Canadian here - pretty good outside surgeries. We’ve got a serious shortage of specialist surgeons up here so you’re usually best going out of country for important non-emergency surgeries.
In my day job I track the US Healthcare system and it’s even more of a shitshow than you imagine.
In Malaysia, you’re treatment are mostly covered by the goverment through subsidies. You usually pay a percentage of the treatment cost. The only exception is cosmetic surgery and certain high end medications, i think. Despite that, there are still people that is unable to pay the fee and the goverment still provide some kind of monetary support or the public hospital helps by paying the remaining fee using available fund. As a result, there are long waiting time for treatment and the public hospital generally overcrowded and healthcare workers were overworked. Thus, most of our specialist or other healthcare workers would escape this hell hole for a much better paying job in private sector or in other country.
In NZ for basic healthcare, you call to make an appointment with your GP, go in later that day, they give you a prescription and you pay $5 for the medication and about $40 for the appointment.
For specialists in the public sector, there is a long waiting period, like a few months sometimes. You can pay for a private specialist, but it is of course expensive. Completely depends on the type of specialist etc.
Dental is not covered by public health care because we still live in 1864 apparently where barbers are meant to be pulling our teeth, but we are getting very close to having dental as part of public healthcare.
A huge amount of medication is subsidised here, basically anything life-saving like insulin, asthma medication, etc. I have an infinite supply of paracetamol because I just get it prescribed when I go to the doctors and pay nothing for it.
It really blows my mind that the US has an objectively vampiric and unfair healthcare system.
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
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.
For most medical services, the govt will reimburse you a set rate. The GP or specialist can charge you whatever, sometimes the same as the govt reimbursement, sometimes quite a lot extra. You don’t pay anything at public hospitals (which are nice).
I recently had some great problems, I stayed overnight in hospital twice, for a total of 3 nights in private rooms, had an internal scaffold inserted in my artery. i also had numerous consults with specialists and drs.
The whole thing cost me about $500, a few days work on average wage.
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