julies

I am one who believes that travel involves much more than just being a tourist looking at the sights. Learning more about how other countries function is one of the things I find most fascinating when I travel. One of the things that I most enjoy about travelling to Europe is when I have a chance to talk to people who live other places and thus learn about their lives and their country. This is why I am asking this question here.

We're from the US. When travelling outside the US we've talked with some Canadians, some French citizens and some Germans about health care issues. Recently there was also a thread here about retiring abroad and the issue of health care also surfaced there I think. So many people in the US say that we wouldn't want to go to a Canadian system or British system, for example, because the waits are so long for anything but emergency care. I'd like some comments from those of you who really know firsthand what other countries' healthcare systems are like. Here is my example.

My middle-aged husband hurt his knee and needs arthoscopic surgery. The orthopedist said it needs repair, and while it is not urgent, he shouldn't wait longer than 3 to 5 months. This is what he is looking at as a time schedule. Time from injury to surgery--about six weeks total (2 weeks wait to see the orthopedist, 2 weeks of thinking before deciding to schedule surgery, and 2 weeks wait for the surgery). If this had been your country, how long would he have had to wait? How does your healthcare system operate? I should add that we are lucky that we have good insurance through my employer because in the US this is a huge component to the healthcare picture.

Christina

I think that is a good way to get an answer, by a concrete example. I don't know if it's that realistic, though, as I'm an American, and I couldn't get an appointment that quick for nonessential surgery. I know because I just had such an experience (not the knee thing), and had to schedule about two months off.

A lot of people who denigrate other countries health care systems do it for political reasons, and don't have the facts or are deliberately distorting them if they are a politician. It doesn't matter how quickly you can get in to get surgery if you are wealthy. You can always get surgery if you are rich when you want.

A lot of people wouldn't know the answer to your question even in their own country, though, so wouldn't know how long it would take for that or whether it was be considered elective or not.

I have some resources on various country health care systems if you really want to know more about it. There are lots of books and articles written about it. I'm doing some work with McGill U researchers right now on funding of mental health inpatient stay differences by type of payer for use in some Canadian health funding debates. This isn't an easy thing to really describe nor can it be done simply, unfortunately.

Christina

oh, sorry, I did not mean to say I wasn't interested in what people would have to say about this question in their country, I am. I have a friend who has German and US citizenship, and she prefers to go to Germany for her health care, and it's not because she doesn't have insurance here.

JJ5

I have 4 different friends who have their parents here (in the USA)
because they could not get the "help" they needed in Europe. I happen to live near Chicago with many 1st generation Americans who have parents with other citizenship.

Two are from Ireland, one is from Italy and one is from Poland.

One of the Irish citizens was literally "warehoused" because it was deemed her condition was terminal. She was given 6 months at the outside and sent to a 3 person to a room hospice type environment quite far from her home. It was a lymphona.

She was treated for 13 weeks in the USA and it is now 6 years later. She calls her daughter at work every day about 4pm
or so and asks when tea will be.

The others are not as extreme, but the Italian gentleman could not get the knee replacement he needed where he was. He told me that he would have had to wait one more year and it would have been done too far from where he was to get the right kind of physical rehabilitation afterwards.

The Polish Grandpa could not get the medicine he needed in Poland.

I have no political agenda and wish we could have a Universal Health Insurance for hospitalization that would work for 100% of our citizens. My grand-aunts and second cousin in Germany are quite happy with their care, especially their eye care.

But I do know that there are no easy answers, especially when I see people who DO have many free health care perks using the ER as a regular doctor's visit: for colds, sore throat etc.

And so many other things involved are not addressed by this kind of comparison. Especially RX. R& D for RX is only done in so many places. You can't just go by production costs etc. And right now a large percentage of the R&D is being done in the USA.

My daughter is an American citizen from birth and went insurance-less from the time she was 22 to 25. She was still in school or doing jobs without that benefit and could not afford an extra bill. We fought over it and I tried to buy her some.

That is wrong. But so is the fact that at that same exact time, a person I worked with at another library was a new immigrant (as was her husband) with Lupus from Indonesia. She had 4 babies in 5 years when I worked with her and had LUPUS as well. She got top of the line care gratis, including ultrasounds every month or two at U.of C. system. My experience has seen that very costly care can be obtained as long as you have no assets to attach. And if you are very wealthy, it also isn't an issue.

I do think we should cover all our citizens.

In reverse, I have heard of two people going to Canada to have their teeth/ dentures done there.

nytraveler

The answer is actually fairly simple. Each society gets the type/amount of healthcare it is willing to pay for.

In the US most people want to keep taxes very low (versus the rest of the industrialized world) so many people have limited or no healthcare.

Major employers typically provide - or at least support - a resonable quality of healthcare (although some people with HMOS would argue with this). And the indigent have some government support of basic health needs. However a lot of people in the middle (and their children) who have part-time jobs, seasonal jobs or work for small employers that don't provide insurance have little or no care except in major emergencies.

In Canada and many parts of europe it has been decided that everyone is entitled to at least basic healthcare - which is supported by taxation. This may result in delays or sub-optinal care for some people - since taxpayers are not willing to pay the even larger taxes necessary for faster, better care for all.

In both systems there is the possibility of random abuse - but bascially the care offered - and to whom - is directly related to the amount society is willing to pay.

(In every one of these counries the best possible health care is available almost immediately to anyone willing to pay the costs themselves out of pocket.)

ira

Hi J,

>...2 weeks wait to see the orthopedist, 2 weeks of thinking before deciding to schedule surgery, and 2 weeks wait for the surgery...

The middle 2 weeks should not be debited to the health care system.

BTW, I now know 8 people who have had both knees done. They all say they wish that hadn't waited as long as they did.

nytraveler

Sorry - I left ou my actual example. I work with two MDS - one originally from Germany , the other from England. They both said waiting time for a procedure can vary significantly from one part of the counry to another - depending on resources available.

(Just as in the US there are areas with a plethora of MD in every specialty - and there are ares that are significantly underserved - and those needing specialists may have a significant wait or a long trip.)

Matrexx

Very interesting topic.

I am a Canadian. I am probably not the best spokes person for our system as I am personally young and healthy so I have not personally seen or experienced the horrors claimed to be happening in our system.

My mother-in-law has Crone's disease. She lives in a relatively small town which does not have the highly specialized treatment she needs. She is able to go to facilities within a 45 minute drive for all medical tests. She has had no difficulty with access to specialists. Last fall she had to have a portion of her instines removed. THey brought the specialist surgeon to her town so she could stay at her local hospital and be near her family. When she has been hospitalized in the past she her specialist has come from the neighbouring town.

Another incident - last fall I developed a strange swelling on the side of my nose. Nothing particularly uncomfortable and definitely not life threatening. The only thing was that it looked horrid and people kept staring at my nose. I had to wait for 3 weeks to see a dematologist and then another 2 months to see a plastic surgeon. I dutifully waited my turn to be told that there was nothing to be done. Were the wait times a pain? Yeah, but did it really matter to me? No since I didn't have the look at the thing!

I guess as you can tell - I love our system. I think it works well. Those who need treatment in a timely fashion get it and for elective procedures the rest of us can just wait our turn. Personally I figure if it's elective then you can wait for to let someone who really needs treatment go first. Maybe it's my British heritage, but I think that people whine and complain too much these days. The sense of personal entitlement makes me nauseous. I like how our system treats everyone equally regardless of financial means. I am absolutely willing to pay higher taxes if it means that I can help someone less lucky than I receive the help and treatment they need.

FainaAgain

It all depends what type of insurance you have and how you personally take it.

I am happy with HMO, some people can't stand it. Had a tooth filled without even a co-pay with my work insurance.

Eyeglasses are not covered - feel being robbed after paying $195 for new glasses, but the full price was $320, insurance discount.

With my prescriptions practically covered: $10 generic, $20 brand I don't need to go to Canada.

So it all depends on your personal needs.

Elizabeth_S

Boy - this is my hot button issue!

I'm Canadian and have put the system to the test for the last couple of years. 2 years ago I was diagnosed with breast cancer - it was very early so I had minimally invasive surgery and chemo/radiation for extra insurance. My experience has been outstanding - although you do have to be a strong advocate for yourself.

I've become quite involved in the efforts to reform our health care system. There is no question it has problems - particularly orthopedic and diagnostic imaging. I am encouraged, though, by the depth and breadth of the effort now being made by the federal and provincial governments to reform the system; while preserving the basic access. (yes their backs are to wall...but at least there is action).

For example - at a major Toronto hospital the wait time today for a non emergency MRI is less than 4 weeks - I believe that is an acceptable period of time (for non emergencies) if it means everyone has equal access to the technology.....at that same facility I've had MRIs in 12 hours when there was a problem.

I'm not Pollyanna about our system - but I see real efforts to reform it and ensure universal access.

And ladies - early detection is the key!!!! Get that mammogram you've been putting off!

julies

Ira is right. The actual wait time is only 4 weeks.

I'm just curious how all these people JJ5 referred to manage to pay for their healthcare here in the US when they come in from another country where they have been dissatisfied with the care they are getting. Are they independently wealthy or what?

My new daughter-in-law (she married my son who is an American from birth) is from Lithuania and she is working part time jobs now that she finally got work papers. My son doesn't have a job that offers insurance yet. They are paying for their own, and they had a real problem finding a company that would insure her (she's young and healthy) because many companies will not insure someone who has been in the country for less than a year. Also, someone who sponsors an immigrant has to certify that for 10 years he or she will provide support so that the new immigrant is not receiving government services. That's why I can't figure out how these people from other countries come here to get health care. And, yes, my son took care of his dental work in Lithuania because even with his meager salary there it was much more affordable than in would have been in the US.

I had some necessary but not urgent eye surgery last year and my wait was not long. I think my husband and I would both have been willing to wait a bit longer for our surgeries if that is what it would take to ensure that those who are uninsured could have some basic level of health coverage. We too have seen our young college graduate children go uninsured because of the strange system we have here where an employer, rather than the government, is the means by which insurance is obtained.

MyriamC

Your specific example in Belgium:
between 1-2 weeks to see the specialist
between 2-4 weeks to wait for non-urgent surgery.
It doesn't matter whether one has private insurance or not. Every Belgian citizen is entitled to basic (more than basic) healthcare for a very small fee. It even includes free healthcare abroad.

JJ5

My examples were all paid for by their children, who all have been US citizens for more than 30 or 40 years.

Access for new immigrants is all over the board. And as for US Citizens, if you are on welfare, you get health care but through the county system. It just so happens that Cook County has some very good hospitals. My Lupus patient example was living with a sister and brother in law in a house with 6 other people and was on welfare. She had a CS and high risk pregnancy care for 4 years in a row without any payment.

FainaAgain

Julies, I came to USA from the former soviet union. Being on welfare (we came legally) our family got Medi-Cal - the cheapest insurance, not widely acceptable, but the basics are covered.

I was just happy I didn't have to bribe doctors and nurses to have a check-up! Where I lived I could never go to a doctor empty-handed.

And people from different countries come with different statuses. "Refugees" get 100% coverage of all life expenses - rent, foodstamps, medicine, some cash.

Status "Parolee" doesn't give any material support.

But everyone knows the status before coming to USA, so they have time and opportunity to decide to come here or not.

There is also a government "share of cost" FREE insurance for poor families, they pay out of pocket depending on income, and the rest the government picks up. For example, I had a co-worker with one child, her co-pay was $150 a year, and she was extremely happy with it.

AnselmAdorne

Matrexx and Elizabeth_S have posted some positive comments about the Canadian public health system, which I would like to echo.

While this is the experience of only one individual, my father has had several dealings with medical services in Ontario recently. (He's 97, lives by himself in Ontario, and I live in Nova Scotia; I've spent a lot of time with him in doctors' offices and hospitals over the last year.) Contrary to all the horror stories about agonizing wait times and overcrowded facilities, I found the services to have been accessible, prompt, and effective.

One thing that should be pointed out, however, is that delivery of heath services is in the hands of ten provinces; I am not confident that he would have had the same level of care in Nova Scotia.

Anselm

jody

And read why Toyota is by-passing all offers from the US ,to build their new plant in Canada!

US healthcare is great if you are insured with your employer..but if you have to pay for it out of pocket..you better be making mega bucks!

We always had insurance with employers but I decided to retire and though I had COBRA for 3 years at $400.00 a month it ran out 2 years before Medicare kicked in. For those 2 years , it was hell to find something affordable! An HMO for 2- 63 yr olds, in good health was $1700.00 a month! We finally bought a major medical policy with a $5000.00 deductible for $450.00 a month! Even with Medicare , which costs us $120.00 a month we pay and additional $275.00 a month for a supplemental!

We have a friend , who has dual citizenship in the UK and no insurnace here. She needed a hysterectomy(SP) and had to pay out of pocket...she has 5 months to go until Medicare kicks in! The cost in the US was going to be around $35,000.00! She went home to her mother's in London and paid cash>>> $3500.00!

Something is seriously wrong here!

FainaAgain

Jody, I agree with you, MediCare is awful, you pay all your life out of your paycheck, then part of your pension goes to pay additional MediCare and still doesn't cover everything! This is the worst treatment of elderly. Speaking of elderly abuse... what is it if not abuse?

You can tell it's hot topic with me as a relative is affected.

Is there a place in the world he can go to get medical help? And if different citizenship comes with it, who cares!

kswl

Jody said, "We finally bought a major medical policy with a $5000.00 deductible for $450.00 a month! "

You must have our insurance---our deductible is $4900 per year, and the premium is about $450 per month. We have NO prescription coverage. Last year our son broke his elbow at camp and needed an operation and graft. He was in the hospital one night. Total bill about $3200. The year before, our daughter had her tonsils removed as an outpatient. Total bill $2300. (not including Rx in either case)

I am thankful we are able to pay for care when we need it. My husband is a physician and he, too, advocates some kind of single payer system for the U.S. It just makes sense that the technology is costly enough without third party companies trying to make a profit by insuring only the healthiest individuals.

Our current system could be likened to a patient getting a blood transfusion: blood comes out of one arm and goes back into the other. But between the two arms there is a siphon that takes about 2/3 of the blood out of the line!

RufusTFirefly

Basically, modern medical care is expensive. You can either pay a lot for an on-demand system (like the USA has), or you can ration it like most socialized medicine countries do.

The USA does a big business along its northern border with people who come down from Canada to get care quickly. Canada does a big business with Americans seeking cheaper drugs.

The fact is, you're going to pay one way or another, or a combination of ways. Insurance premiums, out of pocket, or taxes. Pick your poison. Nothing is free in the medical world. Somebody has to pay for it somehow.

kswl

We're paying for it all three ways: through insurance premiums, out-of-pocket, and taxes. And we still have a large population of non-and under-insured citizens.

Going to the ER when you don't feel good, having very expensive and unnecessary tests, getting a Rx that isn't filled because it's too expensive, and having no "regular" physician for follow-up care is hardly an admirable system.

Every society is judged in history according to how it treated its most vulnerable citizens.