Non-American health care

Good old American health care is all I’ve ever known. I remember when the family doctor made house calls. I think I even remember when the insurance company existed to help us (but that could have just been a dream).

We can’t really call what’s happening a national “debate” on health care — more of a national shriek– but there are those who think we have the best health care in the world. Since I haven’t been a lot of places in the world, I decided to get the opinion of some of my over-seas pen pals.

Keith Povall lives in or near Birmingham, UK and has recently had more of their national health care than he would have liked. You can read his full assessment in the comments, but here’s an excerpt:

“In modern times, much criticism has been leveled at the NHS because there is a lot of truth in the opinion that it is a monster grown out of control. It is the largest employer in Europe for example and many say / believe that there are too many chiefs and not enough Indians (to coin a phrase). Over the years, governments have thrown billions at it and the monster gobbles up the cash. It is believed governments would like to introduce a private service to replace it, but in the main “the people” love the NHS, something that is there as a safety net for when they need it and whilst you will hear complaints about income tax and stealth taxes, no one complains about their NI contributions.”

Peter is a psychiatric nurse in the Netherlands and –as a health care provider– might be less than objective on this subject. On the other hand, he has first-hand knowledge of his country’s system.

“The insurance companies want to control everything; they even want to control what professionals like me should do or not. The basis of their policy is not what the clients want (those who put money in the big jar) but what the shareholders want. Their goal is not good health care for their members, but profit and big bonus for a couple of hotshots. A very bad development which surely will be changed the moment the issue is hot again and elections are due. As you see we are quite a normal country in this.”

Again, I hope you’ll read Peter’s full email in the comments.

I’m still waiting to hear from a friend in Belgium and will add her thoughts if and when we get them. My thanks to Keith and Peter for taking time to respond to a serious inquiry from me. Something they are rarely called upon to do.

4 thoughts on “Non-American health care

  1. Having read Peter’s longer account, I see he too is “over managed” rather like I said about the NHS in the UK.

  2. I’ve seen healthcare systems from the perspective of a physician and a patient in American, New Zealand and Denmark. I have no doubt that universal healthcare is the right choice. It is easier, simpler, cheaper and at the same time more effective.

    No country that has adopted universal health insurance has ever voted to stop it. Every developed nation on earth has universal health coverage (except the USA).

    Is Universal Healthcare perfect? Of course not. There will be aggravations, but am certain that the pains in the new system will be much less than the horrific cobbled together system that we have now.

    I encourage everyone to write their congressman now to express strong support for the Obama Healthcare plan.

  3. I’ve been thinking about your question. It is not an easy one. A lot has been changed in our system of health care and security/insurance. Some things are better now, some things are worse. But, I can’t win them all (for instance, I haven’t tried to get in touch with our prime minister wearing a Fez)

    We used to have a system in which some health care was insured by paying an insurance company. An other part was insured through taxes. Everybody was obliged to get an insurance. The monthly tax and insurance money was held from your wages by the employers. This way everybody paid and everybody was insured. The more you earned, the more you paid: broad shoulders carry more.

    As the cost of health care started rising higher and higher, changes were made. People got more responsibility by giving them more choice on the conditions of health care and insurance. The companies are obliged to insure certain part of health care in a basic package (f.i. GP visits, hospitalization). Other things can be chosen from. Also the first 150 euro was set to be your own risk. This way people were stimulated, to go to their gp for real complaints an not with every fart they felt bothered by.

    In the meantime health care providers (hospitals, specialists etc) got another budget system. From open budget in the sixties and seventies, it has changed to a different style of payment. We call it Diagnose Treatment Combination (DBC). Every disease can be linked to a certain treatment. Every provider of healthcare has to mention his price for all the DBC’s they have and the insurance company buys the cheapest of health care.
    Another thing that has changed very much is the demand of our government for perestroika (openness, clearness) of everything the doctor or hospital is doing. This way the patient knows what he gets.
    There are poor people now who do not pay insurance money and therefor they can only get health care in emergency situations. Health care is more and more a thing for people with money.

    Advantages I witnessed in 35 years of working in psychiatry (yes, I did work in the looney bin): more and more focus on best practice and evidence based medicine. More efficiency and the best thing is: we ask the client whether he agrees with the treatment we have in mind. No more Cuckoo’s Nest; we kind of know what we are doing these days.

    Disadvantages: We have to produce more in the same amount of time, as loads of nursing staff has been replaced by (very expensive) managers, who make shure we produce more in the same amount of time, so that they can be paid. There is also more bureaucracy as we have to write down every fart that bothers our clients and write down the way we thing it has to be treated. Too much paperwork.

    The insurance companies want to control everything; they even want to control what professionals like me should do or not. The basis of their policy is not what the clients want (those who put money in the big jar) but what the shareholders want. Their goal is not good health care for their members, but profit and big bonus for a couple of hotshots. A very bad development which surely will be changed the moment the issue is hot again and elections are due. As you see we are quite a normal country in this.

    As you can see I do not think market thinking belongs in health care. I think it has te be controlled by the government and it should be available for all. I think evidence based and best practice do belong in our system of health care. And professionals should be very critical about what they do and how they do it. Not for the money, but because it is their job.

    A motto: The level of civilization of a country is determined by the way the weaker in society are treated.

    Well Steve this is just some of my thoughts in a nutshell. Hope it answers your question a little.

    Peter

  4. The National Health Service (NHS) was originally set up in 1948, to offer “free” health care to all. In actuality, the service was and still is funded from what are called National Insurance contributions by those in employment and partly by employers.

    Personal NI contributions are approximately 9% of gross income and are paid separately to income tax. An employer also pays a similar amount on each company employee, so this is how the service is funded.

    In modern times, much criticism has been leveled at the NHS because there is a lot of truth in the opinion that it is a monster grown out of control. It is the largest employer in Europe for example and many say / believe that there are too many chiefs and not enough Indians (to coin a phrase). Over the years, governments have thrown billions at it and the monster gobbles up the cash. It is believed governments would like to introduce a private service to replace it, but in the main “the people” love the NHS, something that is there as a safety net for when they need it and whilst you will hear complaints about income tax and stealth taxes, no one complains about their NI contributions.

    On the dark side, recent news stories have covered a hospital in north Staffordshire (about 30 miles from here), where a number of older patients died through neglect. The investigations are still ongoing as to what happened and some management heads have rolled.

    As I said, the purposes if this report are to essay my own experiences of the NHS over a period of 12 years or more.

    I didn’t go near a doctor in maybe twenty years preceding that, then in my forties I went to see my GP (general Practitioner) at the surgery and was diagnosed firstly with high blood pressure and then type 2 diabetes.

    Both these conditions have been well controlled for the ensuing years with oral medication.

    I have an annual blood test to check on my diabetic condition and was referred to my local hospital about 6 years ago, to have my eyes checked. It was discovered that there were new blood vessels growing on my retina, which can be disruptive to vision in later years and these were destroyed painlessly by laser.

    Last year’s blood test picked up an abnormal liver function and I was asked to go back to my local surgery for an ultra sound scan. Being on the corpulent side, this scan was somewhat inconclusive, but did show something on my right kidney.

    I was referred to my local hospital again and had a CT scan. One week later I saw a consultant urologist at the same hospital who announced I had a “neoplasm” and not a cyst.

    I was immediately referred to a high ranking consultant urologist/ surgeon at the large teaching hospital in Birmingham (our second city), which has a renal treatment unit amongst other things).

    Mr. Wallace had a consult with me and explained my options. The tumor was approximately 4cm (about an inch and a half) and was hanging off the lower pole of my right kidney.

    None of the tests or scans could reveal whether this growth was cancerous or not, only a biopsy, which are not carried out on organs, because of the possibility of “leeching” and spreading any cancer which might be there.

    My options were to: Ignore it (where it might grow and eventually kill me). Have it removed surgically or have it cooked with a procedure (still new in the UK) called radio frequency ablation.

    I’d been sent to Mr. Wallace, because he is something of a pioneer in this country of the partial or nephron sparring nephrectomy. The removal of the damaged part of the kidney rather than the whole organ. Because of my diabetes, this was considered the best of options, but I wasn’t leaned on to accept.

    In fact my personal fears explained to Mr. Wallace led him to give me a breathing space of six months to seek some cognitive behavioural therapy (again funded by the NHS) to help me condition myself for surgery, something I had an uncontrollable and irrational fear of.

    During this period, I was again given a CT scan and blood tests, to monitor the condition of the tumor which did not grow by any appreciable amount.

    At my next consultation in October, I told Mr. Wallace that despite my fears which were still not conquered, I would go for the surgical option, because I would much rather trust the experience of a surgeon who can look at my kidney and judge what action to take, rather than have 2 needles pushed into it, fry the alleged affected area and hope it was all cooked and destroyed.

    We agreed that I would go in for my procedure immediately after Christmas (yet if I had wanted it sooner, the option was offered).

    In January, I attended a pre screening session at the Queen Elizabeth where one is checked for the superbugs (which have caused a lot of bad press) and other body functions.

    This is where we discovered during an ECG, that I had an irregular heartbeat and my heart rate was too high. It was considered too dangerous to operate and I was put in the care of the cardiologists.

    I did not respond to oral medication and when a cancellation came about, I was invited into hospital for an overnight stay and subjected to a procedure where an electrode was pushed up through my groin and one of the valves in my heart cauterized to regularize the heartbeat.

    The procedure was a success and I was cleared for my kidney surgery, which happened about 3 weeks later.

    At all levels, the medical staff were amazing and it is this which went a long way to my dealing with my fears of being cut open. The night before my operation, I had a consult with the anaesthetist who explained his part of things.

    Unfortunately, following my surgery, I found myself sitting up in bed and experiencing severe pain in the surgical area. Tests were carried out and it was discovered partly that the epidural I had been given during surgery, was not covering my abdominal area, but based on my responses to questions about the pain, I was X rayed in my bed and then an anesthetist came to my bedside and administered some morphine.

    It was discovered that the main artery into my kidney was bleeding and I was taken back to theatre and operated on again.

    I woke up 2 days later in the high dependency unit on a ventilator.

    Here, I was treated like royalty. I was told as soon as I came round, that I was on a ventilator and the harder I breathed for myself, the sooner they could take me off it. I was off it by lunchtime that day. There’s motivation for you !

    I was moved to the regular recovery ward that evening and over the next couple of days, I went through a few unpleasant experiences. Firstly, I was suffering low haemoglobin (where you lose the will to live). The doctors reacted positively and put some blood into me.

    Next day, I went through a period of being violently sick (a common post surgery condition). The doctors pumped me full of anti sickness drugs and by next day I felt like a human being again.

    Two days later, I was allowed to go home.

    I shall never forget those wonderful people who helped me through that ordeal. From the nursing auxiliaries who mop up the puke, to the surgeon (who’s a bit of a bulldog), but treated me with respect.

    My one complaint was the nursing staff making me laugh. Quite difficult when you are stitched up to high heaven.

    Hospital food is pretty dire, but for six days of my stay, I was in no condition to eat anyway.

    The tumor was cancerous by the way, but a low grade. Mr Wallace tells me the chances of a recurrence over the next 5 – 10 years is about 5%. I’ll take those odds thank you.

    I shall be going back for a CT scan in September and then about one a year just to keep an eye on things.

    Meanwhile, I shall be at my local surgery for my usual diabetic blood tests which discovered all this in the first place.

    9 weeks on and I feel like a new person. I have one or two minor discomforts which will heal over time.

    As a patient, the NHS has not only looked after me, but has saved my life, something else which I will never forget.

Leave a Reply

Your email address will not be published. Required fields are marked *