Why would you buy health insurance if your country has UHC?

Factual Questions
1

There’s a thread over in IMHO about the accomplishments that are supposed to signify middle classhood, and one of the hallmarks, according to the OP, is that you have health coverage. GHO57, who I believe is German, says he meets that criterion twice over, because he has self-purchased insurance in addition to the national program.

My question is, why? If you live in Europe or Canada where you have NHC, what does buying health insurance get you? Is it more elective treatment choices, or a better room when you have to go in the hospital? Better prescription coverage? Or do the national programs in Germany and Canada, just to pick a couple of examples, leave large gaps in your coverage? I’ve long seen ads in German media for Krankenkassen, but I never understood what exactly it is they’re offering or why you’d need it.

2

It’s another layer of security net in case you’re hit with a disease that’s expensive to treat, can only be treated abroad or that cripples you. Yes, the government takes care of most things, but if you catch a disease that only specialized private doctors in Germany have good track records for curing, the government doesn’t always fund that treatment if there’s an “adequate” treatment in-country. Of course you’ll want to take the treatment that has a 35% chance of complete cure rather than the one with %30 in-country.

Or you can be hit with something debilitating that keeps you from working. Being lamed, for instance - yes there’s resources for lamed people in UHC countries, but the state pention for people unable to work isn’t necessarily something to write home about. In that case, it’s nice to have an insurance policy that enables you to live with your current quality of life and lifestyle.

3

In Canada, certain things aren’t covered by provincial health care. For instance, prescription drugs, prescription eyeglasses, massage therapy and dental work (among many other medical or paramedical goods and services) aren’t covered in Ontario.

4

Are you asking about insurance that supplements the government’s insurance plan? For example, here in Canada, we cannot buy private health insurance that replicates the government coverage we have. We can, though, buy supplementary health insurance to look after the things that the government insurance does not (e.g. prescriptions, dental, vision), or perhaps to enhance the government insurance (e.g. a private hospital room). This supplementary insurance is often a benefit of employment, but it is entirely possible for an individual to purchase it if his or her employer doesn’t supply it. Could this be what GHO57 was talking about?

5

This coming Wednesday I will be getting Medicare, which can, in a broad sense, be considered a type of UHC. But Medicare doesn’t cover everything. The parts that are “free” still involve premiums and copays, and many things just aren’t covered, like prescriptions. So I’m getting supplemental coverage for these things, as well as coverage in the “donut hole,” which I won’t even try to explain. The process is insanely complicated; I devoted over three weeks, full time, to decide which plan is appropriate for me. I sincerely hope it’s easier in other countries.

One example of the insanity is that, up to a point, my prescriptions will cost more than I’ve been paying on my own, with no insurance.

6

Am I correct in guessing that the cost of this insurance is usually quite reasonable? It sounds like what we call umbrella coverage here; it doesn’t really kick in until you max out your other coverage, and it won’t do anything for you without that first layer.

7

Finnish actually.

One of the differences is, the national system has longer waiting times, I might have to make an actual appointment… or hang around in a waiting room with sick people if there’s a flu epidemic. I’d rather pay a couple of hundred to go private and stick it to the insurance company.

Some treatments are not covered under the national system… iirc erectile dysfunction for example isn’t deemed life threatening enough to merit coverage… not that I have it *knocking on wood *(no pun intended). Well, to be precise it’s not *normally *covered… but they make exceptions… getting one would just be a load of bureaucratic haggling I’d rather bypass. For some reason erectile dysfunction caused by another covered condition (or is a side effect of medication for one) *is *covered.

Oh, and the national system is mostly just basic medicine, they buy expert services from private contractors. If my knee hurts, I’d have to make an appointment with an NHS doc, who would then check me out first, and eventually send me to an orthopedist. And then I’d have to wait for them to make a decision if the condition merits an operation… and then wait more for an opening in the slice-and-dice queue. I prefer to go straight to the expert, in and out in a day.

Besides, I pay 500-ish per year for near absolute coverage; if I can get a doctor to sign off on something, it’s completely free (excluding cosmetic surgery). I also like the fact that if I get sick in a foreign country, I can get an ambulance flight back home if the expected hospital stay is more than 5 days. Seriously… anything a doctor will sign, like getting my head x-rayed for the sole purpose of using it as Halloween decoration. Instead of buying sunscreen and a snakebite kit for the holidays… I get a doctor to prescribe them, and the insurance company pays.

8

Oh, and I also save the trouble of trying to remember where my NHS card is. You’re supposed to show it when you get a prescription filled, that way you pay on average 5% of the actual price… with my insurance, I can just grab the drugs at full price and hand the bill over to the insurance company to pay.

9

This is the same type of additional insurance coverage we have through my husband’s work, too. The cost of it is deducted automatically from his paycheques once per month (I think it’s about $75 per month).

10

Here in Oz we have Medicare (the government UHC) and private coverage. The mix of services and payment is a curious thing.

You are guaranteed a base level of coverage. No matter what your income or circumstances, the idea is that you will get care. Hospital says are in state run hospitals, you get a public ward, full of beds with other patients. You do not get to choose who treats you. For less urgent (or elective) surgery, you join the queue.

Private care, you get to stay in private hospitals, usually with a single occupancy room. You choose your doctor. Access to less than urgent treatment is vastly faster. Private cover includes ancillary services - physiotherapists, and the like. There is however often a co-payment for these. Private cover may be extended to include dental, although the co-payment is of the order of 40%, or even more for crowns and bridges. Government dental cover does not exist, and remains a political football. (You can, and many do, attend a clinic at the dental school, which is free. You are of course seen by students under supervision.)

Now the weird one. No matter whether you are privately insured or not, your doctor is paid, at least in part, by Medicare. There is a government ordained scheduled fee, and Medicare will pay betweem 100 and 75% of that. So even with UHC, there is a co-payment. However a doctor may elect to not bill you, but bill Medicare (termed <i>bulk billing</i>). In which case he gets the 75/85%, and eats the gap. Many GPs bulk bill all their patients, especially in less affluent areas, and pretty much always where there is any hardship. (One win for them is that they are assured of payment from Medicare, and don’t have to go chasing bad debts or late payments.) Doctors are of course free to charge more than the scheduled fee as well. In which case you get to pay the gap. But you can shop around. If you want treatment from a specialist, you can’t get a rebate from Medicare unless you have first seen a GP and got a letter of referral.

It is illegal to insure for the gap. Unless the treatment is whilst admitted to hospital. So for hospital stays, you can get full personalised treatment from a doctor of your choice in a private room in a private hospital (and some look more like five star hotels than hospitals) with little to no waiting, even for non-urgent treatment, essentially at no fee. If you have private cover.

It is accepted that for some things, you will be in the public system no matter what. A serious motor accident will have you in the nearest big public hospital’s ER.

In Oz, prescription drugs are already seriously subsidised by the government. For drugs that are approved we pay a capped prescription cost of about $30. If you go over $1000 of prescribed drugs in a year, the cost drops to $5 per script. The private insurers do extend coverage for some drugs not on the schedule, but since the coverage is actually pretty good, this isn’t an issue for most people.

The Oz government really likes people to have private coverage. So much so, there is a 30% rebate on the cost, which can be claimed against your income tax. The government breaks out some of the costs for Medicare as a separate component of your income tax (it isn’t true really, the real cost to the taxpayer is higher) and if you don’t have private cover, they increase this amount.

11

Francis Vaughan covers most of the issues,I live in Australia and have private coverage, I’m more in control of my destiny if something goes wrong, the biggest disadvantage of universal coverage is the waiting list, you can’t make an appointment to get something done you have to wait for a call a day or two before surgery , private you can set a date ,it might be months away but you have a date your not in limbo wondering whats happening.

12

Just to be clear, you get what’s available. When I went into the public hospital to have my baby I was in a private suite for the duration of my stay with its own bathroom and a double bed (and they set up a cot bed for my mother when she stayed with me the first night while I was in labour). My entire out-of-pocket cost for the induction, birth, aftercare, and five day hospital stay was something like $19, and that was to cover the iron tablets and ibuprofen they prescribed for me to take home with me - all the medication taken as an in-patient was covered by Medicare.

13

Hmm, this almost sounds American. We have Hospitals where anyone can go for ER treatment or because they have a cold. The difference is if you have coverage already you don’t go to the ER as your primary care unless you really need ER. If you aren’t covered then go to the ER, get treatment, plus you may get aftercare treatment.

Where can you go in the USA and be denied ER medical care? And even after. that be denied care? The waiting list for after-ER-care in the USA seems to be at least as good if not better then the UHC countries. And the care itself I might argue even better.

Any stats?

14

Yeah, it really is worth mentioning that for childbirth and neonatal care, the public system is very very good. I know women who have have given birth in both, and many find the difference not all that great. (Although you get some very polarised opinions too.) And again, if there is a serious problem, mother and child will be whisked down to the major public hospital.

The other point I omitted. Public hospitals have private beds. To be assured of getting one you need private cover. However nothing is absolute. A public patient may get a private bed, and a private patient may be bounced into a shared ward, even in a private hospital, depending upon availability.

15

The difference in care seems to come in the middle. If I wander into ER with gallstones, or cancer, it isn’t going to work. When the treatment is for a non-acute, non-urgent issue, you are back to the main problem. If I wander in with heart pains I will get seen instantly. But ER won’t provide ongoing care from a cardiologist.

Here in Oz, you will be: booked in for an cholecystectomy at some time in the future (some months unless you have a complications); get referred the the public hospital’s cancer clinic; or the public hospital’s cardiac care unit. You won’t get to choose you doctor, and you won’t even necessarily be seen by the same doctor each visit. However, another curious point. The same doctors working in the public system may well also be working in private. It is common for specialists to do some sessions in the major public hospitals and also to work out of their own consulting rooms. These specialists have bed rights (i.e. they may admit patients under their care) to both the private wards of the public hospital, and to a private hospital.

When I had a cholecystectomy it was done in private. I saw my GP one day, he muttered, sounds like gallstones doesn’t it? Yup says I. OK, lets get an ultrasound. Got the US an hour later from a clinic down the road, walked back to my GP. Yup, big gallstone. He wrote me a referral to a surgeon. I called them up, got an appointment for a couple of days hence. Walked in, “Gallstone eh?”, “Yup”, “Want it out?”, “Yup”, “Next Tuesday is good for me”, “Yup.” Private room in cute little hospital, all done and dusted in a bit over a week from being sick. No charge with private cover.

16

I’m French, here buying a supplementary mutual (or not) insurance, is a way to get better funding for some stuff.
Like, most meds are only funded by our NHC at 65%, so you have to pay the remaining out of pocket unless you have a supplementary insurance (barring some exception, like being poor enough to qualify for a supplementary coverage from the state or the med being part of an ongoing long term treatment for which you can get 100% coverage). It’s kinda the same for specialist visits.
Or, our NHC doesn’t give much money for stuff like dental or eye care, so having additionnal coverage helps.

I used to pay about 35 euros/month for mine, I dropped it when money got tough and because it was paying for something I was never using, and then I qualified for the supplementary insurance from the state so I took that.

17

In Spain, it can be for additional coverage or to have perks in a particular center or network (like a single room; note that in Spain any room bigger than a double went the way of the dodo decades ago), although you have to be careful with those as many of them have been involved in SS fraud. It’s very unusual to have it, except for catastrophic coverage (which is not for medical costs, but for surrounding costs like stay of a relative).

Also, there is a kind of insurance companies/medical centers which specialize in labor-related illnesses and accidents, called Mutuas; they are older than SS. These are part of SS coverage now, but they’re both generalists (in that they treat all kinds of things) and specialists (in determining whether it’s job related or not); companies and the self-employed have to choose which Mutua provides their service (I do not pay the Mutua, I pay SS, but I had to choose a Mutua from a list and if I get hurt at work I’m supposed to go there rather than to a hospital, if possible). SS coverage has been universal only for a couple of decades, and some people whose jobs transferred to SS only recently were given the choice to opt to keep Mutua coverage instead of SS coverage for their regular medical needs and retirement (including medical needs and the retirement “pay”). Mutuas do not have hospitalization facilities: if you need hospitalization and it’s for job reasons, the Mutua handles the paperwork but you’re in a normal hospital.

18

When Fierra, a UK citizen born and bred, had her serious kidney problem which was in danger of causing her to lose a kidney entirely, she was told that because people can do just fine without a kidney, they weren’t going to be scheduling any surgery for her anytime soon. In fact, after she had an intensive renal scan she was told that it would take 6 months to even see the doctor to merely talk about the results! Hence the need for private health insurance in the UK - so when something is seriously wrong with you, you can actually be treated for it and not lose a kidney.

Funny story, she had her kidney scan a few months before she moved over here to be with me. Since my insurance covered domestic partners as well as spouses, she was covered, and she had two scans, tests, and surgery performed by the best kidney surgeon in the area and her kidney was saved. FTR, the kidney specialists here said that not only was her kidney in desperate need of fixing, but it could lead to stress on the other kidney and could have led to both kidneys failing, and then a transplant or possibly death. And then right after her surgery, 9 months after her UK exams, she received a message on her UK phone, telling her that the doctor might be able to see her now to talk about the tests, and then they would see about which year they might schedule the surgery for. :rolleyes:

Fierra’s mother, even though she has dental access under the NHS, has to use private dentists because there are none in her area which can see her. Fierra’s grandmother received third-world care in the UK under the NHS, which even the NHS physicians treating her admitted was what ultimately killed her. Friends in the UK have had to pay out of pocket for private doctors because they cannot get in to see NHS doctors.

One can debate UHC somewhere else; the factual answer is one reason “average people” get health insurance in UHC countries because obviously something is seriously lacking with the UHC system in their circumstance.

19

Canadian here. It’s not cheap. If you’re lucky - e.g. me - it’s simply part of your employment benefits package.

Were it not for my benefits package I’d be out an ass-ton of money. Eyewear, drugs, dentistry, a private room at the hospital when my daughter was born - and a dozen other things - thousands and thousands of dollars I’d have spent without that insurance.

20

Brit here, people go to private hospitals if they’re reasonably well off because it saves waiting time for minor ailments to be operated on, plus they get individual (very, very comfortable rooms with extra service, cable etc.).

As to the actual standard of proffessional ability they get absaloutley nothing more then N.H.S. patients do.