As a universal healthcare consumer, what's it really like in the UK or Canada?

Silverdragon102, BSN · Mar 8, 2008

For those of you Canadians and Europeans, I'm wondering what healthcare coverage in the UK or Canada is really like. Here in America we hear that Universal Healthcare is not a good thing because it takes 3 or 4 months to get a doctor appointment, ER wait times are hours on end, if you are a certain age and get a terminal illness you won't be treated etc... Is it true? What's it really like?

Interesting question.

Here in the UK everyone that is working pays National Insurance (unless working illegal) therefore apart from some small fees like prescription charges treatment is free unless the individual has private insurance or opts to go private. Regarding seeing a GP (general practitioner) it does vary although a lot of surgeries are trying to address this. From experience of where I worked and where I went to see my GP if needed was able to see a doctor the day I rang ie emergency otherwise if not urgent I was able to see a GP within 2 weeks. Hospital appointments to see a consultant varies again. If cancer is suspected then it is expected to be seen within 2 weeks this also included breast lumps, anything else if not referred urgently can vary from a couple of months to much longer, times vary depending on specialty. Demand on all the services both community and hospital based is very high and often unrealistic (my opinion) but government doesn't help as they place targets which have to be met on a service which has high demand, short staff and in some areas shortness of bed availability.

Waiting times can vary in Casualty (ER) but again like many other countries I bet people us it because they can't get to see their GP or think they will get treated quicker when in fact they make the wait longer and also attend for things when could be seen by the chemist ie colds.

I have never heard of any issues pertaining to age and treatment. Things are taken into consideration ie age, quality of life and discussion with patient and family and acted on accordingly. What can happen though is what is called postcode lottery and depending on where you live may depend on whether the local health authority will fund certain treatments due to cost and you can find somewhere close by but another health authority will fund same treatment. Although the government is trying to get away from this I think it will be hard as depending on area ie whether deprived or not, health issues may differ.

This is just my opinion and would be interested to see how other UK nurses see it

LiverpoolJane · Mar 9, 2008

I have family in NY and when I go there I am surprised that my sister in law has to order and pay for the 3 year old daughters asthma medication, as in the UK anyone under 16 is entitled to free NHS prescriptions (also people on low income, on oral contraceptives or have certain chronic conditions)

My last visit my SIL accompanied her grandmother to the ER, after she was seen my SIL then had to arrange her own transport (I think it was an ambulet??) and pay for this herself to get her grandmother home.

Her grandmother was carried up the stairs by the driver and in the process she sustained an injury to her leg - as I was visiting I attended to her leg and had to buy the dressings etc. In the UK transport would be demanded, a district nurse would visit, dressings would be free - and no doubt the ambulance driver would receive a complaint!

I have never seen healthcare denied a pt because of their age - in fact I have seen some 90+ yr olds with multiple comorbidities being treated quite aggresively and my personal view is that it can be cruel.

I think we have good care for the terminally ill both in their own home or hospice - but I have limited personal experience of this so others may disagree.

In the UK I must admit that I am worried about the future of the NHS as people seem to think there is a bottomless pit of money and they are entitled to anything and everything.

I have had a job offer from a hosptial in NC and they sent me info on the med surg wards comparable to the one I work on now and the average length of stay in the US was approx 4-5 days, on my ward the average LOS is 13 days. This is partly because there is no hurry to vacate a bed because people don't understand the costs involved and at any one time in a NHS hospital (medical wards) you can have about 30% of patients who are medically fit but are reluctant / unable to leave for many different reasons (social / family dynamics)

I realise I sound cynical but I sometimes get frustrated with the "It's free - I'll have it - what is it?" attitude I come across daily and having med fit patients in acute care beds when there are critically ill patients needing an ITU bed but cannot get into one as they ITU cannot discharge their patients to the wards as grandmas family have left her in a hospital bed while they enjoy a two week holiday! On my ward we several people med fit - for as long as three months - but the family are in no hurry to take them or find a residential home as then they will need to fund it.

There are also healthcare tourists - those that will nip over for a "holiday" and while here will present themselves at the nearest ER with problems. I have nursed people from one country in particular who have left all their family behind boarded a plane to any UK destination and now they are on the chronic dialysis programme.

I don't think either system is ideal and in the UK we hear these stories that treatment not available in the UK is available in the US - what it doesn't go on to include is the cost.

There are longer waits for accessing care but we are all under pressure to bring waiting times down and I have worked in the private sector and know it can be done. For instance when I worked in the private sector one surgeon would carry out 30+ cataract ops per day - safely and we had a 98% pt satisfaction rate so we could be more efficient but it will take time and a lot of kicking and sreaming!!

I hope this has answered your question - or have I just gone off on my own little rant?

Jane

allnurses Guide · Mar 9, 2008

Again another UK perspective.

The NHS is working very hard to reduce the length of waiting times and we have very strict government targets to meet.

I know that there are some places that have to wait for non-urgent primary care appointments but urgent issues are dealt with straight away. So if I phone my GP because I have an aching toe that has been sore for 2 weeks I may have to wait a week for an appointment, but when I phoned because I needed analgesia for post dislocation pain I was seen that same day.

My daughter always gets same day appointments.

Emergency units have to comply with 4 hour trolley wait targets, we do not always achieve this but the government demands 95% complience with that target. We are getting there.

Elective surgery we are now down to a 6 month wait from referral to treatment, again the govenrment demands that we meet these targets and in general I think they are achieved.

I had always had good health and was very fit up until a year ago when i dislocated my patella, following that I have had to go through the whole process as a patient from emergency care, to outpatient treatment and now as an elective surgical patient.

The emergency care was outstanding, I was treated quickly and the staff were fantastic. I was seen by a physiotherapist within 3 weeks and had weekly out patient appointments to monitor progress.

In august I was recommended to have surgery and because I wanted to try physio for a bit longer I deferred until December when I was placed on the waiting list.

I have a date to have surgery in May. To be honest I could have been done in February but it wasn't convenient for me as I was going on holiday and had just taken a new job.

All preseciptions in Wales are free so I don't pay for any medication.

THere is also a great deal of emphasis placed on chronic disease management and health promotion and general practitioners also have targets to meet with chronic disease management.

I run a pre-operative assessment clinic and all patients are seen 6 weeks prior to surgery for thier condition to be optimised. Here we give health promotion advice and refer to places like smoking cessation and dieticians. Access to these services are without charge.

There are not so good bits, working on the wards is hard as ther are high patient to staff ratios, having said that from what I see the standard of patient care is good.

loriangel14, RN · Mar 9, 2008

My experiences with our Canadian Health care system have been nothing but positive.My oldest daughter was born at 24 weeks gestation and received the best care I could have asked for. We were fortunately living close to a top notch hospital and had the services of some wonderful specialists. After 15 weeks we were able to bring her home and her follow up care was very thorough. We incurred no expenses during any of this and continuing to see the specialist after we got home was convenient and easy.

I have found that wait times at our local ER are not as long as I have heard others are. When my daughter broke her ankle we were tended to quickly and when our family doctor referred us to an orthopedic specialist we got an appointment within days.We are able to get in to see the doctor usually within a week or so.

A friend of mine was diagnosed with breast cancer a couple of years ago and she was on the operating table in two days.

I have seen no evidence of the terminally ill not receiving treatment, most cases the pt gets as much as they and the families want and most treatment is covered. Even whether or not you are a code is decided by the pt not the md.

I think one benefit of our system is that we can access health care at no cost( yes I know it comes from our taxes) and be proactive in taking care of ouselves.Not waiting until we are sick to get help that we have to pay a fortune for. As a parent I cannot imagine having to think about whether or not I can afford to take my children to the doctor or going into debt because of an unfortunate accident or unforseen condition.

This is just my view and I know that everyone has their own.

RGN1 · Mar 10, 2008

I echo a lot of what the posters before have said - the UK system is not perfect & some Trust managers seem determined to bring it to it's knees but on the whole if I was on the economically poorer side of the spectrum (as most nurses here are) & elderly I know what sort of healthcare system I'd be wanting! It may not be perfect but at least it's there!

tammy777 · Mar 14, 2008

Wow, thank you all so much for your replies. It sounds like there are good and bad aspects to Universal healthcare. It's a big thing right now in the US with our presidential election coming up and our democratic candiates talking about providing Universal Healthcare. I've been on the fence because it seems that so many people in the US lose everything because of medical bills and that just doesn't seem right. I had a medical issue not too long ago and I don't have health insurance. Sure I could go to the emergency room, but the bill would be on me to pay and I'm a full-time student. All the tests are so expensive that 1 hospitalization can cause you to go bankrupt... it's pretty crazy... But I don't know how our country would foot the healthcare bill for everyone with healthcare costs being what they are (although I'm sure the billions of dollars spent on the war may have covered it, but that's a whole other can of worms ¤Ü¤). Anyway, I thank you all for your input, it's been enlightening.