My uncle just had a surgery that the doctors deemed shouldn’t wait. He had to have a coronavirus test a couple of days before the surgery (it came back negative). Presumably, if it had been positive, they’d have re-evaluated how urgent it was. But if you test everyone before they go into the hospital, I’m not sure what the problem would be. I guess they still just don’t have enough tests?
Pretty much all of the above. Your second paragraph is the biggest concern.
It seems to me that many posters are ignoring the bolded line of glee’s post. I’ll highlight specifically the words that are being ignored:
That’s not about people not having a job due to no elective surgeries. The quote specifically says that they’re cutting doctors because they can’t make enough money. So, if this is happening in UHC countries, that means that they are also losing funding from COVID-19. But seeing as they don’t get paid from the people, why would they be losing money? Why would the national allotment for services go down?
It seems unlikely to me that the bolded section, clearly the focus of the post since it was in bold, is going on in countries with UHC, unless you guys are so bad that your government is running out of money and can’t increase its deficit to cover it.
I guess the idea is that most postponed procedures will be done in addition to the ones you would normally expect. So in total it wouldn’t be much lower than in a normal year…of course hospitals get money for covid cases as well.
Money just hasn’t been much of an issue, as far as I can tell from watching the news. And pretty much every industry that is suffering has been all over the news, so if hospitals were in the same boat…I think I would have heard.
A lack of ICU beds was, but it turns out we managed. Lack of protective materials is still an issue. Former ICU nurses returning to help out was happening, weeks ago we were told to please see our GP if you don’t feel well… cardiologists and neurologists saw a big drop in consultations and were afraid of the consequences.
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Actually, yes, there are a few ways it can be different in UHC.
A lot of staff in the UK NHS are absolutely being cross-trained to work with COVID patients. A friend of mine spent a few weeks, as it was becoming obvious how serious this was going to get, training surgical staff, who were called off elective surgery, on some of the procedures that were likely to be needed if her normal specialist team gets overwhelmed. Sure, they’re not going to be immediate experts, but a few weeks of training in one or two specific procedures is enough to be at least competent at those, given the background they already have. Also not everything involved in patient care is specialised, some of it just involves an understanding of good hygiene practice. She did say most of the surgeons were kinda being arseholes about it, because they don’t like not being the boss of the room, but still… She did mention that one of their most experienced surgeons requested a badge without his job title on it, because he didn’t want people to assume he was the expert in the room rather than the qualified nurses, while he was basically going to be acting as a nursing assistant.
Staff are also being loaned from my local area - which currently has a low number of cases - to places with a nursing shortage and lots of patients. The fact that the whole payment system is different, with central funding and staff on salary, rather than paid by procedure, also means that staff and aren’t being sent home without pay and can just be moved between departments- or even between regions- without many problems. There is just a general principle of cooperation here.
I’m not going to pretend the way the government has been handling the situation here is perfect, very far from it, and the PPE shortages do appear to have been worsened by politicians playing politics rather than making decisions on medical grounds, but the flexibility within the NHS is pretty damn good.
It’s a YMMV type of thing. My daughter (nurse in maternity-delivery) and her fiancé (MD) work in the same hospital and are swamped with work. They are working 12 hour shifts and making excellent money. They’re closing on a home purchase they had previously planned to wait a few years on. It’s just a question of how long they can handle working long shifts before their patients suffer.
I’m going to duck for cover after making this comment, but…
…there’s a part of me that the whole fucking thing would just collapse so we could start over, so that people would be so outraged that they would demand something better that services the collective need. Yes, the healthcare system is run by corporate scam artists, but we put up with it because of this “I’ve got mine, so I don’t give a shit about you” attitude among so many people in this country. Take a fair chunk of union members, for example, which is ironic when you hear them complain about low wages and workplace safety and expect everyone else to join their chorus.
The privately-run health system is best at doing one thing in particular: reinforcing inequality in our society, and providing inequities in health care. Beyond that, it’s pretty much average in terms of the results, average in terms of innovation, and downright shitty when you start looking at it in terms of real value. No country on earth pays so much for mixed results.
So yeah, burn the whole thing down. Let’s feel the pain together, and let’s collectively demand something better that provides equal access to people.
The thing is that UHC isn’t just one thing- it’s not always that every doctor/healthcare provider is a government employee and every hospital is run by the government or even that doctors are funded a certain amount per person enrolled as a patient and hospitals are funded to serve a given catchment area. There are absolutely UHC systems where doctors are in private practice that function in many ways like the US system , with the main difference being that all residents have “insurance” in which all doctors participate * - but it’s still fee-for-service , so the doctor still has to see enough patients to bring in enough revenue to pay the rent and the staff. Seeing fewer patients means bringing in less revenue even though everyone has coverage and there aren’t insurance companies involved.
*from the patient side , you don’t have any issues of being unable to afford medical care or being unable to find a doctor who participates in your network
*
In Norway at least Covid will have thrown a wrench into the hospital funding system. It is all public money, but it’s funneled to hospitals based on procedures performed, so a Norwegian hospital would have similar revenue stream issues in a lockdown.
It would have completely different solutions to those issues though. They are government owned and can run deficits and borrow money in a way a private entity cannot.
And of course our whole labor system is different, so that even for private health service companies, of which there are many, and that the health care system relies on for a lot of tests, lab work and outpatient procedures, you could furlough or fire your employees, without it being as much of a hit to them as in the US (furloughing would smart for your company though).
Look, the ONLY purpose of a for-profit company is to make money. No other. In fact, if it is publicly held, it could be considered malfeasance to behave any other way.
So the real question is: Do we want a healthcare system in the United States that is for-profit? Answer that and your questions will be answered.
Note that only a minority of the hospitals in the United States are owned by for-profit companies. More than half are owned by not-for-profit organizations (although some owner groups are truly massive) and a bunch more are government-owned. See here for numbers.
I agree, but it could be run with a long term view as opposed to next Q’s earnings. Sort of the possibly apocryphal Henry Ford story about paying his workers enough to be able to afford his cars.
Not exactly sure how that works for a hospital, but perhaps giving up some short term profit to build good will? Because at some level, it is good for a hospital’s revenue stream to encourage people to be sick - this is of course not ideal for society as a whole.
The Netherlands is one of the countries with both UHC and insurance companies that charge premiums and pay health care providers (well regulated of course).
I just saw the latest news about the insurance companies having aproved a support package for small health care providers worth several bilion euro’s. Exactly for what we are talking about here: care providers that cannot provide care because of corona restrictions. This is to allow these companies to pay salaries and other bills while they wait before they can start up again.
No system is perfect, and ours certainly isn’t, but it is possible to have a system where the actors have a more cooperative attitude… even when they are all for profit companies.
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Most countries don’t have as many types and levels of nurses as the US do. The idea of having a “scrub nurse” vs a “floor nurse”, for example… nope.
I’m not sure what you mean by this - do you mean that in most countries a nurse might be assisting in surgery on Tuesday, working on an inpatient floor on Wednesday and working in the ER on Thursday or do you mean something else?
Some UHC countries nationalize health care providers. Many don’t. They get paid for services provided to patients. Getting a check from the government to pay is not different for their bottom line than getting one from an insurance company. Many UHC systems are not even single payer. Whether they offer tiered services or allowing supplemental insurance to cover things like deductibles and copays, providers do not get all of their funding from the government. In many UHC countries private providers still get paid for service by some combination of the government, insurance companies, and the patient.
Single payer with nationalized health care providers is more the exception than the rule in countries with UHC systems. That model is simply not a universal part of what we call UHC. You seem to be assuming that it is.