In the UK the cost of healthcare is included in a tax called National Insurance, it’s about 10% of wages. It can be thought of mostly as emergency use only. Mental health and minor ailments are not treated. If you want that kind of service you need to go private and most people cannot afford that so they go untreated. I know a newly qualified doctor who cannot find a job despite there being a shortage of doctors.
On the plus side, we do have a brand new aircraft carrier and a royal family.
As an American, that’s a way higher tax than I expected. Does everyone pay it, even people earning under a certain threshold? In the US we have social security and Medicare that everyone has to pay.
They say it’s a thousand years old and have no intention of changing anything. It makes sense because the world hardly changed since 927 so they might as well keep going with the same schtick.
It doesn’t really matter, but worth knowing, only a small amount of your national insurance goes toward NHS costs. The NHS is primarily funded by general taxation. Your National Insurance contributions largely go to paying for state pensions.
That’s an excellent point, state pensions are a significant burden, particularly police. We need to look after those guys so they can continue to prosecute the unwinnable war on drugs.
I still have to pay to visit the dentist though, which can be quite expensive.
Regular doctors visits are free, but if youre refered to some specialist, like… i had an issue with my knee, i was directed to some therapeutic pro. That cost me like 20 euros per visit. However, a friend of mine had to visit an eye doctor which was also free.
And medicine also is self paid, like antibiotics or whatever. Its rarely super expensive though.
But i when my kid was born we had no expenses at all. His mother had to stay (with him) for 2 days at the hospital and while there she had full free access to a stocked fridge, stuff for the baby (diapers etc) and all that jazz.
Ive not heard of anyone having other expenses either, like cancer treatments or getting a broken arm fixed
I still have to pay to visit the dentist though, which can be quite expensive.
It’s interesting that this is a pretty common thing across different countries. The public health care system in Australia doesn’t cover dentists either, and in the USA you generally have dental insurance that’s totally separate from your regular health insurance.
Rural Guatemala and it’s mostly done through mobile doctors because it’s so remote. We have universal healthcare on paper but the government spends so little on it that the resources are awful and private care tends to be a lot better and trustworthy.
I have been told that Guatemala is private insurance. I provide care in rural Guatemala (Huehuetenango) and was told that the natives have in reality no insurance. If they need medical care they have to travel to Guatemala City and pay privately. Is that incorrect?
Now that I’m insured, healthcare actually costs more than when I wasn’t. And I’m not talking about premiums - I’m talking about copays and deductibles being non-negotiable.
For instance, I thought I may have hurt my ear scuba diving a few weeks ago, so I went to the ER to see if my eardrum was perforated (ENT visits can take months to get).
They told me it was, had me pay a $300 copay, prescribed me $130 eardrops my insurance wouldn’t cover, and referred me to an ENT.
When I finally got to an ENT, they told me that my eardrum wasn’t every perforated and the ER did didn’t know what they were talking about.
Then I got an additional bill from the ER for another $1800 because my insurance company refused to pay the bill.
Had I been unisured the hospital bill would have been maybe $250 all-in after negotiations, but since I have insurance it’s $2100 for a wildly wrong diagnosis that ended up costing me another $430 in specialists and prescriptions.
Australia has a hybrid system with both public and private health care. You can pay for private insurance (like in the USA) if you want to, which covers the costs for private hospitals, better doctors, etc, or you can just use the public system which is funded by a 2% income tax. My family couldn’t afford private health care when I was growing up, so we only used the public system. It was mostly okay, although regular doctors (a general practitioner or “GP”; what you’d call a “primary care physician” in the USA) always had long queues to see them. Sometimes I had to wait 3 or 4 hours to see a doctor. Some specialists have a long wait time of several months or even a year. I did have to go to hospital a few times, which is completely ‘free’ (taxpayer-funded) if you go to a public hospital.
The public system today isn’t quite as good as it used to be due to various cuts over the years, but it’s still a good safety net to have.
Australia also uses a single-payer system for prescription medication, called the Pharmaceutical Benefits Scheme. All prescription medications are government-subsidised, with the government being the only entity that negotiates prices for the entire country. It means they have a lot of bargaining power, and a lot of medications are significantly cheaper than in other countries that don’t use a single-payer system. Medications that are hundreds of dollars list price in the USA are often less than $20 list price in Australia. Insulin is around $8 retail in Australia compared to ~$100 in the USA.
Now I live in the USA and my insurance is pretty good (flat fees of $10 for doctor visits, $20 for urgent care, $100 for emergency room, max $5 for generic medications, maximum $2000 out of pocket per year after which everything is 100% covered), but it varies a lot. Health insurance is often tied to your employer, so if you work at a “better” company, they tend to have higher-end insurance coverage. There’s been some attempts at introducing universal health care (most notably the Affordable Care Act, nicknamed “Obamacare”) but there’s a surprising number of people that don’t want it because “they’ll have to pay for other people’s healthcare”, even though it’ll actually make their health care cheaper too. ¯_(ツ)_/¯
U.S.A., I have a “high deductible PPO” plan, more or less what my parents would have called “Major Medical”.
It covers only some preventative care, for $0 out of pocket, whatever is mandated by the government basically so annual wellness, annual woman-care, birth control, one dermatologist visit.
Then nothing, until we spend some ridiculous amount in one year, I think it’s $7,000? At which point it starts paying 80% until we have paid an even bigger $, then it pays 100%.
So we don’t have healthcare, exactly, we have limited liability for healthcare cost.
Specialist I can just schedule, do not need to be referred by GP. Prescriptions are subject to that same high deductible.
This plan costs, out of my paycheck, kind of a lot for family coverage, and employer puts back some of it onto a “health savings account” that can be used to pay towards the cost. Not anywhere near that $7k but some, and what is not used stays in there. I also put money in that account out of my paycheck to build it up so that when we do eventually have a bad year again, the money will hopefully be there to use.
Yes it is. And besides the premium and other costs, we also pay taxes for care for the sickest and the oldest. These private insurers are cherry-picking the group they insure and still charging the outrageous fees, raking in profit and outsourcing the more expensive groups to the rest of us to pay for. So I get about half of my paycheck as netpay after medical, tax, HSA and 401k; same as someone in a socialized nation, but without the assurance of healthcare or a pension.
When I lived in Alberta, Canada (as a USA expat circa 2010), it had pluses and minuses. Pluses: The cost was very low; in our province the premiums were nominally $44 CDN per month for an individual or $88 per family, but the windfall from oil production meant they could waive that and it was free. Emergencies were treated quickly and well. Drugs were inexpensive. The doctors seemed competent. Minuses: extreme shortages of doctors, facilities, and services. I could not find a primary care doctor taking new patients, so I had to wait at least two hours each time to see a different doctor at the walk-in clinic. They did not take or keep a medical history, so it was all up to me to know if what they prescribed was contraindicated by other drugs or conditions. Drugs, while cheap, were not covered by insurance, and some were simply not available at any price. Dental and vision coverage were not included and had to be bought on the private market. Wait lists for non-emergency procedures or treatments were ridiculously long, like 18 months to get the first appointment to talk about a hip replacement. Three months to get an MRI to diagnose chest pain.
That sounds awful having to go through all that! In America, just buy a splint from the drug store for $20 and go back to work same day. No exhausting time in the hospital and seeing lots of doctors. No missed work. No being a drain on society and suckling on the government teat. FREEDOM!!!
Define slow. I have to wait months or more for an appointment in the US. Is it that slow? Emergency visits take hours, sometimes charging people who wait but don’t get service. Is it that slow?
Not the other poster but a Canadian too. It varies. To see my GP I can get an appointment within the week, usually same day, though most people here need to wait a couple weeks. Then there GP refers me to specialists, that’s usually between 1-6 months wait.
Emergency yeah you are usually looking at 4 hours wait absolute minimum. Though you don’t get charged for it at least. Though I guess it depends on severity, they will prioritize by how serious it is not by first arrival.
The other thing the other poster didn’t mention is that medication is not covered so you have to pay full for that unless you have insurance. Also for some reason dental isn’t covered at all without insurance (or I think recently for low income families but I’m not 100% sure if that’s implemented yet or not)
Depends. I have had a bunch of specialist appointments for cardiologists, endocrinologists, reproductive health specialists and pulmonologists. The average wait for an appointment is about three months.
We are very fond of calling the Canadian system slow but my understanding is it’s decently comparable to a lot of the States and is actually pretty impressive considering how spread out and small our population is.
Not only province, but doctor/hospital but mostly urgency.
If you’ve got something critical, it’s super fast, otherwise it can be pretty slow.
Examples:
went to the emergency for something stuck in my eye, 3am. Went in, waited 3 minutes to be checked, saw a doctor 15 minutes later, by the 1h mark I was out with 1 nurse and 1 doctor who had seen me and removed what I had and another nurse who had given me a vaccine shot.
On my way out, I talked to someone in the waiting room I had seen at 8PM getting a softball to the side of the eye, she finally saw someone around 11h after getting to the E.R. (they quickly evaluate the urgency when you arrive).
Almost 4 years later, I’m still waiting for my vasectomy appointment.
That is not true. Not fully true, and the true part is blown out of proportion by various populists (especially right-wing, who would like to replace what we have with USA model or worse).
Most basic health care is organized by the government and paid through taxes and social insurance (which is obligatory). Unfortunately it is not financed enough and it shows, more in some areas and less in others. GP access is quite good, especially in larger cities, unless someone didn't care to choose his 'first contact clinic' right. Those clinics are mostly private, but working on government contract. One can usually get a GP appointment within a week, often same day. Urgent GP appointments are available 24/7 through special 'holiday and night health care points'.
Things became worse when popular specialist help is needed. One needs a referral from his GP and may need to wait months for appointment. There is the point were people who can afford that, would often go private. That and dentists / orthodontist.
Big problems are in children psychiatry, mostly due to lack of funding.
Medicines are much cheaper that in USA. When prescribed by a doctor they are usually partially or even, in some specific cases, fully paid by government. That is not make it affordable for everyone that needs it, but it is not very bad.
When something very bad happens – serious accident, cancer, etc. then the public health care gives the most. Public hospitals will do what they can (with limited funding and overworked personnel) for free. People are not sent away because they are poor and won't have huge debt to pay just because they got sick.
There are private insurances, or rather subscriptions services. They used to give better access to basic health care that the public services, but recently they don't offer much more. And you must pay for the public service anyway. They usually totally fail in more serious case (chronic illness, cancer, serious accident) – one would get to and be treated by a public hospital too.
In short:
Pros:
health care is basically free for everybody by principle
GP access is good, and serious cases are handled quite well
medicines are available and prices are not horrendous
Cons:
not all the free health care is practically available, sometimes available appointments are months or years in the future
dentists, orthodontists – not really available via public health care and private options are expensive
doctors, nurses are other personnel are underpaid and overworked
there is a lot of bad PR around health car here – this doesn't help improving things
National Health Service, currently struggling with lack of personnel, but in general I have a family doctor I visit, on average, twice a year, for general check-up and follow-up. I can be recommended to a specialist if deemed necessary, with varying degrees of waitimg time.
For emergencies, I can either call a line, speak with someone and either have an ambulance sent directly to wherever I am or get directed to the nearest hospital, where they will already be expecting me.
No payments, even if I need an ambulance ride, a surgery and a few days in the hospital.
A good portion of people - mainly in large population centers - resort to private care, through health insurances, some out of pure need (pediatrics, cardiology, ob/gyn, psychology and psychiatry are specialities where long waiting lists exist) but the professionals working at the hospital are usually the same working private, due to a lack of effort from the state to make doctors exclusive to the NHS.
Private healthcare is usually faster to access and feels more luxurious but when things go very wrong you always get sent to the public hospitals. Cancer and other expensive care illnesses are sent to the NHS, which is usually the first to invest in expensive treatments to get a situation solved as quicky as possible and save time and money and free up space for the next in need.
Is it perfect? Hardly but it works. Nobody really knows or even understands how but it truly works.
I open Google, search “am I gonna die”, and if it says probably not, then I ignore whatever it is and hope it goes away. And if it says I am, then I wait for the end to come.
I’ll start with the German system. Here you are either automatically insured in one of the public insurances (there are many), which marginally differ in their cost (think single digit euro differences) and have to cover basically the same procedures. If one reaches a certain income level, being privately insured is possible.
If you are publicly insured, you wont see most costs, as these are directly handled between your insurer and the doctor/hospital. For some medications and procedures there are co-pays that are flat fees (5 Eur for Medications, …).
Access to specialists mostly need a referral from your family doctor.
In private insurance, often you yourself will be billed and you will need to hand this to your insurance company.
The good side is that in most common situations I have never needed to worry about cost in public insurance, wait times for referrals can be very long and understanding what you need to get certain care can be very difficult. Private insurance often has better payment schemes for providers and less artificial limits on number of patients or which doctor is able to provide services, so access to most care is faster and more widely available.
Access to specialists mostly need a referral from your family doctor.
That hasn’t been the case in many years now, you can just make an appointment without a referral.
In private insurance, often you yourself will be billed and you will need to hand this to your insurance company.
An experience that’s quite common, as public insurance only covers the absolute bare minimum for dental health (including only the visibly ugly fillings). So many (at least many compared to people having general private insurance) people tend to have additional private dental insurance, and there it works exactly like that, you pay, and then you send the bill to your insurance.
one of the public insurances (there are many)
For those wondering how you decide, it’s mainly about the extras. The one I’m at (TK) is well known for having an English-speaking hotline, which is great if your German isn’t that good, as they also can make appointments for you. One other feature I accidentally found once is that they support OAuth for netdoctor (digital dermatologist visit), while others have to send in forms.
It’s mainly small stuff like that, niche procedures that get covered, paid exercise, and obviously (because it’s Germany) what and how much esoteric bullshit they cover.
Access to specialists mostly need a referral from your family doctor.
That hasn’t been the case in many years now, you can just make an appointment without a referral.
Well, for most specialist. There are still a few cases were it is required, e.g. radiologist.
Also with public insurance you might have to wait longer for your appointment with a specialist - but if you have a referral from your family doctor, they can add a urgency note (Dringlichkeitsvermerk) on it and you will get an appointment faster. With that you can also call the health service hotline (116117) and they have to find an appointment for you.
In edge cases it is possible to be uninsured though. For example mentally ill people who drop out of a job and fail to get their paperwork done will be uninsured after 3 months or so. Social workers need to help them, but sometimes the ill people hide or refuse help.
That is not correct anymore - they are absolutely insured as long as they are entitled to Bürgergeld,even if they don’t actually get it or have the three month block in it. The problem is more that the insurance works retroactively in that situation and they often are billed privately by health care providers (which is somewhat illegal) and some of these claims “stick”, especially if you don’t have the resources to fight it.
I guess I’ll give a non-horror story account from the US. My wife and I are fortunate to be on a good insurance plan though my work, we pay about $200/month total for the both of us out of pocket, and my work covers the rest.
Were on an HMO plan, so basically we have a fair bit of restrictions on which doctors we can see, and finding a new primary is always a pain.
On the brightside, medical care for us genuinely is cheap as hell (besides the insurance cost, ofc). My wife recently cut her hand in the kitchen and we had to rush her to urgent care to get stitches. We didn’t pay anything at the time, and got a bill in the mail for $20 the next month, and that was pretty much it.
We’ve never (thankfully) had any major medical issues that need treating though, so hard to say how something like that would play out in reality.
All that being said, if I lost my job, or if my job decided they wanted to cheap out I health insurance and I was - for some reason or another - unable to get a better job, then I’d be fucked. So don’t misconstrue any of this as an argument against universal Healthcare, just because it works well for me personally
Sounds pretty terrible though. Paying $200 monthly to pay $20 for a simple visit is insane to me. I’m an expat living in Europe (so I don’t have the full privileges of locals), yet I pay about $200 per year for private medical insurance which makes doctor visits pretty much free for me. There is also an extended health insurance from the company (costs me about $20 monthly), which covers drugs, dental health an profilactical visits for free
It’s so interesting that the main point against universal healthcare is that it’s cheaper because you don’t pay in your taxes. Yet the US have taxes and you still have to pay 200$/month, and your employee is paying even more money that would go in your check.
Also, you lose your job and you are fucked, that seems like a horror story to me, how do you not live in axiety?
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