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.
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.
Late but USA, wanted to share a personal experience. While at work I collapsed and had to take an ambulance to the hospital. I got sent the bills for everything. Including the ambulance ride. I stayed in the hospital overnight for observation. They couldn’t figure out what happened and I didn’t have symptoms anymore so I was discharged. Whole event cost maybe $500.
Here’s the kicker, I work(ed) as a paramedic for the ambulance company that transported me. I had insurance that was not from the company so prices were reasonable relative to what one would expect in the country. Had I been insured through work, well, the insurance provided by the company doesn’t cover transport by that company’s ambulance.
America. Ideally you have insurance through work. Going to your PCP may be ~$50, same for specialists. Urgent care and ER will be higher, then there will be additional bills depending on what needs to be done and your insurance. Then there’s “in-network” and “out-of-network”. In-network will be covered more by insurance than out-of-network. It’s tricky for hospital stays. In my area there are doctors who are out-of-network working at in-network hospitals. So you will get 2 separate bills - one from the hospital and one from the doctor.
Honestly it’s terrifying having an emergency because you really don’t know how much it could cost. Most insurance plans have a max out of pocket. One number for the individual, one for the family. The lowest I’ve seen is $2k/$6k while the highest was ~$16k/30k. I’m in a LCOL city though. Max or of pocket is the maximum you should ever have to pay for a single year. You will almost definitely hit this if you have a baby or need more than a couple days in a hospital.
For people with low income there are sometimes assistance programs at hospitals. One common outcome is you go into a payment plan and maybe years later your remaining debt is forgiven. The payment plans can be very cheap. I’ve heard of $25/mo. Still it’s probably for a bill that’s in the thousands if not 5 or 6 digits.
If you don’t have insurance through work you can buy your own insurance but many people just wing it. Most hospitals will charge less when there is no insurance to bill. Maybe 1/3 what they would charge insurance. This will still be in the 4-6 digit range. So you go into a payment plan, or maybe there’s additional financial assistance from the hospital, or you just ignore the bill and take the credit hit when it goes to collections.
There are programs through the government, Medicare and Medicaid. They cover quite a lot but if you’re under 65 then I believe you have to be disabled to qualify.
The quality of care is generally high though, so that’s cool.
I write or call my GP, they call me in for preliminary examination and/or conversation to determine the best course of action. Blood tests are usually done directly at the GP, either on the spot or within the week. Other simple tests like blood pressure are done at the GP too. I get the results in an app, and the app also tells me if the result is low or high or whatever.
If I need to see a specialist, the GP gives me a referral and I find one I like, or they queue me up and I get the appointment sent to me in the government’s digital mail system. The appointment times vary but I’ve yet to be dissatisfied.
I go to the specialist, and they do their thing. Tests, interview, whatever. They decide on a diagnosis and prescribe medication. It’s assigned to me digitally, and I can either get the meds at most pharmacies or immediately on the spot depending on what you need. You might see a specialist more than once to change or adjust treatment.
This is where you might start reaching for the wallet. All appointments, examinations, tests, etc. are paid for with taxes. In total, my income tax is 43% and VAT is 25%. That’s totally fine by me. Medication prices vary of course. Some are free, some are cheap, some are expensive. Broadly speaking, people can afford their medication.
It’s not a perfect system, but I have confidence in it, and am generally satisfied. Most issues are human in nature - I understand that women and immigrants (like myself) might not get the same quality of treatment, which of course sucks, and shouldn’t happen. I haven’t noticed any poor treatment but that might be due to my personality, gender, race, etc. Dental care isn’t covered and is prohibitively expensive. I’d like this changed. Psychiatric care is rough, and doesn’t really apply unless you have… significant issues. I don’t know if you can get therapy through the system but the private stuff is prohibitively expensive.
Overall my experience has been a solid 8/10, and I’ve interacted with various elements of the healthcare system in Denmark
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.
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.
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.
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?
In Mexico the government has their own health care system, if you are a Mexican citizen you have access to it for free (if you are a student or you work legally), it’s sustained by taxes that employers pay to the government, there are two health care systems IMSS and ISSSTE, depending on if you work for the government you get one or another.
These institutions will give you the treatment that you need and surgerys as well, except cosmetic stuff. Since these institutions aren’t optimal (usually takes a long time to get attention) you might prefer to use a private health care, and you just pay a private company for what you need or pay monthly for an insurance plan, which will cover certain hospitals and specific diseases
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