Joined: 29 Sep 2004 Posts: 2498 Location: Los Angeles, California, USA
Posted: Sun Jun 17, 2007 5:27 am Post subject: Nationalized health care around the world
On another forum a discussion of Michael Moore's new film Sicko sparked a conversation about nationalized health care (notice that I'm discussing such things elsewhere like a good little girl).
I can discuss the Canadian system because I've had a good deal of experience with it. But once out of the US and BC I'm limited to what a retiring American doctor told me a number of years ago which was that the best medical research, in his opinion, came from countries with national health care because they had such comprehensive data and complete populations.
If anyone cared to enlighten me as to how (the mechanics) it works in your country and how you'd review it I'd be thrilled to expand my personal databank. Thanks so much. _________________ God writes a lot of comedy... the trouble is, he's stuck with so many bad actors who don't know how to play funny. -- Garrison Keillor
Well in Britain there are large teaching hospitals that are also involved in research. St Thomas' and Guys Hospitals are examples of that. Many of them are also linked in some ways to nearby universities albeit loosely and the research can happen in that way through the hospitals and fed back into the universities.
Of course there are all kinds of permission that have to be sought but the result benefits everybody. And all this is part of our National Health Service, which is free at the point of delivery.
I am, I suppose, a teensy bit biased in favour of the NHS as I was born with a condition called Fallot's Tetralogy and I had my heart surgery, in 1971 at Guys Hospital in London, which incidentally is where the young John Keats trained to be a doctor. _________________ Confusion comes fitted as standard.
In Ireland we have a system based on the NHS - hospital care is free to all. This works well for urgent things but waiting lists are long for elective procedures - 4 years for a hip replacement anyone? Consequently we also have a private hospital system that deals with a lot of this stuff (and has better food and facilities). Most doctors work in both the private and public sector, the waiting lists in the public sector are primarily created by a shortage of beds.
The public hospitals in the cities are all academic teaching hospitals allied to one of the medical schools and research would be an element of the job for all the staff in these hospitals.
In terms of primary healthcare there is a means tested 'medical card', if you qualify all doctor's visits and prescription medications are free. No family pays more than E80 a month for prescriptions - no matter how wealthy they are.
Joined: 29 Sep 2004 Posts: 2498 Location: Los Angeles, California, USA
Posted: Sun Jun 17, 2007 10:23 pm Post subject:
Thank you for sharing that info.
If I am gathering it correctly (and I certainly want to before I represent it someplace else!) in Britain and Ireland there is some sort of means testing that establishes a modest rate for payment appropriate to the means of families but provides any service to any family provided they are willing to wait. And alternate private facilities exist for those who don't want to wait or prefer more posh amenities.
This is different from Canada where everyone gets the same services and uses the same facilities. A few years ago a new Prime Minister got himself in some deep doo-doo because it was discovered that he had private health insurance and was going to the head of some lines. Don't know if he survived that scandal. _________________ God writes a lot of comedy... the trouble is, he's stuck with so many bad actors who don't know how to play funny. -- Garrison Keillor
You've got the gist of how it works here - although as long as you are prepared to wait the public hospitals are completely free to everyone, it's just family doctors and medications that are means tested. Some facilities like Accident and Emergency departments and anything specialised or complicated (neurosurgery, paediatric surgery, transplants) are only available through the public system.
Fundamentally it's a really good system the main problem being that we've gone from being one of the poorest countries in Europe to one of the richest in the last ten years and the capital infrastructure programs just haven't kept up with the pace.
Joined: 29 Sep 2004 Posts: 1196 Location: buried under a pile of books somewhere in Adelaide, South Australia
Posted: Mon Jun 18, 2007 12:37 am Post subject:
One of the best insights I've had into the Canadian Health System was from watching 'The Barbarian Invasions' - fantastic movie. One of the very rare ones where the sequel is (much!) better than the original - 'The Decline of the American Empire'. _________________ Doing what you like is freedom
Liking what you do is happiness
Joined: 26 Jun 2006 Posts: 184 Location: London, UK
Posted: Mon Jun 18, 2007 3:22 am Post subject:
Australia's health care system is pretty complicated but it is based on a system called 'Medicare' which is available to all Australian citizens and others on permanent visas. It entitles you to free treatment in any public hospital as an inpatient. If you are in line for elective surgery however this is not such a fantastic option as you will be waiting for a loooong time for most procedures.
Out of hospital care is a different story- certain GPs (or family practitioners as you call them in the US) 'bulk bill' their services meaning that they get their fees directly from medicare for seeing you- and therefore is free for the patient. Other GPs (the vast majority) charge you a 'gap' where they charge medicare for the majority of their fee but then charge you a small (ish) fee on top of that, usually about $15-30. Again, most bulk billing GPs have waiting lists (up to two weeks). Specialists also charge a proportion of their fee to medicare but their gap is usually a lot higher (it can be $100 or more). People can only see a specialist if they have been referred from their GP for some specific problem.
Rather than relying on medicare many people choose to be members of a private health care fund which allows you to 'jump queues' for elective surgery, see your choice of doctor in a public or private hospital and in some cases get a private room. Many people prefer this option if they can afford it because who wants to wait two years to get a knee reconstruction? Also there are other benefits like free spectacles if you need them, cheaper hearing aids, discounts on gym membership etc.
Medications are often covered by the pharmeceutical benefits scheme (PBS) where the cost of medications are discounted to make them more affordable for everyone. I think that most countries have a scheme like this. If you are members of certain health funds they can be even cheaper as they cover part of the fee. If you are unemployed, on a single parent pension etc. you can get a 'health care card' which gives you access to most medications on the PBS for a heavily discounted price (like, $5 or something)
All of this is based on my own limited knowledge, having had only a few brushes with the hospital system in my life (touch wood). I have never worked in the health system and therefore I am quite happy to be corrected...
If I am gathering it correctly (and I certainly want to before I represent it someplace else!) in Britain and Ireland there is some sort of means testing that establishes a modest rate for payment appropriate to the means of families but provides any service to any family provided they are willing to wait. And alternate private facilities exist for those who don't want to wait or prefer more posh amenities.
Rainey,
There's no means testing in Britain NHS. If you're ill you get treated free. Ireland's system may be based on the NHS, but clearly isn't the same. There are certain services that have become privatised (privatisation being mostly considered a dirty word here), such as dentists and eyecare, but those are means-tested. If you're unemployed or receiving welfare benefits, then you are treated free and the NHS picks up the bill.
There has been creeping privatisation, but governments have learned the hard way that you tamper with the NHS at your peril. Thanks to the health improvements because of the NHS since it's foundation, it's become considered a national asset. It's paid for through taxation, but also when you get your pay, as well as tax, national insurance is also taken off, that is what goes towards the NHS so that we all get free healthcare.
I've been in hospital for brief spells over the last three years and found it to be pretty good still.
But the Choccy Moose is right that there are waiting lists, which I would say is in large part due to government interference at least here. Spending over 6bn on the Iraq war didn't help either. That was money that could have been very useful for the NHS and people know it. _________________ Confusion comes fitted as standard.
Joined: 28 Oct 2005 Posts: 118 Location: Haifa, Israel
Posted: Mon Jun 18, 2007 7:57 am Post subject:
In Israel, everyone must belong to a health provider. A portion of your salary is transfered to your provider of choice (the more you make, the more you pay, of course). For this, you get pretty decent health care, though like in other countries, elective procedures and some services generally mean a wait (NOT four years, though).
Visits to primary care doctors, pediatricians, OBs and possibly other specialties are free; for most specialists, you'd pay the equivalent of about $3. Hospitalization I think is free; ER visits are free if you were referred by your physician or if they resulted in hospitalization. Physical therapy and many outpatient services are subsidized. Medications included in the coverage are very cheap (usually $3-6); however, if you are unfortunate enough to need something that has not been included, be prepared to pay. There's also a system of centers for pregnant women and for them and their children after the birth, which I've heard is very good and free of charge (have not had the opportunity to use it myself ). I know the costs are regulated to a large extent but am not sure who the regulating body is (the Ministry of Health, maybe?).
In all, it's a pretty decent system but it's still best to get some supplamental insurance because some things either require too long a wait or are not covered. I think the options this gives you are pretty similar to what emilyj described as being offered in Australia. There's been some talk about the effects of this - i.e. one sytem for the poor and another system for those who can pay.
Research opportunities exist though naturally they require assorted clearances and permissions (for ethical reasons and so as not to pester patients and staff without good reason).
Joined: 08 Aug 2006 Posts: 136 Location: France, Bordeaux
Posted: Mon Jun 18, 2007 10:40 am Post subject:
In France we have what is called social security. Everyone is supposed to have some basic coverage. When you work, or are retired, part of your salary/pension goes to paying for it. Your children get coverage through you, until they're 18 at least, then they can ask for student coverage. When you don't work, you are still covered, the basis varying according to your situation. You then add to this minimum a private insurance, if you can afford it. Doctors can choose to charge regulated rates or free rates. The general principle is that you have access to all doctors, medication, hospitals.
It goes 3 ways : you pay then get a refund, whose amount can be as high as 100% of the bill, according to your insurance. You pay just the part that your insurance covers, and it refunds you. Or you don't have to pay, social security pays the doctor and sends the info about the rest of the bill to your insurance. This works for doctors, hospitals and medication.
The charge for a GP is 21, 25 for a specialist, 35 for a psychiatrist. Social security pays 70% of the bill, you (or your insurance) pay the rest. If you go to a doctor who has chosen to have free rates, social security pays on that 70% basis, and the rest depends on your insurance. Some cover up to 300% of the SS rate. For drugs, the refund rates vary, 35, 40, 60, 70%, and some are not covered at all.
You have the right to choose your doctor, your hospital, and, according to prescriptions, your medicine. But some will charge more, some drugs are more expensive, or not covered. If it costs more than the standard rate, you pay. In case of severe illnesses, like cancer, you are covered 100% for all expenses pertaining to that illness (a day in hospital can cost as high as 15000, for a heart attack for example).
For people with really low income, who can't afford insurance, there is a state coverage that goes to 100% of the SS rate.
I'd say it is a pretty good system, but it was set up when France had lots of workers and few retired people, who usually died fairly quickly. Now that the workforce is somewhat diminished, and retired people are more and more numerous and live longer, the balance is tipped the wrong way. That's what we call "the social security hole". Someone who retires now at 60 can expect to live 15 to 20 years at least, there are more and more people 80, 90 or more, and long term medical care is weighing heavily on the system : more Alzheimer cases for example.
Plus there is this idea that "I pay my dues, so I have the right to be treated and spend as I please for my health". French people love their meds ! And the system can be used and abused. Many new noses have been passed as "deviated septum" cases, and with the right doctor, you can have your breasts redone, practically free of charge !
So the system is not perfect, but it insures that everyone can be treated. Will it last in this incarnation ? Can it last ? I don't know. I hope some rational means will be found to amend what does not work well, and maintain what does.
Rainey---that Prime Minister was fairly quickly led to the guillotine but for many other reasons besides the healthcare issue! _________________ Vivant Linguae Mortuae!!
Joined: 29 Sep 2004 Posts: 2498 Location: Los Angeles, California, USA
Posted: Mon Jun 18, 2007 9:00 pm Post subject:
Thank you everyone. I have not read through your posts carefully yet but I can see that there is a lot of variation. I look forward to finding out lots more about it as I suspect it will become a major theme of the upcoming elections.
David- I was just there when Chrétien had announced his retirement and was being pushed to get on about it and Martin was highly anticipated. It was well after we returned to the US that the scandal developed. So, there were others as well? Did he survive it (not that it sounds like he did)?
Sorry to have lapsed into ignorance but we're headed North for a wedding the weekend after this and I'll try to catch up.
The wedding will be in Kalona. I have only been to the Okanogan once and it was early in the spring when nothing was in bloom. I can't tell you how excited I am to go back and see it and sample all the ripening fruits I've heard so much about. ...oh, and there's a lovely couple who have been together forever who are finally making it "official" and letting us celebrate it with them. _________________ God writes a lot of comedy... the trouble is, he's stuck with so many bad actors who don't know how to play funny. -- Garrison Keillor
Rainey--what did in the benighted Martin was what is infamously known as the sponsorship programme scandals, which in all truth the poor man had nothing to do with, but which tarred his party--the Moribund Liberal Party of Canada (aka Canada's natural ruling party) with a broad brush which, sadly was richly deserved! Watch for the rise of the Greens next election! _________________ Vivant Linguae Mortuae!!
Rainey-----you must, when in Kelowna at least have lunch on the outdoor terrace at Mission Hill, then find a bottle of Quail's Gate Old Vine's Foch. Oh what fun for you!!! Cedar Creek is another wonderful one---and then there are a whole passle of dandies south of there we didn't get a chance to check out. We sent 11 cases of wine back after a 4 day visit! _________________ Vivant Linguae Mortuae!!
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). I know the costs are regulated to a large extent but am not sure who the regulating body is (the Ministry of Health, maybe?).
