£20bn and counting, and it still isn’t working.
What about psychological counseling not involving psychiatry? I.e., talk therapy as opposed to pharmaceuticals?
How about substance abuse treatment?
It’s available. However, mental health treatment is one of the worst-performing areas of the NHS, with long waiting lists, high staff turnover, etc etc etc.
Same thing here in Canada in general - there are options which one must pay for, but the free services have long wait lists.
I have a friend from British Columbia. He needed a heart transplant. They tried many things before they finally went through with it. He is doing quite well in the year since he got it. He id not have to declare bankruptcy . He just worries about his health and takes care of it as well as he can.
As for France :
I drive to the nearest doctor (well, actually, I walk to my usual doctor’s). Alternatively, doctors still do house calls, over here. I pay him and I’m later reimbursed (the doctor either fills an online form or hands me a hand-written form that I send to my “Social Security” office. The money is wired to my account in both cases)
Nope. I can pick whoever I want.
There are no wait times I’m aware of. It depends on how booked the doctor is. For generalists, it’s rare not to be able to see him on the following day. For specialists, it depends a lot. Some will be able to see you right now, others will give you an appointment two months later, and anything in between, but generally some days or a week. There’s no waiting lists in hospitals, as far as I’m aware of.
There’s an almost symbolical co-pay (€1 or maybe 2 for a doctor’s visit).
Otherwise, the “Social Security” reimburse a fixed amount for each medical act. Doctors, on the other hand, have the choice between charging just this amount, overcharging (in which case you’re reimbursed only the fixed amount), or completely stay out of the system (you’re reimbursed nothing).
A large part of generalists only charge the fixed amount. Almost all specialists overcharge (and how much they overcharge varies a lot). Doctors who completely opt out are very rare. In the case of dentists, the fixed amount is ludicrously low by comparison with what they actually charge.
Public hospitals charge a fixed (and low) amount per day, regardless of the care provided (except, I believe, for the emergency ward). Private hospitals charge on the basis of the care they provide (but are not as commonly used as public hospitals. There are very few large general private hospitals. A private hospital is typically small and either specialized, or treat less severe conditions while offering more “pampering” than a public hospital).
Drugs are categorized depending on their efficiency and their necessity and are reimbursed accordingly at rates ranging from 0% to 100%. People with serious chronic conditions have a 100% coverage. Glasses are poorly reimbursed.
A lot of people have complementary insurances, covering for instance the afore mentionned overcharges, stays in private hospitals, dentistry, etc… and often other indirect risks (mine, for instance, covers my burial expenses and my income loss). Most of these complementary insurances are non-profit, and are ran by the insured people more or less in the way stockholders run a company.
Actually, in France, the system isn’t exactly state-run. For historical reasons, it’s an organization ultimately headed by a board made up of half representatives of workers’ unions, and half representatives of employers’ unions. The government, however, is heavily involved if only because it often has to fund the healthcare system deficits and because no decision made by the "social security"could be enforced without passing a law
The funding comes mostly from a contribution withheld from pay checks. This cover employed people, people unemployed for less than two years and retired people. Self employed people pay a direct contribution. The government foots the bill for the others (that is, essentially people without income).
There’s generally speaking few paperwork involved for the patient. Even less so for serious medical conditions, since, as I mentioned previously, the 100% coverage of all medical expenses kicks in in these case.
Elective procedures aren’t covered. That said, I don’t know what is considered elective and what is not, nor how it is determined that an usually elective procedure becomes medically necessary and hence covered (say, plastic surgery for someone who has been disfigured).
I know that in some case a “pre-agreement” from the “social security” is required. The doctor’s request is reviewed by some of their doctors according to some sort of guidelines, but I’ve really no clue as to how it works in practice and when it applies.
I suspect that many “semi-elective” procedures might be covered by the complementary insurances I mentioned before rather than by the general healthcare system, but once again I don’t really know.
Thanks all for the replies. Very interesting and informative. Keep 'em coming.
RickJay, even though you have a NHS in place, you still have an employer health plan? I could see where this degrades to the point that the government plan is garbage because the employer picks up the tab for most stuff, but the costs keep rising, etc.
I remember being in a bar in Niagara Falls, ON in '94 or '95. It was a few months after the Clinton Health Care plan crashed and burned and was done for good. I was chatting with a few locals and they told me that the U.S. had dodged a bullet. They said that when Ontario’s plan started it was great and covered everything, but since then more things weren’t covered and the costs and wait times kept increasing.
Now, of course, that is not concrete evidence, and it is more than a decade old, but it gave me pause at the time…
Not the way you’re thinking of it.
There is a Provincial Health Care plan in every province in Canada.
It covers all the basics - visit to a GP, a specialist, MRIs, blood tests, pee tests, pregnancy & delivery, etc, etc.
An employer health plan (which I also have) covers Rx drug costs, dental care, therapeutic massage, orthotics, etc, etc. Those things are NOT covered under the Canada health act hence the appeal of additional insurance.
However, a person in Canada on a small income who became very ill could reasonably expect to get life saving medical care (including Rx meds, depending on how low their income was) and it would cost them nothing at all. They certainly wouldn’t recieve a massive $50K bill from a hospital after their tripple by-pass, or whatever.
Unless there was a clerical error, you also had to pay for the emergency room visit. I’ve been in them enough.
In short, in the Swedish system you pay a little for everything. The fees are so small that they might as well be nonexistent, but we tried that back in the 70s and the emergency rooms, doctor’s offices and so forth were swamped with people wanting treatment for trivial complains.
Hospitalization costs in the neighbourhood of $7 a night. Perscription medication costs are capped at around $250 a year if I recall correctly. There is also a cap for doctor’s visit costs (I’ve reached it at least once but don’t remember the exact sum). Surgeries and other additional treatments are free.
So, how well does it work? Well, in my experience and the experience of patients and medical staff I know, it works very well for serious cases and not very well for less serious cases. If you have vague pains or fatigue, you may have to wait a while and not get well in the end. If you show up in the emergency room with something serious, they’ll have you in a bed, all tests taken and morphined halfway to heaven in no time, for prompt forwarding to a ward.
On the other hand, I have received excellent care for a nonserious complaint, and I did once tell my doctor I was shitting blood twenty times a day and got the answer that it was nothing, so mileage varies.
There’s a related GQ thread going on right now: How much do Americans spend on medical care and insurance?.
I posted the following in that thread:
Here’s a link to a recent article in the Canadian magazine, Macleans: Good health, for less: We’re much healthier than Americans, even though we pay half as much for health care.
The gist of the article is that Americans are estimated to spend almost double the per capita amount that Canadians do, including both public and private expenditures:
However, that increased expenditure doesn’t buy Americans better health than Canadians, on average:
The article notes that there are life-style differences that come into play. Canadians tend to have healthier diets, eat less, and get more exercise. But the Canadian public health system also plays a significant role.
The article notes that the health rates for well-insured Americans tend to stack up well against the average health rates for Canadians. What pulls the US overall health rate down is the uninsured and under-insured Americans:
Not to go GD on everyone, but something most have left out:
How does socialized medicine work in your country?
First, by setting exorbitant income tax rates. 
Cite, please?
This website suggests you’re incorrect, at least when comparing the federal tax rates in Canada and the U.S: A comparison of tax rates between the United States and Canada.
He then gives a detailed table in support of that analysis - I won’t try to copy it because of the formatting, but it’s worth looking at.
Of course, just looking at the federal tax rates isn’t a complete comparison, but it’s a good starting point. Can you show that his analysis is incorrect, to support your assertion?
First, a quick personal bitch. I am VERY suspicious of this term “socialised medicine” - it seems to be designed specifically to strike at American Cold-War-Era fears of the Demon Socialism. You don’t refer to any other government run system as “socialised”, do you? Socialised Education (public schools)? Socialised Law Enforcement (the police force)?
Having said that, here’s an Australian answer to your questions:
Theoretically, possibly, but in practise you’ll probably have to pay something.
The government-run health service is known as Medicare. It publishes a set of scheduled fees for various medical services. If a doctor chooses to charge only the Medicare scheduled fee for your visit, they take your Medicare number and bill the visit straight to the government. This is known as “Bulk Billing”. If they wish to charge more, then you pay the whole cost of the visit, get a receipt and take it to a Medicare office, who will reimburse you up to the scheduled fee (but not the whole cost of the visit).
Pure Bulk Billing doctors are getting harder and harder to find, because the scheduled fee is pretty mingy (and not index-linked). However, many doctors will bulk bill certain categories of patients (pensioners/kids/students etc).
Of course, not every non-bulk-billed patient bothers to go through the hassle of getting reimbursed by Medicare, which helps keep costs down.
No way. It’s also much less restrictive than the British system which makes you pick a doctor then stick to them. In our system, you just go off to any old GP’s office you like.
It’s hard to get a same-day GP visit. There’s a bit of a doctor shortage, apparently. This seems to be due to the Universities not training enough of them.
You could see the “non-bulk-billing” system as embodying a kind of co-pay. The slightly arcane reimbursement system is presumably to sort out those who won’t bother to get reimbursed, and hence keep costs down for the system.
I don’t really know what a deductible is.
there’s a special tax - the Medicare Levy - of 1%, rising to 1.5% for high-income dudes who don’t choose to have private health insurance (the latter being part of the previous, conservative* government’s attempt to carrot-and-stick people out of the public system)
As it happens, I was just in hospital last week for a sleep study to investigate possible apnea. The beaureaucratic procedure was - a) give them my Medicare number, b) Sign a form saying “I assign all my Medicare benefits for this procedure to this hospital”. That was pretty much the way it worked when I had my kids too.
*In Australia, “conservative” is spelt “Liberal”. I don’t want to confuse you guys though…
Living in Sydney Australia I’d have to say treatment is generally 100% free, some doctors do charge a fee but plenty still bulk bill, I’ve never had to pay or would expect to. I don’t dispute Aspidistra’s comment in some country towns no one bulk bills, I sure Sydney and Melbourne have a mix of doctors with different billing methods.
Fascinating thread! Sitting in the UK, bitching (sometimes) about the NHS you don’t realise the variety of ways medicine is funded elsewhere.
One of the stranger aspects of the NHS is that, along with the old, the young, those on low income or out of work, the GBP7 prescription charge is waived for those with certain long term conditions, diabetes, hypothyroidism, etc., not just on the drugs needs for their long term condition but for all their prescrption. So I pay 7 quid for my hay fever medication while Mrs Marcus gets it for free :smack:
Moving this from General Questions to In My Humble Opinion.
Gfactor
General Questions Moderator
This has already been explained, but I’ll go into more detail. The employer health plan covers everything that isn’t covered by OHIP (Ontario Health Insurance Plan; although the system is nationally required, it’s provincially administered.)
What IS covered is fundamental health care - going to your family doctor, going to the hospital, seeing specialists, surgeries, emergency care.
What is NOT covered by the government insurance system is basically everything else:
- Dentistry and orthodontrics
- Eyewear
- Cosmetic medical procedures
- Quackery and nonsense, like chiropractic stuff and ear candling and all that
- Some physiotherapy-type stuff
- Prescription and non-prescription medications
- “Extras” during hospital stays, like private rooms
- Orthotics
- Hearing aids
… and all that sort of crap. Employer health plans do not cover the stuff covered by OHIP and its equivalents in other provinces. The basic guideline is that if a doctor or a nurse does something to you and you need, or likely need, it to be done, it’s covered, as long as it doesn’t have anything to do with your teeth; anything else is your problem, or your insurance’s problem. Obviously, plans differ in quality. My health plan’s very good, and covers pretty much everything I have listed; my wife’s is pathetic, so fortunately she’s covered under mine.
Ontario’s health care system certainly wasn’t good at around that time; the government we had at the time was extremely inept and had done a poor job managing, well, everything. They were, as a result, crushed in the 1995 election, so you were there right at the end of their highly ineffective term. One of their strategies to reduce health care costs was (I swear I am not making this up) to reduce funding for medical schools so there would be fewer doctors around. They reasoned that if there weren’t as many doctors, they wouldn’t get so many pesky bills from them.
The quality of the public system goes up and down, and it has its problems - again, depending on where you live, to some extent. But it generally does work, and while I would certainly change some thing if I were Emperor of Canada, the basic system’s sound and functional, and the current trend towards allowing more private practice is helping a lot. Canada could learn a lot from some European models, but the American system is a disastrous, stupid mess.
User fees and such are a fact of life now and people do complain about it, but I’ll be quite straightforward; people who complain because their doctor charges a few bucks for a medically unnecessary service are whiny little bitches. User fees are an economically sound way to reduce excess demand on physicians so that they can spend more time doing things that are more important.
One of the reasons my wife and I got private healthcare insurance is the scarcity of bulk-billing doctors. The Medicare bulk-billing rate is something like $38 for a patient, and that won’t even pay for a tank of petrol in an average-sized 4-cylinder car anymore. I don’t blame doctors not wanting to bulk bill if they can help it (Medical degrees are bloody expensive and so are the HECS repayments!)
In theory, it should be free to visit your GP. (We found one which bulk bills, hurrah!). Hospital treatment is also free, and there’s a $100 or so Ambulance Levy built into the power bill (it’s a really, really long story) which covers the cost of ambulance transport if you ever need an ambulance.
Medical insurance here uses a system called HICAPS, which works a bit like EFTPOS. We swipe our insurance card through the terminal, which dials up our Health Insurance company, says “Are these guys covered for this?” and, assuming the answer is yes, arranges for our insurer to pay our doctor/dentist/specialist.
The difference between what Medicare and our Health Insurance covers and the actual cost of the service/treatment is called the “Gap”, which is what we have to pay. For example, the last time I visited the dentist I had a lot of work that needed doing (having not been to the dentist in about 5 years) and it would have cost about $800 if I’d just put it on the credit card. The Medical Insurance bought the cost down to about $97, which is still a long way from “free” but it’s a hell of a lot better than trying to find $800.
Dental care is not covered by Medicare, interestingly, and while there are free dental clinics run by the Queensland Government, the waiting list for them can be measured in geological time.
My dad recently had his hip refurbished, and because he had health insurance his specialist simply opened his diary and said “How does Tuesday next week sound?” for the operation. One of his friends has been on the waiting list for 5 years on the public system to get the same operation done. So a lot of what you’re paying for with health insurance isn’t just “better quality” health care (although that’s a part of it), but also getting medical procedures and tests and operations and what have you done in days or weeks instead of years.
In British Columbia, there is a monthly Medical Services Plan premium. It’s sliding scale – if your income is below a certain point ($25,000, I think) you pay nothing. It is common for employers to pay your MSP as part of the benefits package. I have a decent salary, so I pay the full premium – $52/mo.
Yes, you can pick your own doctor; you just walk into any office and bring your medical card. I have never received an “extra” bill for medical services - emergency room visits, testing, etc.
I had elective surgery a year or so ago - it was scheduled six months from the consult.
My only complaint with our system is that I would prefer to have the premiums taken out of income tax revenue instead of having to keep track of another bill to pay – other provinces have this approach and it seems like less of a pain in the ass.
UK:
Although the NHS provision is excellent, many people still use private healthcare for a range of treatments.
Private hospitals in the UK earned £2.7bn in 2006 so there’s a more-than-healthy market for non-socialised care.
It’s worth noting that the NHS out-sources an increasing amount of treatment to the private sector (£360m in 2005 but rising steadily).