Naw, feel free. I basically got the answers I was looking for in the earlier discussion, so at this point knock yourselves out talking about whatever you guys want, including comparisons to the US system or any other system out there. I simply didn’t want the discussion to get sidetracked as it did later on until our British 'dopers got the chance to actually answer the questions and give their thoughts.
A lot of them have never been to the ER, and don’t think of it. Others have been but didn’t see any kind of triage: it took place, but they didn’t see it. I’ve been to the ER accompanying patients in the US and in Spain; in the US we were given a lot less information regarding waiting times, reasons for anything or even what was the patient being given. Just anecdata, but think that people in the US are used to getting Rxs in a personalized bottle with no prospectus whereas in any European country we’re used to getting the full information. Americans are used to getting a lot less information, including less information on what is their position in the queue and why is it that one.
Back to UK experience:
(a) Pills in bottles went out years ago - I assume it was some EU-wide agreement, but they come in blister packs and every pack has a standard-format fact sheet on what it is, how to take it, what the side-effects might be and what to do if you get them. It’s one of life’s minor irritations that I always seem to open the packet at the end where the leaflet has been folded round the blister packs, and I have to fish it out every time.
(b) If you’re on repeat prescription (as I am for a few things) your standard prescription will be for two months (less for high-strength painkillers), and there will be a review as your GP determines, with the relevant tests (blood pressure, blood samples) to look for side-effects: in my case, it has been up to an annual interval, sometimes six months or less if there was something they thought needed closer watching. In addition, the NHS will pay the pharmacist to encourage them to undertake a “medicines use review” to double-check that you understand what your medicines are for, when to take them, and possible interactions with anything else you might be taking.
I actually have another question for UK 'dopers and the NHS. I get a regular prescription, Ambien actually (well, I usually get the generic zolpidem instead but it’s pretty much the same thing). Anyway, if I were under the NHS, how would that work wrt getting the prescription every month? As a contrast, the drug is basically dirt cheap…it costs me like $2 per month for 30 pills. The bad part is I have to get this renewed literally every month with my doctor so it’s a huge pain in the ass having to call it in every month then having to have the doctor approve/authorize it. How does the NHS deal with things like sleeping aids which some US insurance plans deem to be ‘optional’ (plus list as a controlled substance)? Just curious if it would be harder, easier or about the same. I assume the costs would be similar.
If a treatment is within the NICE-recommended guidance, the NHS cannot second-guess a doctor’s judgement as to whether it’s necessary in any individual case. “Controlled drugs” in our system (which I understand to be the addictive painkillers) might well come under a strict “one month at a time” practice (I’m guessing there’s an international consensus and agreement on that through WHO and the various agreements on narcotics); and as that guidance on Zolpidem indicates, GPs will try to steer you into non-drug therapies for insomnia rather than just keep on doling out sleeping pills. I don’t know what mechanisms there are for checking whether doctors are following the guidance, but I think there is some process of clinical audit that alerts the system to GPs whose prescription practice seems to be out of line somewhere. And as most are in group practices, there should be processes for mutual discussion and review within the practice, I suppose (if they’ve time).
Costs to the patient would be £8.60 per prescription (free or with financial help for some categories of patient). Costs to the system depend on whatever price the NHS has negotiated for the generic - and the guidance recommends sticking to the cheapest generic wherever possible.
Again from the similar Spanish system; hit me if it’s a hijack but AFAICT the biggest differences between how we work and how the NIH does it are “behind the scenes”, in the financing and contracts-management end of things, rather than on what the patients see.
A few years ago, Spain started trials on something called “electronic prescriptions”; it started in one of the smallest regions (as it usually happens with this kind of organizational changes) and went so well that the biggest problem for a while wasn’t deciding whether to implement it for everybody else or not, it was lack of resources to do it. Pharmacists were already linked to the healthcare system for their billing, so the physical infrastructure was in place; what was needed was the software, the training of the pharmacists themselves, and the choice and training of the people who’d manage it on the system’s side.
The way it works from a patient’s point of view is that you don’t need to deal with paper unless you’re going off-system (traveling or using a fully-private clinic, which are rare). If your doctor or nurse is in the system they can enter the scrips into the computer and those are instantly available to the pharmacists. The prescription indicates how you should take your meds, which includes “at will up to X” (my mother’s anxiety medication, for example). The pharmacist will check that you or an appropriate companion/caretaker know what is it you take, when and how; they can also make notes. For example, one of my mother’s at-will scrips was for a pretty large box; since she takes it very rarely, there was a risk that she’d be automatically flagged to be taken off it if she didn’t buy it for several months. Her pharmacist made a note for the nurse to change the scrip to a smaller box (our nurses can’t diagnose but they can renew doctor’s scrips and they can give scrips for OTC medication). The direct costs to my mother are zip, since she’s in one of the payment-exempt categories. For me, it’s 60% of what the box says. For the system, 100% of the negotiated price on the box for Mom and 40% for me.
Sorry, I realized I hadn’t answered the question of what to do when you have a long-term scrip of something sensitive. The whole point of long-term scrips is that you don’t need to renew them all the time; the great advantage of the electronic version is that you don’t even need to spend five minutes every month getting your renewed scrips from the nurse’s office, like you did when they were on paper. Your medication regime gets checked any time you see a doctor or nurse for any reason (both scrip and non), but that’s it; the only periodic medication checks are part of periodic check-ups.
Yes, we’re on electronic systems as well: IF the medicine is put on your repeat list, you can use the relevant website or phone app to put in the repeat request and the pharmacy you’re registered with will send a text to tell you it’s ready for collection. But the request will be reviewed by the doctor or delegated prescriber in the practice, and if they think it’s time for a review they will say so. Where it’s something like a sleeping pill that’s only to be prescribed for a short while, presumably they will call you in for a review and/or not renew until it’s done: either way, you don’t get a medicine just because you think you want it, there is some intervention by a qualified prescriber, either at the point of decision to put it on repeat, or as you ask for a repeat.
Meant to add: when I pick up my prescription, it comes with a print-out copy of what the paper prescription would have said, identifying me, the prescribing doctor and the dosage, the next scheduled routine review date and a summary of assorted general terms and conditions to do with prescriptions and charges.
I am a chronic asthmatic and have been for 40+ years. I use salbutamol and beclomethasone but the amount I use varies. Whenever I need a repeat, I log in to the Surgery’s website, go through some security and tick the boxes for what I need. 48 hours later, I can collect them from the pharmacy that I chose. I am over 60 so it costs me nothing. Before that, I used to pay an annual charge (£100 or so) which covered any prescriptions I had for the full year. With an average of two per month, I was quids in.
Once a year, I get called into a group session where we get some tests (BP, temperature, lung function) and a bit of a chat to ensure that we are okay with our current medication. This is done by a Nurse Practitioner. About ten years ago, after one of these, an increased dose of the steroid was suggested.
Just to add - when I was on co-codamol for a while I requested extra before a holiday. I actually had to speak to the doctor to get the request sanctioned as there are strict limits in controlled drug prescriptions.
Appreciate it. It gives some direct context to things.
I should also underline again how central the GP is to a patient’s dealings with the NHS: the GP you’re registered with holds your records and has the full picture when dealing with prescription requests. You wouldn’t be able to go to another practice and expect to get a prescription, and certainly not for a controlled drug, except in emergency.
Theoretically, records are now shared electronically, so the doctor should be able to look up your records and prescribe accordingly. But they will want to verify your condition - I spent a day at York Hospital while they verified my uveitis.
I should be grateful you’ve given up on the whole “I was misdiagnosed in the USA, so in the UK I would have died” rationale, and moved onto Texan sharp shooter fallacy, if only for the variety.
I agree, the UK could surely do with more imaging equipment. However, for a slight more encompassing set of stats, how about this:
UK life expectancy: 81.6 years
USA life expectancy: 78.74 years.
We drink more than you (11.6 litres of alcohol per year to your 9.2*), more of us smoke (16.9% UK, 15.1% USA**), we exercise less ( 63.3% of UK adults don’t regularly exercise, compared to 41% of adults in the USA***)…and yet we live nearly 3 years longer on average, with a a health system that costs far less per person (Private and state healthcare cost per person in the UK was $3500****, compared to $8,200 in the US)
I guess you could conclude, à la Trump, that the UK just has better genetics than the USA, but really I’m going to have to stick to my belief that we’ve got a system that (apologies for the repetition) has its flaws yet still manages to deliver fantastic health care to ALL that need it.
- List of countries by alcohol consumption per capita - Wikipedia
** Prevalence of tobacco use - Wikipedia
*** Which are the laziest countries on earth? | News | theguardian.com
**** Health care system - Office for National Statistics
***** Health Costs: How the U.S. Compares With Other Countries | PBS NewsHour
I picked the 2 most popular diagnostic machines used because that’s exactly what the article did. But lets read the whole paragraph:
The UK also has one of the lowest numbers of practising doctors per population (including GPs and hospital doctors) in the EU and although the number of nurses is around the EU average, it is lower than comparable countries like France, Germany and The Netherlands. The UK also has fewer CT scanners (8 per million population compared to an EU average of 21.4) and MRI scanners (6.1 per million compared to an EU average of 15.4) than most other European countries. However, this data does not include diagnostic scanners based in non-NHS providers that are used by the NHS.
I didn’t write the article I simply added the US statistics to other European countries.
I read it.
Quality: The indicators of quality were grouped into four categories: effective care, safe care, coordinated care, and patient-centered care. Compared with the other 10 countries, the U.S. fares best on provision and receipt of preventive and patient-centered care.
This is in line with what I talked about regarding delays in medical care. We have the diagnostic tools to make timely decisions. We get lower rankings because we don’t have UHC.
Do you want to know who suffers in the US? Veterans. Unlike Medicaid which handles the poor through our private medical system our veterans go through a separate government run system. Lots of delays. Probably a very efficient program.
There’s a reason for that. We have a demographic subset that has a statistical propensity of killing themselves at a much higher rate than other groups.
Yes, we spend more per person in the US. And the lines are shorter.
I said it once already. If the private insurance cuts through the delays the DHS is known for then you have the best of both worlds. If it doesn’t then you’re stuck with the delays.
And please don’t say the delays don’t exist. They do. I can’t imagine a system where 18 weeks for non-urgent consultant-led treatments is the benchmark for failure. They’ve made improvement’s over the years but the numbers are still high.
Presumably not allowing for the people who triage themselves out of ever joining the line in the first place because they can’t afford it. What’s their waiting time?
Magiver, i’m interested in your view on why successive US presidents have campaigned on reform healthcare while people march in the UK to protect their healthcare service?
That division is mirrored on this message board yet you seemed convinced by one report from 2003 in particular. Are you not at all impressed by decades of personal experience and national sentiment?
well, I don’t know where to start. The USA does not fare best for patient-centred care, The UK does, followed by Switzerland, followed by the Netherlands. That’s what the numbers 1,2 and 3 stand for. The table even provides pretty colours to make interpretation easy. The USA does not come top in any criteria and out of the 11 countries it comes 11th overall.
If you are seeing things that aren’t there then there really isn’t a meaningful discussion to be had.
Trying to include “infinity” in determining averages plays havoc with one’s calculator.
But it remains true that lines will be shorter if vast numbers of people are unable to join them.