What's the health service like where you are?

[iBrian]

Here in the UK the National Health Service (NHS) has problems. To their credit, they'll rush you into hospital for any suspected emergency, but then rush you out of any bed as quickly as possible to make room for the next person, leaving you to wait around for a lift or taxi back home. If you need any routine work the waiting lists are long. For non-urgent care it's often the case of fighting to get an appointment. The NHS is free, but it feels very much at the moment that you get what you pay for.

The US healthcare system - so long as you have medical insurance - has always come across as very efficient, with little waiting. However, is that really the case, or do service levels vary greatly?

For other countries, what's your health service like?

Btw, I'm looking to keep this discussion focused on healthcare provision for those who are eligible, rather than distract into debates about free vs private insurance, and the exclusion of care for those who can't afford it.

 

[Faithfulservant]

I have noticed a change since the pandemic. Not positive changes either.

 

[wil]

Mine is currently all screwed up and have to pay out of pocket and hope nothing happens.

That being said I have discovered that our system charges insurance companies AND people with insurance more than people without insurance. ie I have paid less for meds in cash than others have to pay for their deductible on the same meds.

Note this is my anecdotal exlerience and does not apply to all drugs, pharmacies, docs or situations.

That being said, when I had insurance, my conditions put me to the front of emergency lines and too the rear of elective surgeries (docs not fixing my knee because of my heart)

 

[Faithfulservant]

I have s high deductible insurance which is new. I made the choice to pick it because i would rather have a PPO instead of an HMO. I wanted control of my decisions. Ive been having some issues this year and my deductible is almost 5k and ive already almost matched that.

 

[TheLightWithin]

After not having health insurance most of my adult life, in recent years I have had good insurance because my husband works for the state.
(previously I had insurance on an on and off basis depending on various factors)

It used to be (during my adult life) if I got sick I went to an urgent care, paid out of pocket, and got antibiotics (I tended to get sinusitis, strep and/or bronchitis every couple of years for many years) When I was a kid we had Medicaid and went to the doctor if needed. I expected to wait.

When I had a crisis with my gall bladder 3.5 years ago, I had a very long time in the ER, but I got very good treatment, there just weren't enough nurses or doctors or PAs around. I was on a gurney in an alcove, so not in the open hallway, but there were gurneys everywhere throughout the ER and including spilling into the hallways.
I was told the reason I had to wait so long in the ER for the attending was that there had been some kind of multi car accident (the attending told me herself) that kept her in that one wing - they didn't have enough staff and I guess they couldn't call more in. But even though it took hours, I was sent for scans, I was given a clear explanation of my problem and how critical it was, I was admitted without incident, and even had a private room. I didn't request anything they just put me there.
(I am SO GLAD I had that insurance, I don't know what I could have done without it)

For some reason despite their anxiety about my status I had to wait a few days for surgery. I attributed that to the multi car accident that made the ER visit so long. They kept an eagle eye on me checking my stats every couple of hours.

Some things went kind of wrong in that I had complications. My understanding is that complication can happen and probably wasn't due to an gross error (how would you prove it anyway) and is easily corrected by a follow up procedure which did take care of things. (but required yet a 3rd f/u procedure to finalize) when usu gall bladder surgery is one and done.

My biggest criticism is how the entire process of discharging me was sloppy - there were several things there that could have been done better, pretty much every detail of every step, but the failure to schedule me for a follow up was a huge oversight esp since I DID end up having medical complications post discharge. My issue could have been caught sooner.

Luckily the insurance company care manager called me as part of THEIR follow up (the hospital didn't seem to notice the lack of a f/u appt and didn't call me! ) And I was affected such that I wasn't thinking clearly. But I knew enough to call the case manager back at the insurance company and they stepped in and got things rolling again. I ended up back in the ER and back in the hospital but the medical issue was dealt with.

I know that if I have a problem I can get good medical care. The fact that things went wrong in the organizational end of things does not surprise me at all, based on my work experience in care coordination in my mental health career - and also hearing many, many, many client stories during my mental health career.

 

[moralorel]

Mine is currently all screwed up and have to pay out of pocket and hope nothing happens.

That being said I have discovered that our system charges insurance companies AND people with insurance more than people without insurance. ie I have paid less for meds in cash than others have to pay for their deductible on the same meds.

Note this is my anecdotal exlerience and does not apply to all drugs, pharmacies, docs or situations.

That being said, when I had insurance, my conditions put me to the front of emergency lines and too the rear of elective surgeries (docs not fixing my knee because of my heart)

You are correct. Often those with insurance are charged double the price of those who don't have insurance. It has to do with the negotiations between the insurance companies and the providers. It's somewhat complicated, but you are definitely not imagining it. In some cases it actually does apply to drugs and pharmacies. When I didn't have insurance years ago, the pharmacist at Walgreens was able to drop the price of my meds by 80%. I just had to became a rewards member. I'm sure that deal has changed, but I wasn't bound by any agreement they had with an insurance company.

 

[moralorel]

My experience has varied by state and city. I have a daughter with many health issues. She has had many visits to the ER. Most of the time she has been admitted within minutes. But one year we were on vacation in Florida. We spent 6 hours in the ER before we could be seen. Thankfully she was fine.

What we have been experiencing, at least where I live, is a lot of clinics and hospitals closing down. My family used to go to an amazing family doctor. We could go see the doctor all at the same time. My wife, daughter, me, and my son could all be seen all at once. We could all do our physicals and/or checkups at the same time and all get our vaccinations at the same time. But then the clinic closed down. Now the new clinic in town isn't so accommodating and is double the price. We lost 2 hospitals. They claimed that they had to close down because Medicaid was only paying half of what they were supposed to pay in my state. The clinics had the same issues. The politicians have been very successful at finger pointing. That's about it. When our first son was delivered we had an amazing staff at the hospital and a huge room for the delivery. But that place closed down so my wife gave birth in a different hospital. While it wasn't bad, the hospital had half the staff and delivered our baby in a glorified broom closet. It was so small. At least the good news is that after my son was born my wife was transferred to a much more comfortable room.

The thing is, where I live the economy is booming. Our population is growing. So there isn't a shortage of customers.

 

[Thomas]

Here in the UK the National Health Service (NHS) has problems. To their credit, they'll rush you into hospital for any suspected emergency, but then rush you out of any bed as quickly as possible to make room for the next person, leaving you to wait around for a lift or taxi back home.

I wonder how much of that is a postcode lottery? Not disputing the case as laid out above, but in two cases:

Hip replacement: Diagnosed to operation, a couple of months ... but that is probably because I'm North London.

In hospital (wife drove) 8.00am.
Saw the clock just before I was sedated, having previously been umbed from the waist down (spinal block?): 9.00am.
Woke up in theatre after op: 9.41am
On phone to wife, around 10.00am (couldn't remember her mobile number for a while ...)
Walking up stairs on crutches by 12.30pm.
Climbing into car to go home 5.00pm.

+++

Wife had recent heart-bypass surgery 'twice', so a 4-hour procedure took about 8.

In hospital, when cleared to go home a few days later, nurses said, discreetly, 'there's no rush, if you want to stay?'

I wonder if because St Barts in London is a specialist heart hospital, and doesn't have an Accident & Emergency entry route?

Waiting times at A&E are the worst, we've done that more than once, and you best write off a good few hours.

 

[Thomas]

There's also a seeming case for hospitals in affluential areas, compared to hospitals serving less affluent communities.

We have a case of 5 hospitals all under one governing 'trust' body. The hospitals serving monied segments of the community are notably better all round than the poor relation hospital which serves a broad community without an affluent area of well-off and connected people who have influence and can make a fuss ... it's quite obviously unfair.

On the downside, one hospital located in a notably well-to-do area is notorious for its lack of access. Hospital parking is always full, with cars lurking, waiting for a spot to become clear. We go early, park outside the hospital grounds and walk in. Every other hospital has a multi-storey car park, this one doesn't, because the local (very well-off) community lead a successful campaign against it.

 

[wil]

There's also a seeming case for hospitals in affluential areas, compared to hospitals serving less affluent communities.

All.over this country (USA) i have heard of folks who drive or even take the train outta the city and into the suburbs for the more affluent hospitals...me? I got a thing for teaching hospitals, the kids are learning the latest and greatest and the docs will "do rounds" in your room and you get.to hear all the ideas and discussion from.the residents and interns!

 

[Thomas]

I'm with you, Wil.

Our twins were born at University College Hospital, London, a teaching hospital.

Our third daughter elected to have her children there, as the local hospital is the 'poor relation' hospital mentioned above.

 

[TheLightWithin]

All.over this country (USA) i have heard of folks who drive or even take the train outta the city and into the suburbs for the more affluent hospitals...me? I got a thing for teaching hospitals, the kids are learning the latest and greatest and the docs will "do rounds" in your room and you get.to hear all the ideas and discussion from.the residents and interns!

I'm with you, Wil.

Our twins were born at University College Hospital, London, a teaching hospital.

Our third daughter elected to have her children there, as the local hospital is the 'poor relation' hospital mentioned above.

I was born at a teaching hospital. My dad was a student at the university (undergraduate-I think) and my mom said she could go for free.

 

[Phyllis Sidhe_Uaine]

Convoluted (in more ways than one!)

I'm on an HMO/Medicaid, and there have been times that I knew more about what I needed than the medical staff! Then there have been physicians/prescriptions that weren't covered by my insurance, not to mention procedures! We won't discuss the physicians who retire without mentioning that they were! Oh, and then there are/were places where I could get an eye exam, but not fill the prescription, and then there were places where I got glasses for a while but the optician's office closed!

Oh, and there were a couple of (former) physicians who "played" what I call "the religion card", telling me what my "role" was "as a woman"! I gave both a piece of my mind, telling them that, if they had read my file, they would understand why I couldn't fulfill that perceived "role" (the physician after one of them understood the problems that I'd have, even though he was a practicing Muslim and I'm not...)

Lastly, there were medication changes right after I ran out due to either a blanket termination of coverage or the medication was discontinued by the either the FDA or the manufacturer...

Phyllis Sidhe_Uaine