. I worry. I know I need medical care. I know my blood pressure is high. I try to do what I can to help bring it down but I’m pretty sure if I had insurance a doctor would have me on some kind of medication. But what can ya do? Order some off-brand from Vanuatu and hope it’s not a sugar pill?

17

I grew up with a parent in the armed forces so I was covered under that system. No way to judge quality but I did not like it. I had to be driven to the nearest military hospital ER when I broke my arm and stayed in a ward and not in a private room. Going to the local urgent care meant long waits in crowded waiting rooms.
After college I got cheap insurance but never used it so I let it lapse. I would go to the local urgent clinic to be treated if I had and issue and it costs 75$ each time. Very convenient and very little wait.
When I got a good job with health insurance attached I paid a lot more for it, even though it was free in the same sense that other country’s insurance is free. I have changed jobs and insurance companies several times since then and had to change my primary doctor once. I have developed hypochondria so I use doctors more than I should and I have been to lots of different kinds and the only bad experience I had was when an insurance company misclassified a mouth surgery as a dental procedure. That was mostly my fault because I went to a doctor that did not take insurance because I did not want to wait two days to be seen. Had two kids in hospitals. Due to overcrowding had to spend one night in a shared room with the first one and that was annoying, the second time we got a private room but they wanted us to stay longer than we wanted to be there. No complaints at all.

18

Argentinian here. I work for a medium sized company. All employees pay 1% of our salary for medical insurance, and all get the same benefits. Our insurance is pretty good. Most procedures are covered without copay in private hospitals. Medicines 50%, glasses some fraction of the total cost, dental depends on the practice.

For public employees it’s the same concept, but their medical coverage is considerably poorer.

For unemployed people, there is the public health system. Not terrible, but could and should be much better.

19

To amplify posts above about direct cash payments to the NHS, I’m copying here a post I did on the thread about tax rates for public medical services in Europe:

FWIW I did some back-of-an-envelope sums, and reckon that, since something like 18% of our government expenditure goes to the NHS, you could work out contributions to it as being roughly this:

  1. Everyone pays (18% x 20%=) 3.6% on any VAT-able purchases, and of whatever you might spend on incidental duties, such as on alcohol, fuel, airport departures and insurance premiums.

  2. Median household income is £26400, therefore

  • income tax payment to NHS is (18% x 20% x(26400-11000)=) £554.50 p.a.
  • National Insurance contribution to NHS is (18% x 12% x (26400 - 8060)=) £396.13 p.a.
    TOTAL £950.63 p.a.

Plus employers’ NI contribution is (18% x 13.8 x (26400 - 8060) =) £455.56 p.a

  1. On £40k a year: £1044 income tax and £690 NI: TOTAL £1734 p.a.
    (employers’ NI contributions: £793 p.a.)

  2. On £100k a year: £3204 income tax and £959 NI: TOTAL £4163 p.a.
    (employers’ NI contribution: £2284 p.a.)

  3. On £150k a year: £5004 income tax and £1039 NI: TOTAL £6043 p.a.
    (employers’ NI contribution: £3526 p.a.)

For that you get whatever your GP, and/or any specialists they refer you on to, consider clinically necessary, within the budget - and if the budgets are under pressure, deciding who gets what treatment when is down to the doctors’ clinical priorities. As long as their recommended treatment/drug has been rated clinically effective or cost effective by the National Institute for Clinical Excellence, then no-one’s in a position to second-guess it or say it isn’t covered.