Poland: Citizens can opt for available services at very low cost but with a time delay. Anyone can buy private services on demand. Private services are inexpensive. Physicians have two or three practices. First, a regular hospital job, next an area clinic position and lastly a private office practice. Total income is very low. The government subsidizes many drugs. Example - PSA test at local clinic, 26 zlotych or $8. No waiting! An office appointment is 100 zlotych/$30.
Health insurance is an oxymoron. Somehow people have decided that they don't have to pay for medical care. Middlemen have created medical insurance as a business not a social service. A rational society could create a universal health care system paid for with taxes. Best advice, build a personal health care fund.

For the NHS in England, you can get all the latest figures at
http://www.performance.doh.gov.uk/wa.../qm08_y00.html

(Scotland, Wales and Northern Ireland all keep their own figures in their own ways).

For the original specific example, access to a hospital specialist would vary, depending on local facilities and the degree of priority given to your particular circumstances, but you could be waiting for a couple of months to begin with. Access to surgery itself could take even longer.

The priorities go, obviously, to life-threatening situations, then to the major public health issues like heart disease and cancer, and only lower down to elective and non-acute conditions. Targetting and new ways of working have driven down waiting times in most areas and the priority areas in particular; but there's a long way to go and a lot depends on both money and managing doctors.

Touch wood, I've had very good treatment from the NHS, but I live in quite a wealthy area. A lot can depend on what we call the "postcode lottery".

I think that the GP system is very good in the UK.

I have an actual example of the difference between the US and UK.
The grandchild of a friend of mine kept getting snuffly colds and running a temperature. The child had a battery of tests including a lumbar pucture, poor mite. After several days of this it was discovered that she had a urinary infection and the parents were told that the condition if undiagnosed in a small girl could lead to kidney failure in later life.

One of our neighbours had a little girl with the same symptoms. The GP, admittedly a very good GP, had seen similar cases before and diagnosed the problem with a urine test. He gave similar warnings.

In both cases, a course of antibiotics solved the problem.

One thing about an insurance based system. If you take a car in for repairs, the garage will usually ask if it is "an insurance job" and no doubt charges appropriately.

I forgot to say that the case with the battery of tests was in the US.

I have private health cover in Germany as I don't pay social security but what I notice is that the doctors appear to constantly overcharge. Calling to make an appointment is considered consulting and the list of things they said they performed during the 10 minute meeting is quite staggering.

I find the standard of doctors in Germany to be very high especially in the field of orthopaedics.

One of the main problems for the govt. in Germany is trying to change the way people seek treatment, normally a person would go straight to the Specialist rather than going to a GP and therefore this costs a lot more for what may be a minor ailment.

I haven't lived in the UK for over 17 years but last March I took my 3 month old son to the UK and during that time he got sick. So I went to a doctor and explained that this was his German insurance but they weren't interested in it, as they said, Germany's in the EU so we have a reciprocal agreemment. I also expected to pay for all of the prescription but the woman in the chemist said that no patient under 16 pays for anything.

So for a family of 4 I pay around $450 per month and this covers us worldwide for 100% prescriptions, consultations, & operations.

Geordie

We've now heard about Belgium, Canada, the US, Britain, Germany & Poland (sorry if I missed anyone). Since I live in the US, I understand that system the best (and think it needs a major overhaul) but still have some questions for those of you who live elsewhere.

As someone mentioned, in the US you can have top of the line coverage with fantastic medical care or be uninsured and taking huge risks because you will be bankrupt for life if something that needs serious medical attention occurs.

For those of you in other countries, do you have people who are uninsured in your country? How is it determined how much you pay per year for health insurance? Do people in your country complain and grumble about your system and think that it needs to be changed? If so, how? In the US, everyone we know discusses our health care system, its flaws, how much it costs and the need for change. But, most people still wouldn't change it because they think they would be giving up their rights to having excellent specialized care in case of a really serious illness.

Well, the whole point of the British - and most other western European, apart from Swiss - system is that it's primarily funded out of tax. There may be some payment at the point of use, for example for medicines or sometimers for doctor visits, there are variations between how different countries provide things free (as opposed to requiring initial payment followed by refunds), and some people choose to top up the state system (a bit) by private insurance. But these are all details.

The central point is that health care is a right, and that people's access to it shouldn't be governed by their ability to pay. And that general principle is, for the most part, honoured - and almost universally accepted even by those of us at the farthest right ofthe political spectrum. And, BTW, almost universally delivered.

Remember that most European countries have higher life expectancies than the US, in spite of spending just over half America's spending per head on health.

Now there are many, many grumbles in Britain - which for the past 30 years has spent less per head on health than almost anywhere in Europe.

But virtually no-one in Britain fundamentally questions the basic principle that healthcare should be free at the point of use, and tax-funded. The debate is entirely about how much the total tax pot should be.

A friend of mine lived in Italy for 15 years and often complained about the health system. She benefited from the state health system, in that she got inexpensive health care. However, it took months for an appointment to check on a possible cancer diagnosis, unforgivable considering her family's medical history.

Recently she told me this sad story: An old boyfriend, age 45, suffered a heart attack at a family dinner. This family cannot afford private healthcare, so they called the public ambulance, informing them of the seeming heart attack. The ambulance arrived in just a few minutes, but it had no equipment of any kind to treat a heart attack. Thirty minutes later another ambulance arrived with the correct equpment, although the poor man was now comatose, a vegetable, and died a few weeks later. If the family was wealthy, they would have called a private ambulance and there's an excellent chance he would be alive today.

This same family is currently experiencing another health care indignity. The boyfriend's father is ailing and has been hospitalized, again under the state system. His wife spends every hour of the day and night at the hosipital because the nurses only visit the patients once a day. The nurses hand over all the medications for the day in the morning and it's up to the patient to take them at the right time. The poor woman is a wreck, mourning her son, worried for her husband, exhausted from the long hospital hours.

US healthcare insurance is expensive, but I'm glad to know that, whatever my means, if an ambulance arrives it will be well equipped, and that I'll receive frequent attention if hospitalized.

I'm a Canadian living in Ontario. In our province, health care comes out of the general taxes. There are continuing mumbles about instituting a "Pay as you go" which is basically a two-tier system.

I absolutely disagree with this. We certainly have problems with our system but I think overall we do very well. I had elective major surgery & got to choose my surgery date (with the admitted proviso that my surgery could be cancelled if the OR was requred for emergency surgery but it wasn't).

There are certain areas - seeing certain specialists where there are too lengthy delays. My mother is waiting 6 months to see an opthamologist but it's for a non-life-threatening issue.

As for Canadians going down to the States for treatment, I suspect that may be for elective surgeries. I personally don't know anyone who has gone this route for any reason, elective or not.

Jody and kswl- $1700 a month??!! What a nightmare!! Yes, if you have insurance with your employer you're okay. We have employer insurance here but it covers things like drugs, semi-private rooms in hospitals, ambulances, dental work etc etc etc.

I do think that healthcare should be a right for all people. We must consider ourselves very lucky, though, even those of us who have to pay high insurance costs etc. We could be in a Third World country and have nothing. Let's count our blessings.

Wow, some of the costs being quoted here are astonishing. The NHS may come in for a lot of criticism in the UK, but at least we're all guaranteed free care (ok, through taxes, but nothing like the cost of what's being quoted here).

Also in the UK, you can opt to join a private health care scheme. Mine costs about £50 a month, and basically allows me to queue jump for treatment, and to stay in a nice posh private hospital. Private health care only kicks in if you want to leap over a waiting list - you get the same doctors. It's regarded as a luxury - by no means a necessity.

I live in Canada.
I saw a vascular surgeon last summer for a varicose vein in my leg. The doctor said it needed to be dealt with. I have to have an ultrasound on the leg. One year later still no appointment booked for the ultrasound. Thinking I must have missed the callfrom the doctor's office to give me the ultrasound date I called back. Nope. I did not miss the call. They were booking appointments for people who saw him in December 2003. I might be apbe to get the ultrasound next July. 23 months after I saw the doctor. Then I will have to wait another couple of months to see the specialist again and then wait for operating room time. We're probably looking at 2 1/2 years from the time I first saw him. But it is FREE, eh?

I'm not a healthy person. I have a number of chronic things my english is not good enough to explain here, in fact, I only know how to say in English that I'm hydrocephalus. I learned it in a forum from Harvard University Hospital with people with the same problem. And I knew there, that even with the hundreds of faults I can tell you about the Spanish Social Security System , I have to be thankful because I had it without a single euro spent.
The surgery I had was about 2 million dollars for the people there. Some of them have good insurances..some of them had lost them because they have children with the illness and children need a surgery almost every year till they left to grow up. The insurances didn't want to cope.
The system here is paid with taxes that can be paid by the employer or by themselves the people who work on their own. It's compulsory to pay and the taxes are both for the health system and the pensions one.
No one is uninsured, never. Not even paperless emigrants, they can go directly to the ER and receive the same attention than anyone else.
You only have to pay a percentage on prescriptions (0 if you are a pensioner).
Yes, there are delays, especially in big cities and in some specialities. Not so many here where I live, its a small one :)
I visit the hospital every month, sometimes for me , sometimes for my parents who are pensioners.
I don't have a private insurance, they don't want me in their files, too much waste they think :) Anyway, the private sector here is not very good, only in the big cities there are valuable private hospitals. Here in Castellón, many people go to a doctor's visit privately..and after that, if they need surgery they go the the Social Security (the doctors are the same ones).
I really think that every system in the world has good things and drawbacks. But if you are on the "health problems" side and not very wealthy..you could have a very rough time in the US system.

I'm not complaining. Our monthly fee (for a family, no matter how large) is 8.50 euro for basic healthcare. Dr visits (at our house) cost 10 euro; 4.70 euro at the drs cabinet. Drugs and hospitalization in private room can cost a lot, though. For all the expenses that are not covered by our legal healthcare we have an insurance plan for which the premium is paid almost in full by my husband's company. I'm not complaining at all!

Agree with Patrick; in the UK it can vary a lot depending on where you live, what you need doing, what time of year it is - all sorts of factors.

I can only offer 2 very minor recent examples. Time from seeing general practioner to seeing consultant - 1) 8 days (I must admit I was surprised), 2) 43 days. Time from seeing consultant to having surgery - 1) 42 days (note that condition was non-incapacitating & had been diagnosed as non-threatening) 2) not required.

Although the NHS isn't what it was, I still believe that when you really need it, the care you need will be there.

Astonished to find myself in agreement with flanneruk for possibly the first time ever !

I'm American, and I actually have two complete health coverages: an HMO paid in large part by the organization I retired from, and a government plan (VA).

While neither provides really quick service, the HMO is much faster than the VA. My wife and I had planned a trip to see the great art of Europe, when I suddenly developed cataracts. After the fairly timely surgery on one eye, my HMO physician left to have a baby, and I sort of fell into a crack, where the other HMO doctors considered me her patient, so they expected me to wait until she returned from maternity leave. I cleverly made an appointment at the VA, but when I went in I was screened and told I could see an opthamologist in eight months, to decide whether I needed surgery, which of course would probably be done in the next life. I went back to the HMO and became demanding, and they finally found someone who would do the second surgery, and I was able to enjoy our trip.

I don't think the government health care is bad, but it is certainly slow, and in my idle moments I looked at how much is appropriated annually for VA health care, and at the number of patients they claim to treat, and it appears to me they could shut down the VA health care system, buy us each the finest private health care plan, and still come out far ahead.

One valid criticism of government coverage for all is that treatment is often available at the start of the fiscal year, but has to be rationed near the end of the fiscal year, so I guess you have to time your illnesses and accidents. I also think there is something to be said for having to bear at least a part of the cost of your own treatment, as it encourages you to take better care of yourself to avoid having to get more medical care; the people who are misusing emergency rooms seem to me to be those people who don't have to cover any of the costs of their care, which of course drives up the costs to the rest of us.

I think both government and insurance programs also drive up the cost of care, even as they try to hold down costs, as they add a whole layer of bureaucracy to the system. Our family dentist is a sole practitioner, with one hygenist who cleans teeth, and a staff of four in the office, who keep track of appointments, and process all the insurance paper!

Caroline:

In case you're worried about the company you're keeping, fear not.

I'm describing the national view (which was julies' request). My own views differ, but julie didn't ask us what we think.

<i>Our family dentist is a sole practitioner, with one hygenist who cleans teeth, and a staff of four in the office, who keep track of appointments, and process all the insurance paper!</i>
Our family dentist is a sole practitioner, hygienist, secretary, ... all in one. Maybe that's why healthcare in Belgium is so affordable.

One way the VA could speed up the process is to let the participants that see other doctor's get their Rxs filled there without having to see a VA doctor first! My husbnad sees a private physican under his Medicare and AARP suppliment, but as we have no drug coverage thru either , he goes to the VA for medicine. But first he has to see one of their doctors and have lab work done..even though he could bring in his lab results from his private DR! BUt it's either that or about $400.00 a month for medicine.

It too 18 months to get hiss first appointment at the VA!

One thing not mentioned in any of this and especially left out of the mention about how our USA costs are so much higher, is the reason why they are higher.

We (USA) do more tests, many more and much oftener. And why? To &quot;rule out&quot; and protect, not only the patient in a more exact (although not needed on numerous occasion as they would improve regardless)manner- but to protect the doctor from being sued.

There is much more to it than the simplification of taxes vs public domain paying. The laws of the lands for retribution in malpractice are not the same.

flanneruk : right ! Well, kudos for getting it right, I reckon :-)