Non-health insurance in universal health care countries

[md2000]

@hogarth

Well, not everything. Unless things have greatly changed recently, prescription drugs aren’t covered, for instance.

In most provinces, there are plans to cover drugs for seniors and for the poor. But yes, for the average working Joe, you pay for your own prescriptions. This is another place where good employers offer a benefit plan to cover some or all of your drug costs. Some plans, the pharmacist can take care of submitting claims and they have online authorization; the computer tells them how much of the cost the plan will cover and approves the cost, and the patient only pays the balance.

If you are hospitalized, then the drugs during your stay are included in the “free” care. I recall an article about patients in one province complaining their chemotherapy had been converted from in-hospital to an out-patient treatment, meaning they would now have to pay for the drugs - a substantial kick in gut for some.

[Northern_Piper]

“Medical costs” is a narrower term than “health costs”. Under our legislation, the Medicare system covers services provide by medical professionals such as doctors and nurses, in medical clinics and hospitals. Does not extend to a broader range of health care services, such as prescriptions and dentistry, which are not usually considers medical services.

[SanVito]

@hogarth

Well, not everything. Unless things have greatly changed recently, prescription drugs aren’t covered, for instance.

In the UK, prescriptions are only paid by people who are working, and then only at a fixed price per prescription (c£8/$13US from memory). If you are unemployed, over 60, under 18, pregnant or postnatal, are an inpatient in hospital or suffering from a long-term condition that requires assistance, you don’t pay a bean.

[njtt]

@SanVito

In the UK, prescriptions are only paid by people who are working, and then only at a fixed price per prescription (c£8/$13US from memory). If you are unemployed, over 60, under 18, pregnant or postnatal, are an inpatient in hospital or suffering from a long-term condition that requires assistance, you don’t pay a bean.

Nor do you pay for prescriptions, IIRC, if you are in Scotland or (I think) Wales, even if you are working and earning.

[alphaboi867]

@bob_2

In the UK, if you could convince a psychiatrist that your massive Cyrano-like proboscis was causing you serious problems, you may well get the necessary surgery done on the NHS. If you merely want rhinoplasty to remove the recherche tip then you will have to pay. There is a wide grey line between the two extremes.

Is it really that simple, or would the psychiatrist’s diagnosis need to say be reviewed by a panel of NHS clinicians before the surgery was authorized?

[Winnipeg]

@alphaboi867

Is it really that simple, or would the psychiatrist’s diagnosis need to say be reviewed by a panel of NHS clinicians before the surgery was authorized?

It may have changed since I left the UK (late 90’s) but it was your personal doctors choice who he referred you to for specialist care, and that specialist was pretty much a law unto him/her self. You could also ask your doctor to refer you to a specialist of your choice, especially if you have private insurance.

I don’t believe there is such a thing as a panel of NHS doctors who authorise treatment on the individual patient level, though treatment can vary depending on where you live, so there must be some level of decision making as to what treatments are available in general.

[Nava]

@Winnipeg

I don’t believe there is such a thing as a panel of NHS doctors who authorise treatment on the individual patient level, though treatment can vary depending on where you live, so there must be some level of decision making as to what treatments are available in general.

In Spain there aren’t panels to review treatment, although some things (such as sex reassignment) require the agreement of several doctors; there are panels to review long-term bajas médicas (temporary disability) and to decide whether someone who’s been on baja for a long time should continue the baja, get the alta (reassigned as able-bodied) or get permanent disability. The maximum length for which an individual doctor can give you disability is three months; after that, reviews are by a three-doctor panel.

[SanVito]

@njtt

Nor do you pay for prescriptions, IIRC, if you are in Scotland or (I think) Wales, even if you are working and earning.

That is true. And a daft use of NHS funding if you ask me - I have a friend who is a practice manager of an NHS GP clinic in Wales and she’s very critical of how the Welsh Assembly have decided to use the funds. The free prescriptions thing is a populist move but it leaves some areas, such as mental healthcare, badly underfunded.

[SanVito]

@alphaboi867

Is it really that simple, or would the psychiatrist’s diagnosis need to say be reviewed by a panel of NHS clinicians before the surgery was authorized?

Nope. It’s that simple.

[Ken001]

New Zealand: public funded hospital care. A visit to the doctor (GP) costs about $50 but free for children. Prescriptions cost $5 per item, welfare beneficiaries often free.

We have a no-fault accident system call Accident Compensation (ACC) and there is no right to sue (apart from rare-as-hens-teeth punitive damages cases). Wages/salary is paid by ACC and they will pay for private hospital operations to get a person back to work.

The public health system has even been doing stomach stapling ops for the obese recently and tattoo removal for incarcerated prisoners.

Dentists and opticians are at your own cost and not normally covered by private health insurance for those who have it.

[Cicero]

Australia. I think it is beyond just auto accidents etc.

Since Medibank back in the 70’s (thanks Gough) you get to a doctor. Some bulkbill, as in the accept the Govt paid portion- a lot don’t.

If you need surgery and it is urgent the public health system will look after it. Public hospitals still retain specialists for such emergencies.

However, when it becomes elective things change. You can wait a long time for a position to be available in the public health system. Private health coverage ensures you can virtually get it done as soon as possible. However, there can still be a substantial difference between what they pay and what you have to cough up.

Plus varying levels of coverage- dental, optical etc. Basically top cover health care is great- if you can afford it. But is is certainly not at no cost after the procedure.

[TheLoadedDog]

@Pinmin

Is this a flat fee / surcharge, or does the cost vary based on your risk like the auto insurance cost?

This varies from state to state. In Victoria, as has been mentioned above, it’s a flat fee. In my home state of New South Wales, it’s a bit more complicated…

From when Adam first bought a car, up until the early 1990s, it was similar to Victoria. There were twelve insurance companies used by the government, and your car’s registration was assigned one at random. They all provided the exact same cover, for the exact same price, mandated by the state government (my memory is a bit hazy, but you might not even know which company you had - it didn’t matter to the individual). You paid your “third party personal injury” insurance as a component of your car registration when you fronted up at the RTA (DMV, DoT).

In 1992, or along there somewhere, a conservative state government introduced the current system. The twelve companies were now allowed to compete, and the individual car owner could choose. So, the RTA resistration cost dropped, but you had to bring along, in addition to a “pink slip” (mechanical roadworthiness certificate") a “green slip” (insurance certificate). The companies initially competed mostly on price, and registering a car became cheaper for a few years. Some companies also competed on product, and threw in a few extras on their policies. Needless to say, prices crept back up eventually. Also, the risk is no longer universal, eg. if you’re male, under thirty (or worse, under 25), drive a high-powered car, and have a poor driving history, you will pay big money (assuming you can find a company who will take you). Years ago, I had the embarrassment of being point blank refused insurance in front of a queue of people - I had a perfect driving history of a decade, and a pretty vanilla car. My crime? I was 28.

Under both the old and new systems, there are three main types of insurance:

1. Third party personal injury (medical insurance for the guy you hit). This is COMPULSORY. Drive out onto (or even park on) a public street without it, and you’re in hot water if caught, because your car is unregistered.
2. Third party property damage (for the Rolls Royce you hit). This is not compulsory, but even if you drive an old beater, it is insane not to have this.
3. Comprehensive insurance (pays for the other guy’s car, but also your own if the accident is your fault. Also fire and theft).

I’ve actually got something between 2 and 3. Because I’m a pretty good driver (I like to think - my record says so, anyway) but my car is a piece of crap, I’ve got third party property damage plus fire and theft. So, the only thing I’m not insured for is my own car if I have an accident that’s my fault. Based on price, I’ve decided to carry that risk.

[Springtime_for_Spacers]

@bob_2

In the UK, if you could convince a psychiatrist that your massive Cyrano-like proboscis was causing you serious problems, you may well get the necessary surgery done on the NHS. If you merely want rhinoplasty to remove the recherche tip then you will have to pay. There is a wide grey line between the two extremes.

Another grey area occurs where a problem is both cosmetic and medical. A friend had extra cartilage in her nose which affected it’s appearance and caused breathing difficulties. They fixed her breathing and made her nose pretty into the bargain. Another friend has a small nose with unusually small nostrils, it’s cute actually but unusual and if she wanted she could cite her difficultly in breathing through her nose when she has a cold to get it altered.

[Northern_Piper]

[QUOTE=md2000]
…(d) given a-c and the general discouragement of contingency fees by the provincial bar associations (from what I’ve read)
[/QUOTE]

md2000, we’ve discussed this before: contingency fees are very common in Canada and are not discouraged by the law societies:

[QUOTE=me]
To quote wikipedia on contingency fees:

Canada

Contingent fee agreements are legal in some provinces of Canada (Alberta, British Columbia (except in family law cases involving child custody or access),[3] Ontario[4] and Quebec among others). In other Canadian provinces, an attorney may collect a percentage of recovery in case of a victory but must charge an hourly fee otherwise.

To those four provinces specifically mentioned, I would add Saskatchewan, which also allows contingency fees. When you add those five provinces together, they have 89.1% of the Canadian population (Source: Wikipedia: List of Canadian Provinces and Territories by Population), so contingency fees are very common in Canada.
[/QUOTE]