A question for Candadians and UK folks and the Universal Healthcare

[joebryant]

Great thread! Keep the replies and opinions coming. So far a great read.

 

[PineappleMama]

Thanks for the info... that'll help me wrap my head around it.

Also... is it just UK or Canada/elsewhere that the government OWNS the hospitals and private are only used in 'emergency' or by private pay?

Also for Americans... anyone know how many hospitals are Gov't vs Private? Percentage? How many would our Gov't have to buy in order to have the control that's had in UK... and would the hospitals, staff, etc be okay with that sort of gov't takeover?

Ohh for that matter are the doctors offices also that way? All gov't docs (but for private) ... are they all in a few buildings, or annexes of the hospitals... or are they allowed to open their own offices any ol' place?

Hard to get a real picture of the system because it seems like it's different from ours on a number of levels... not just taxes... not just who can go when... but the foundation itself...

Ohhh and if the hospitals and whatnot are owned by the Gov't that would mean they control their wages more than in the US... docs that take Medicaid/care have set limits... and each insurance company has it's limits and whatnot... but the doc still has the choice of which of those they want to work with or not... is there that kind of flexibility in the UK or if you're a gov't doc you can only take those... can private hospitals/docs accept state patients?

TONS of questions...

 

[thaiturkey]

Quote:
That works only while you are with that employer. I can't say whether a US employer's scheme is better than the NHS but in the case of the latter there are no exclusions and no financial limits. The NHS sheme is completely portable and continues through periods of unemployment and into retirement.

I had private insurance paid for by employers in the UK and it was taxed as a benefit in kind. It was voluntary on the part of the employers and usually provided only to managers. The reason for giving the cover was so that the employer could interfere in decisions on dates for treatment. It also was a disincentive to managers thinking of moving to another employer. The schemes had limits and the insurers dictated which hospitals could be used. They don't cover the treatment that you can get from a local doctor, only hospital treatment. I always opted for the much better NHS arrangements and negotiated treatment dates with the clinics and hospitals concerned, effectively excluding my employer from the decision.

What do people in the US who rely on employers' schemes do when they retire?

 

[rebelcowboysnb]

Quote:
Government medicare.

 

[joebryant]

I've had medical insurance all of my life. Being retired, I now have Medicare, the best insurance that I've ever had in my life.
We could have passed Medicare for all the U. S. citizens; it was called Single Payer Insurance.

 

[thaiturkey]

Quote:
I think that in Europe the State health care hospitals are State owned as in the UK. It's possible that some of the very new ones are leased by the State from a property company as an alternative to making a huge up front capital investment. Many are also teaching and research establishments too, by the way.

The UK has local general practitioner clinics for the treatment of minor ailments that don't need hospital treatment. This is an example of hoe it works. I used to live in a village of 1,700 people. Six doctors built a big surgery with their own money to serve the village and surrounding area. They employed nurses to take blood samples and carry out minor procedures such as de-waxing ears. There was also a midwife but she was probably paid directed by the NHS. The doctors employed an administrator too. Once the NHS approves such a clinic, it pays the practice according to the number of registered NHS patients and fees for State campaigns such as prostate and breast cancer screening and annual health checks for the over 60's. If you need minor attention you call for an appointment which must be withing a few days. If you need urgent treatment but not in hospital, someone calls to say you are on your way and a gap in appointments is made for you. That system ensures that people don't sit aruund for hours at busy times.

This group practice arrangement also allows GP's to work part time in NHS or private hospitals as consultants or specialists. Therefore, if you are lucky, a GP in your local clinic will also be a specialist in what ails you.

Boy, as I write this I realise just how far the NHS has progressed since I was a kid.

The NHS employs consultants, surgeons, nursing and auxilliary staff directly. Most are paid a salary but top surgeons and consultants pay have a different deal. There are national pay scales that have to take into account what private hospitals pay. As I wrote above, local GP's can employ their own staff for certain jobs but I imagine that the pay is NHS controlled.

Private hospital accept NHS patients only at the request of the local Health Trust, the managing body for NHS health care in each area. Very occasionally, the NHS will send patients to Europe for an operation either to ease pressure at home or because there is a top specialist surgeon not available in the UK. A bit like going to another US State for the same reason.

I'll give you an example of how a real emergency works in the UK. My Thai wife felt very ill one foggy winter's evening and had heart palpitations. The local clinic was closed because of the hour. I called 999, the single number for all emergencies, and asked for an ambulance. One was despatched as I was asked more questions and given advice on what to do while we waited. The operator stayed with us until the ambulance arrived with a colleague relaying what I said to the paramedics. Two paramedics came into the house and put monitors on my wife. They found nothing wrong and decided to have her checked at A&E, 10 minutes away except for the fog. I followed the ambulance in my car so that I could get us home later - or just me. By the time I got into A&E she was linked to several monitors and her vital signs were watched by staff for about four hours. Finally, they decided that she was showing normal signs and had too much chilli with her Thai dinner and panicked with the severe indigestion! If they had spotted anything wrong she would have been admitted.

If the local clinic had been open I might have spoken to them first but we can make our own decision to call an ambulance.

The NHS operates a 'phone in advice service too. Let's say that you sense something is wrong, haven't a clue what it is or what to do and want advice. You call and are asked questions. Each question depends on your answer to the previous question. If the 'phone diagnosis looks bad an ambulance will be despatched and the operator stays with you until it arrives.

 

[thaiturkey]

Quote:
Are some people excluded from Medicare or is it voluntary?

 

[PineappleMama]

Medicare is age specific... it's for the older folks... know that much.

Now MediCAID is for work age pregnant women and minor children and is INCOME specific.
And it DOES include eye and dental... last time I checked anyways.

I'm not sure what the rules are for Medicare but I do know that Gran, NO INCOME, ended up going to JPS (another income based one) in order to get medical treatment. She went to the JPS center for her regular appointments, pharmacy too... donno if for some reason she didn't qualify for Medicare or if Medicare just didn't cover enough or what exactly...

Thai, that sound about like what we do... minus the extra insurance paperwork... if your PMC (primary care physician) is open then you call them, if not then you go to the ER... there are minor emergency clinics as well but I don't know of any that are open 24/7... there are also places like Care Now that have a doctor or three on staff, nurses, exam rooms, lab... like a regular doctor's office, but minus the insurance stuff... YOU can file after the fact but they don't bill them for you. With 'normal' Doc's offices you either have your insurance card or money in hand (heard a lot of stories, even in here, about the difference in price for cash vs ins. customers) ... don't have it, you don't get seen... rather like other businesses, no pay no service/item. It's the same with prescriptions at the pharmacy (which is basically every grocery store around here) you present your insurance, they run it, you pay Co Pay OR you pay the whole amount... meds not handed over without payment.

So... what's it LIKE... is your form at the doc/er like ours only you enter in your Gov't given Insurance number (or private) and the bill automatically gets sent to them? You never see a written bill for services? I mean, there's The Bill... ala taxes... but other than that? Are there still Co Pays for regular checkups... sick visits? What about ER?

Co Pays, and # Visits, and deductibles and so on are SO random depending on which company and within that which plan you're on... it's bloody confusing. Seems like at the least yours is easier for citizens to understand. You can see, in black and white, the amount that's taken from your pay and that's that... heck you could add up the total taken during your working years and figure what your health care costs for your lifetime... which is pretty nifty.

I'm trying to wade through the %taken out and levels and so forth but I'm a bit lost... anyone have a link that shows what the Earnings Levels are? Tax Brackets is what we call them I think... that link before shows what % is taken at this and that Earning Level, but I donno what the EL is so... how can you figure a %?

Basically I'm just nosey.

 

[rebelcowboysnb]

Medicaid is for the disabled too. It does cover eyes but not well an it only covers tooth extractions for anyone over 21. Its great for everything else. Go where ya want, see who ya want, never see a bill.

Its probably different from state to state though.

 

[thaiturkey]

Quote:
UK citizens have a NI number which is theirs for life. We register with one primary care clinic and they create a record on a central database. If we want an appointment we call and give our name and that's it. No forms. If we move to another area or need a doctor whilst away from home our record can be transferred or traced from personal information with or without your unique number. The number might be requested later as a cross check but it's used mainly these days as a form of security check by the tax authorities. If you are prescribed medication at the primary care centre, the doctor will write a prescription which you take to a pharmacy. My clinic had its own pharmacy. We pay a fixed fee for each prescription unless we are unemployed, on very low wages or aged over 60 years. I think that prescription for children are still free but can't be sure.

Regarding the second of your paragraphs above that I highlighted, are you asking about US or UK information? If the UK, post a direct ink to the website and I'll try to answer.