Being from the U.S., I am curious as to the logistics of socialized medicine as it applies to an individual, so I am asking how it works in your country.
If you get sick, do you just drive to the nearest doctor’s office and get treated 100% for free? Does the government pick your doctor? Are there long wait times? Is there such a thing as deductibles and co-pays?
How does your government pay for it? Do premiums come out of your pocket?
What if you were diagnosed with a serious illness like cancer or heart disease? Is it a seamless process to get the surgery/treatment you need, or it is filled with bureaucratic paperwork and nightmares?
What about a semi-elective procedure like a surgery for sleep apnea or a gastric bypass? Is that hard to get, or just have the doctor sign on the dotted line and in the hospital you go, again 100% free?
You register at a surgery to obtain a GP. Normally this is in your village, or somewhere close. You can pick whichever surgery that you like. There’s also “drop-in” centres for people without a GP and overnight calls. Some surgeries can provide more advanced treatment, like casting broken bones. My village also has a clinic, for newborn babies and toddlers that is separate to the surgery.
Each large town also has a hospital, or several that serve the local area. Emergencies are sent to the hospital’s A+E deparment (equivalent of the ER). Specialists are nearly always located at hospitals and appointments are made through GPs.
Special treatments outside the scope of the smaller hospitals will usually be taken to a hospital in a neighbouring city, like Great Ormond Street in London that deals with sick children. There was also a maternity hospital in my hometown where nearly all pregnancies were dealt with.
Treatment is “free” at point of contact. There’s a standard prescription charge of around £7 per item. There’s large classes of people who do not have to pay prescription charges, or can obtain a receipt to apply for a rebate (e.g. certain students, the unemployed, the elderly etc.)
Had to go in to the ER at one of swedens biggest hospitals with a dislocated shoulder (subluxation). Apparently this condition was grave enough to let me byass the entire queue and two nurses were summoned to escort me into an examining room. (apparently they were affraid I was going to faint or something). In due time the doc showed up and agreed the shoulder was out. Got a nurse to give me morphine. And then I was off to the xray. bypassing the queue again (first frost = loads of old people with shattered hips).
got xrayed and then again back to the the doc. Doc got another nurse and they did what I think is called a reduction. Then back for another xray and after the doc had a look at that I was released (had to sit around abit for the drugs to wear off).
all in all about 2,5 - 3 hours.
2 xrays, 2 shots cost $0 nil nothing.
I did have to come back for physio, that had an admin charge of about $20 since it had to be scheduled.
last week I went in to se the GP at the local village “vårdcentral” - care center, about some skinchanges (nothing serious, got some cortisone for it) price $10 admin charge for the appointment… about same for the tube. had to book the time about a week in advance. (wednesday, got time for monday)
For most purposes, yes. I see my family physician, and am referred by her to specialists, for free. Visits to emergency rooms are free. There are some things that are not covered, like getting your doctor to write a note for you to get off work.
Many optional things are not free, however. Cosmetic surgery is, of course, out of your pocket, unless it’s medically necessary. Some extra things, like having a private room for a hospital stay, are out of pocket (or in many cases, including mine, it’s covered by your employer’s health plan.)
Dentistry is completely outside the medicare system, and is paid for out of pocket or by a private/employer health plan. Prescription drugs are also oput of pocket or through insurance.
In Canada you pick your own doctors, of course. The government has no direct role in managing health care at all. The government is basically running the insurance system, not the health care. So they have tremendous influence over health care in the sense that they’re holding the purse strings, and can influence the market by deciding what they’re willing to pay for, but they don’t, for the most part, make medical decisions.
Naturally, how wide your choice of doctors is depends on local market conditions. When we recently moved to Burlington we had our pick of many family doctors. If we lived in Bootlick Junction, Northern Ontario, maybe not so much.
Wait times varies enormously depending on the local market. Wait times for nonessential surgeries can be very long, but it depends on what exactly you’re waiting for. If you need to see a doctor to get a prescription to fight an infection, well, there’s hardly any wait at all; there’s clinics all around I can walk into. Emergency surgery is done as quickly as possible. If you need knee replacement surgery, the wait can be many months long; my father waited six months for his.
More private health care options are opening up, but, of course, that’s out of your pocket. So you can jump most lines and go the private route in many cases, if you’re willing to fork out the dough.
General tax revenue.
There’s really not a great deal of paperwork to be done. There will always be the frustration inherent in dealing with hospitals, which are large organizations and prone to all the slowness and stupidity of large companies, but the payment side of the equation is for the most part invisible to the patient.
Residents of the Province of Ontario have health cards, which look like driver’s licenses, and have unique identifying numbers. (All provinces have similar systems.) Basically all you do is give the doctor/hospital that number, and they just bill everything to the provincial government under that number, and that’s it. Anytime I have had to go to the doctor, or when my wife gave birth to our daughter, we just gave our health card numbers, and that was it (in the case of having the baby I also provided my employer’s health insurance card, thus getting us a private room and stuff.) If you aren’t a Canadian - if, for example, you were an American on vacation - you’d better bring Blue Cross, your credit card or a big bag of money, because then they WILL have a lot of invoices and paperwork for you. At my local hospital the price just to see a doctor if you are not a resident is about three hundred bucks. This is payable directly to the hospital, not the government; the hospital is its own enterprise.
It depends on how “semi” it is. Surgery to correct sleep apnea absolutely would be covered, since sleep apnea is a fairly dangerous disorder. I am not sure about gastric bypass surgery, but if you keep going along the continuum of “necessary” eventually you’ll get to things that are not covered.
GP appointments are available same day for problems that are urgent but not A&E type emergencies. Otherwise, wait times for appointments vary from practice to practice. At mine, about two weeks would be the longest. Waits to see specialists can be quite long. In Scotland at least, the current target is 18 weeks or less. This is for a non-urgent problem of course - you are not required to delay your heart attack until a cardiac consultant has a slot available.
If you need treatment for cancer or heart disease, you’ll get it. There isn’t much, if any, paperwork.
The NHS is funded through tax revenue, and most services are free at the point of delivery. The main exception to this is dental treatment.
Mental health care is handled in much the same way as other types of health care. For “minor” problems, your GP would be your first port of call - he or she can refer you to a psychiatrist if necessary.
Psychiatric hospitals are free at the point of delivery.
The Danish way of doing things - and I hasten to add that my information may be a little out of date. The perhaps interesting bit is that there’s both private and public hospitals, clinics etc. in Denmark, although the public ones are by far the most used.
If the nearest doctor is part of the public system, pretty much yes. Everybody’s supposed to have what probably translates as a “primary care physician”, and (s)he is your portal to the health care system for anything that’s not urgent.
If it’s more acute, there’s a 24/7 system where you call a doctor on duty who’ll get your symptoms and situation, then advise: Drive to the nearest clinic, or he can dispatch a doctor to your home, or he can setup transportation to clinic/hospital. (Or he can tell you to drink plenty of liquids and contact your own doctor.)
Nope. When you turn 18 - or when you move to a new town - you pick from a list of local doctors who can take in new patients. If you’re smart, you’ve done your homework and you know which ones are better. If you’re like me, you just grab whoever has a practice at a convenient location.
For a doctor’s visit? No. Most often the same day, but it depends on the situation. Are you looking for treatment or do you just need a chat regarding that new medicine you’ve started taking?
There are co-pays on medicine. It’s a sliding scale - 100% for the first 800 kr. ($160), then 50%, then 25%, then 15%. Your copay shouldn’t exceed roughly $600, ever - then you’re considered a chronic patient and the rest of the cost is covered by the state.
The entire thing is computerized across all pharmacies, so the co-pay is computed at the time of purchase.
Weirdly enough, dental isn’t covered except for the very basic.
It’s all through taxes. Some people purchase additional insurance, though - dental, chiropractors, that sort of thing.
From what I’ve seen, compared to the US, there’s very little paperwork. If your PCP notices something out of whack, he (or, rather, his secretary) sets up a specialist appointment. The specialist will perform more tests and get you admitted to a hospital, if needed. What I’ve seen of paperwork is pretty benign - mostly appointment letters.
A bit harder. Sleep apnea is taken pretty seriously, but the first line of defense will be a specialist working with you on a non-surgical treatment. As for gastric bypass, that’s considered a medical procedure - i.e., if you’re not obese to the point where it threatens your health, you’ll not get a slot. (That’s where private clinics come in, of course.)
Perhaps a more typical semi-elective surgery is a sports injury. You’ll of course get surgery, but there may be a wait. Or you can walk up to a private hospital, checkbook in hand, and be admitted the day after.
In the NHS, is there a centralized computer system where the physician can look up the patient’s history/medications/past admissions/etc?
The closest we have to the NHS (or any sort of universal healthcare system) in the US, the Veteran’s Affairs hospital system, has such a system any I found it extremely helpful when rotating there as a student.
Addendum to Canada.
Some Provinces still levy a separate premium for Health Care, but it comes no where near covering the actual costs.
Most of the funding comes from General Revenue.
Getting insurance and paying for it: I tell my employer which one of about 200 gesetzliche Krankenkassen I am a member of; the employer accordingly withholds the premium (6.9 % of my gross income for my Krankenkasse - varies between the Krankenkassen), pays another 6.9 % of my gross himself (i.e. 13.8 % in all) and pays the sum to the Krankenkasse. The Krankenkasse furnishes me with a chip card which is my legitimation to receive medical care. If I had children and/or a nonworking spouse they’d be covered under my premium. The premium percentage varies between Krankenkassen but is not depending on age and health. Krankenkassen compete (slightly) on premium percentage and more on customer service and the fringes of service covered (acupuncture, psychotherapy etc)
GP visit: I turn up at the practice (of whatever GP I choose) with my chip card. The first time I visit a doctor in a quarter I have to pay 10 €. Waiting time is according to time of the day and urgency - immediately to an hour or two, unless there is an emergency with another patient. Normally not worth my while to make an appointment beforehand. The GP gets his money from the* Krankenkasse*, on a points system for treatments/services.
Specialist: I get a referral form (Überweisung) from the GP and make an appointment with the specialist. (If I don’t get the referral first I have to pay 10 € at the specialist’s practice again). Waiting time for first appointment is according to specialty and urgency - immediately to weeks. Like the GP, the specialist gets his money from the Krankenkasse, also on a points system.
Hospital: I get a referral from the GP or specialist (the last time I was in hospital was 8 years ago - turned up at the GP with pneumonia and he called the ambulance). In urgent cases I’d turn up at the emergency room with my chip card. Hospital copay is 10 €/day; the hospital bills the *Krankenkasse *directly (for most treatments/procedures it’s a flat sum irrespective of duration of stay, i.e. they don’t have an incentive to treat me for longer).
Pharmacy: Most medications are covered by insurance with a copay, except when the Krankenkasse has made a low-price deal with a manufacturer (e.g. I get a certain brand of omeprazol without copay). Otherwise the copay would be 10 % of price but at least 5 € and at most 10 €. I present the prescription (which references my medical insurance information) plus the copay at the pharmacy.
A number of medications (salves, eye drops, sleeping pills, etc) are not covered by medical insurance; you have to pay them yourself (if they are only available on prescriptio, like sleeping pills, you need a prescription from the doctor which is on a form differen from the covered medications.
Long-term nursing care: covered by a separate, smaller premium withheld by the employer (Pflegeversicherung). mostly provided at home by private nursing services (e.g my mother gets visited by a nurse every morning to get her medications and to help with washing).
The above is how it works under the gesetzliche Krankenversicherung system which covers employed people and their dependants.
Employed people over a certain salary and self-employed people can opt out of that and choose a private insurer.
Difference:
premium is not a percentage of pay but a fixed sum (which is why high-income people prefer it - they’d pay more under the percentage scheme)
dependents need an additional premium
it costs more if you become a customer at a higher age (but they are required by law to cross-subsidize older from younger insured to some extent).
medical services and medications aren’t free at point of use but have to be paid by the patient and he has to claim reimbursement from the insurance.
the rates doctors can bill privately insure patients are higher, so they are more eager to let you have an earlier appointment
the ‘hotel’ component of a hospital stay is nicer (e.g. single-patient room rather than two or three per room).
Canadian here - every province has its own system in place for health care - so it isn’t the same everywhere. This is my experience in Alberta.
I have never had to pay for any required care at a doctors office - I didn’t even know what a copay is until I read about them on here. I searched out my own doctor, but if I didn’t have one or was in another town and need to see a doctor, I could go to a walk in clinic. Even seeing a specialist such as a psychiatrist or dermatologist is free - although to get a mole removed electively, it would cost about $30. There are “for profit” specialists as well (Laser eye surgery, plastic surgery, varicose veins, etc) which do cost money - although it seems that they only charge you for the surgery and private rooms - any drugs given in the course of care while in the clinic or hospital are covered, as is the hospital bed in those cases. There is also a for profit MRI clinic - but I have no idea how it works.
Prescriptions are not covered, neither are ambulance rides, private rooms in hospitals, chiropractors, eye doctors/glasses, and any dentistry. For these services, one needs private insurance through Blue cross, a private plan or work plan. This will cost you any where from $75 to $150 a month depending on the extra coverage you get.
Alberta Health Care Insurance Plan is our coverage for all the necessary services such as visits to a doctor or hospital. Right now it costs $44 per month per person or $88 for a whole family, if you are unsubsisded. If you are low income, you can be subsidized up to 100%. In 2009, they are scrapping premiums all together. The best way of describing it, is each province is an insurance company for the essential services - the government pays the doctors for the visits, services, and surgery. The government also funds the hospitals, to an extent, although the hospitals also have lotteries in order to keep up financially.
As for wait times, for a Family Doctor, I don’t have to wait long to get in - but there is a shortage of Doctors right now - but there are still walk in clinics where you can get in within an hour or two if you need to see a doctor. As for most specialists, you must be referred. Some specialists are harder to get into than others due to shortages, but I had no problem getting in to see an ENT (3 weeks), or getting a CAT scan & an MRI for my sinuses (the appointments were made about a week after getting into the specialist). As for a dermatologist - the wait is a little long…
I’ve never had to do any paperwork except bring a little form from one doctor to lab when I need blood tests - and of course carry my Alberta Health Care card. When I get a prescription, my extra coverage through my work and my husbands work are just cards that the pharmacy just swipes at the till - and it ends up I never pay for anything.
If the need for care is urgent, your wait times will not be long at all - Cancer, Heart patients, etc will get into the hospital quickly, and in surgery if necessary as fast as possible. As for something elective, it depends on the numbers of doctors in that specialty, and openings at the hospitals for operating rooms. I think sleep apnea would be covered 100%, as well as some gastric bypass surgeries - if it was deemed medically necessary for that patient.
More Canadian info - different provinces handle this somewhat differently - Alberta (where I am) currently charges a fee in addition to what they collect in taxes for health care and I DO have a line item on my paycheque that says:
AHC - $22
however this is being phased out at the end of this year.
As far as paying for stuff, I’ve accessed pretty well every level of health care from a GP to specialists to surgeons and never had to pay for any treatment - I have no idea how much the services I’ve had even cost - not a sniff.
I have co-paid for physiotherapy though - that was about $20 if I recall, payable to the clinic. Ditto for dental although I have a supplementary health plan at work that picks up the difference.
As to wait times and whatnot, as RickJay stated it’s very dependent on which province you’re in, as is the level of care you receive. My parents live in Manitoba where health care is notoriously bad. My father was diagnosed with lung cancer and told he had 18 months to live. Mom and dad drove across the boarder to the Mayo Clinic, spent $15,000 for a second opinion, got a recommendation from a MC doctor for surgery. He came back to Canada and had the surgery and is now, apparently, cured. We’re all quite annoyed that he wasn’t offered the surgery option from the Manitoba doctors originally; however, when he did get it, it was fully paid for.
Dentists are permitted to set their own rates. There is a standard book rate which insurers pay - and some dentists choose to charge more, but some dentists charge only the book rate. Same thing for chiropractic and massage therapists - the chiropractor I used to go to had a sign in the office that both he, and the massage therapist in that office charged only the insurance standard rates. My dentist also charges only what the insurance companies book rates state.
At least in my experience, dentists around here charge MORE if you’re insured. Dentistry is a very competitive business, and if you’re not insured even very good dentists will give you bargain basement rates. If you are insured, they charge as much as they possibly can, since of course you don’t care.
I’ve been insured for most of my life - but never had one that charged more. When looking through the yellow pages & websites for a dentist, I found quite a few that advertised that they only charged the insurance rates. I guess I have been lucky but none of them have tried to upsell me additional work, or fancy electric toothbrushes, or even cosmetic work. I decided to go with only ones charging book because of that, it seems I have had far more ethical dentists than many of my friends in both what they charge and in the service. When I last decided to switch dentists to one closer to me, I chose another who only charged the book rate - and no trying to sell me on unnecessary “preventative dentistry” - and I still have great teeth!