Got a phone interview coming up with the Alfred Hospital in Melbourne (coming from the UK) and just realised that I don't fully understand the whole Medicare thing!
Is care at the point of delivery completely free? What about GPs, prescriptions, ambulances etc? Basically I'm trying to compare it to the UK system of a National Health Service which is funded by National Insurance and taxes and is completely free (and dying under the strain, buts thats another story!).
Can anyone describe it briefly or point me to a link? I looked at a couple of things on the net, but got a bit muddled with which bits have to be paid for (bulk billing, what does that mean??!!). Then again I was looking during a night shift, not really the best time to try to understand anything!!
The huge difference that I can see between the US and Australian systems is that there are inbuilt "safety nets" within the Australian system. If your pharmacy bill is over X amount per year - you get medication almost free (In some cases it is free but I am not comfortable with that as it can lead to abuse). If you choose a "bulk billing" doctor (one that only charges what medicare will rebate) then you don't have to pay for GP visits.
Our system has problems - lots of them (just ask our state Premier at the moment:chuckle) BUT it has the advantage of there being private cover if you want it or a public service that is "no frills".
Here in the States, our system is a little different. We just had Part D, medication coverage take effect. You have to choose a provider (40 in my state). They generally have a variety of plans, with a variety of costs and a variety of the types of coverage. At the minimum, you have a $250 deductable to pay each year, then a low co-pay for generics and a higher one for brand names, till you reach the donut hole, a set amount that covers nothing, then you get your scripts with them paying 95% of the costs. Or you can pay more, skip the deductable, donut hole, and generally get your scrips for a reasonable amount if your expense is high enough.
Most of our physicians accept Medicare. A good number, over 65, have gap coverage. Those under are usually disabled and cannot afford the coverage because it is too expensive. Both public and private hospitals accept Medicare. And there is no waiting for elective surgery but you can find yourself in deep debt paying the extras.
There is a major difference between our country's plans. And I think I'll stick to the U.S. one for now:)
Thats sound complicated! In the UK there is a set fee for prescriptions about £6 or $14 for each item - no matter what the item is. If you are on income support, over a certain age or have a certain chronic condition then the prescription is free. In fact evidence shows that anywhere between 80-90% of people do not pay a prescription charge at all!
Here in the States, our system is a little different. We just had Part D, medication coverage take effect. You have to choose a provider (40 in my state). They generally have a variety of plans, with a variety of costs and a variety of the types of coverage. At the minimum, you have a $250 deductable to pay each year, then a low co-pay for generics and a higher one for brand names, till you reach the donut hole, a set amount that covers nothing, then you get your scripts with them paying 95% of the costs. Or you can pay more, skip the deductable, donut hole, and generally get your scrips for a reasonable amount if your expense is high enough.
Most of our physicians accept Medicare. A good number, over 65, have gap coverage. Those under are usually disabled and cannot afford the coverage because it is too expensive. Both public and private hospitals accept Medicare. And there is no waiting for elective surgery but you can find yourself in deep debt paying the extras.
There is a major difference between our country's plans. And I think I'll stick to the U.S. one for now:)
Grannynurse:balloons:
Working with 3 Americans at the moment and one was telling me how much he liked our system!! He and his family are NOT covered by our free system as Australia does not have a mutual agreement with the US (it does with other countries like England) but he is paying less in health insurance here even though it is "full cover" and he gets to choose not only whichever doctor he wants but chiropractic and other things as well!
People hear about the waiting lists and panic - but most are subject to "how sick are you". See it is sickest first with our system. It is a constant battle between US the voters and the politicians awarding the funding over waiting lists. If the waiting lists get too long then we scream until the pollies DO something about it - this is why our state premier is having ulcers at the moment - the waiting lists got too long here in QLD and he is having to scrounge more medical staff to appease the voters:D:D
Working with 3 Americans at the moment and one was telling me how much he liked our system!! He and his family are NOT covered by our free system as Australia does not have a mutual agreement with the US (it does with other countries like England) but he is paying less in health insurance here even though it is "full cover" and he gets to choose not only whichever doctor he wants but chiropractic and other things as well!
People hear about the waiting lists and panic - but most are subject to "how sick are you". See it is sickest first with our system. It is a constant battle between US the voters and the politicians awarding the funding over waiting lists. If the waiting lists get too long then we scream until the pollies DO something about it - this is why our state premier is having ulcers at the moment - the waiting lists got too long here in QLD and he is having to scrounge more medical staff to appease the voters:D:D
I spent my younger years studying the different health care systems of this world. I have been struck by the expense of my country and the lack of it in others. I have not been scared off by the supposed waits because we wait in this country as well. Belonging to an HMO and you can wait a year or more for approval for elective surgery. And then it must be done in the hospital they have the contract with and the same goes for the surgeon. And neither may be one's first choice.
Our last hospital changed from a not for profit to a for profit last year, and I have noticed a change. Before, if I went to the ER with an asthma attack, it usually meant an admission for me. I am pretty well versed on when I need to be treated as an in-patient and when I do not. The last three times I've gone to the ER, I really believed I need to be admitted twice and was not. As a result, I ended up back in the ER twice more, in a relatively short period of time, before I was admitted. I believe it is truly an attempt to reduce the number of delays in payment, since I do not have a gap policy, so I pay what I can.
No health care system meants 100% of it's country's needs. While we have good surgeons, good researchers, good hospitals, we fail to meet the needs of more then 43 million of our population that are not covered by any health care insurance. And we treat those on Medicaid and to a certain extent, Medicare, on an episodic bases. And as such, make their care more and more expensive to the rest of us because they come in sicker. I don't know what the answer is but I do think that health care is a right.
In Victoria ambulance cover has to be paid separately, although some unions and insurance policies cover it. Otherwise it costs around $50/year for individuals and around twice that for families.
In Victoria ambulance cover has to be paid separately, although some unions and insurance policies cover it. Otherwise it costs around $50/year for individuals and around twice that for families.
Think I could call Victoria 911 the next time I need an ambulance. One of the reason's I hesitate to call one, here in Florida, is cost. And ours comes from our county's fire department. Last time, my bill was over $400, for a seven mile trip, with an attempt at an IV. My share was just under $150. $50 sounds like a good deal.
I was wrong - it's $55/single, $110/family. It's a great service, and membership covers metropolitan, rural and air ambulance. It can cost a bundle if you don't have cover - thousands, if you have to be flown in, for example :)
I was wrong - it's $55/single, $110/family. It's a great service, and membership covers metropolitan, rural and air ambulance. It can cost a bundle if you don't have cover - thousands, if you have to be flown in, for example :)
Is that $110 a year? If it is, it is a bargain. I read in today's New York Times about the growth of private hospitals in Canada. Part of the reason given is a three week to nine week wait for different types of surgeries and treatments. I don't think that is necessarily long, considering I waited four weeks to be admitted for cervical lami in 1997. Forget air ambulance. I once chartered one for two clients to be flown from Moorehaven (in the middle of the state) to Tampa. It cost the employer a ton of money. And following Hurrican Charlie, which shut down all three of our hospitals, I had to be transported from the ER of one, to the cardiac floor of another. I hate to see what that bill was but FEMA (Federal Emergency Management Agency). paid it all.
It is interesting to see what other countries cover and what they charge. We are constantly barraged with the fear of long waits for elective surgeries, less medications being available, huge public expenditures, etc. The so called socialized medical systems of our friends and neighbors is appealing to more and more of my fellow countrymen.
Granny - I can't complain too much. I have an odd eye condition caused by thin and sagging corneas - medicare covers ALL my bills at the optometrist. I have to pay for lenses ($120 PER lens!!) but the majority of that cost is covered by my private insurance. I can see any optometrist I like for this as well.
Dental is not covered under medicare but most private health insurers will cover for dental and you can get private cover that JUST does the "extras" (i.e dental, physiotherapy, pharmacuetical, dietitian, podiatrist etc)
I know my private health insurance also offers discounts for Gym membership!! (they have this strange belief that if they can KEEP you healthy that they will have to pay out less LOL!!)
A two tier system does seem to be one of the best options around in lots of odd ways too. In some of our regional hospitals what has happened is that services like MRI might not be in the major hospital but in the town's private hospital - if you need an MRI you can go to the private hospital and it is paid for under the free system (they basically subcontract - it is cheaper than having the equipment themselves). Yes it is inconvienient but it is the most cost effective.
There are other issues that underpin the difference in cost in the two countries. Here we do not have itemised bills in private hospitals (except for pharmacy and other incidentals) - there is one "set" rate for bed stay - this reduces the clerical overhead (however that incidentals list IS growing longer each day). I think too there is a definite difference in the culture and expectations of people in relation to hospitalization here.
I had noticed that we seem to "pull the plug" a lot earlier and talking to my American colleagues working here that is there impression too. We are less likely to continue to intervene if the outlook appears hopeless and more likely to refuse admission to ICU in terminal cases. That does not mean that we are turning away 80 year olds who normally are self caring but we are unlikely to admit a 99 year old who has spent the last 10 years in a nursing home having full care. This though, could be less a function of the health care system than a part of the Australian culture - would make a fascinating research study - one I would be happy to undertake if I can get funding to tour the US and gather data:P:chuckle
Granny - I can't complain too much. I have an odd eye condition caused by thin and sagging corneas - medicare covers ALL my bills at the optometrist. I have to pay for lenses ($120 PER lens!!) but the majority of that cost is covered by my private insurance. I can see any optometrist I like for this as well.
Dental is not covered under medicare but most private health insurers will cover for dental and you can get private cover that JUST does the "extras" (i.e dental, physiotherapy, pharmacuetical, dietitian, podiatrist etc)
I know my private health insurance also offers discounts for Gym membership!! (they have this strange belief that if they can KEEP you healthy that they will have to pay out less LOL!!)
A two tier system does seem to be one of the best options around in lots of odd ways too. In some of our regional hospitals what has happened is that services like MRI might not be in the major hospital but in the town's private hospital - if you need an MRI you can go to the private hospital and it is paid for under the free system (they basically subcontract - it is cheaper than having the equipment themselves). Yes it is inconvienient but it is the most cost effective.
There are other issues that underpin the difference in cost in the two countries. Here we do not have itemised bills in private hospitals (except for pharmacy and other incidentals) - there is one "set" rate for bed stay - this reduces the clerical overhead (however that incidentals list IS growing longer each day). I think too there is a definite difference in the culture and expectations of people in relation to hospitalization here.
I had noticed that we seem to "pull the plug" a lot earlier and talking to my American colleagues working here that is there impression too. We are less likely to continue to intervene if the outlook appears hopeless and more likely to refuse admission to ICU in terminal cases. That does not mean that we are turning away 80 year olds who normally are self caring but we are unlikely to admit a 99 year old who has spent the last 10 years in a nursing home having full care. This though, could be less a function of the health care system than a part of the Australian culture - would make a fascinating research study - one I would be happy to undertake if I can get funding to tour the US and gather data:P:chuckle
If you are fortunate enought to have an employer who offers health insurance most offer everything that your public and private system offers. What has been effecting them is a rise in cost and a reduction in benefits. For employers to lower their cost, many have negotiated to HMO and PPO coverage. HMO is Health Maintaince Organization. They generally contract with primary care physicians and specialist. You need to see a PCP who will refer you to the specialist. He is known as the 'gate keeper'. They also contract for lab and x-ray, as well as facility and free standing surgical centers. Go outside their coverage and you can be socked with the bill. Many also have a stipulation you must get prior approval for certain services, including ER visits. It is generally done thru an 800 number and a nurse who has written standards for her/him to follow.
PPO is Perferred Provider (forget what the O stands for:) ). You have a little more freedom. Not as much as a gate keeper and not as much as prior approval. The choice of physicians is greater, as is the choice of labs, hospitals, etc. It is more expensive for the employer and employee.
I live in a county that has approximately 110,000 people during season-Oct-April. We have three for-profit hospitals, several free standing, same day surgical centers, seven MRIs, 8 CT scanners, three Radiology Centers, eight animal hospitals, one animal ER:D :rotfl: (thought I'd throw that in, my daughter is an Animal Control Sgt.:) Sarasota County, north of us, and Lee County, south of us, have three and five hospitals, I don't know how many MRI centers, etc. All three counties have public health departments that offer AIDS service and some very minimum health screening and care, plus immunizations.
Most hospitals do not provide a detailed itemized bill to either the insurance companies or patients, unless they ask for one. Room and Board can vary within a facility, as well as the cost of medications, surgical supplies, OR supplies, charge for the OR room, pre and post op room and care. Of course, HMOs and PPOs have all ready negotiated a lower price. And Medicare sets it price-but it is also set by area, rural, urban, city, inner city.
You are correct about the not willing to let people die attitude. In some cases, it is totally wrong, what we do. But in other cases, I don't know. I have a Living Will and a Health Care Proxy-my daughter. They have taken hold with my generation and the baby boomers. My daughter had surgery, this past September, finally made them out. We, as a cultural, have been told that medicine can do almost anything. This coupled with family dynamics generally puts many of our seniors in very poor situations. As an older person, now, I tend to want to remain active as long as I can, why else would I go back to grad school at 60:) ? But I also do not want to end my days in a nursing home. Both of my parents die at home, I hope to follow them.
:rotfl: (thought I'd throw that in, my daughter is an Animal Control Sgt.:) Sarasota County, north of us, and Lee County, south of us, have three and five hospitals, I don't know how many MRI centers, etc. All three counties have public health departments that offer AIDS service and some very minimum health screening and care, plus immunizations.
grannynurse FNP student
1,016 Posts
Here in the States, our system is a little different. We just had Part D, medication coverage take effect. You have to choose a provider (40 in my state). They generally have a variety of plans, with a variety of costs and a variety of the types of coverage. At the minimum, you have a $250 deductable to pay each year, then a low co-pay for generics and a higher one for brand names, till you reach the donut hole, a set amount that covers nothing, then you get your scripts with them paying 95% of the costs. Or you can pay more, skip the deductable, donut hole, and generally get your scrips for a reasonable amount if your expense is high enough.
Most of our physicians accept Medicare. A good number, over 65, have gap coverage. Those under are usually disabled and cannot afford the coverage because it is too expensive. Both public and private hospitals accept Medicare. And there is no waiting for elective surgery but you can find yourself in deep debt paying the extras.
There is a major difference between our country's plans. And I think I'll stick to the U.S. one for now:)
Grannynurse:balloons: