Socialized Medicine the myths and the facts

[caramel]

Hey madwife. i agree with you completely . i am not sure why people are so against it. i have heard a lot of nurses say, if we get socialized medicine nurses will not be paid as well as they do. so if its not broken ,don't fix it which is totally stupid.

[ambermichelle]

Yes, I do have a question that I have been wondering about for a long time regarding coverage in countries with socialized medicine.

My son is a hemophiliac and his medications (Recombinate, Factor VIII) are unaffordable (unless you are a millionaire) without private medical insurance here. Because he does have insurance, it is provided for a very small copay. This coverage is from his dad's employer and will last as long as he is a college student and under 25, but that is not much longer. He is hoping to get a good job after graduation but it is uncertain.

His protocol is prophylaxis--he gives himself an IV infusion every other day to prevent spontaneous bleeding. He needs this protocol because when he was on the "treat only when bleeding occurs" protocol that many hemophiliacs are on, he had frequent crippling joint bleeding in the knee and elbow, a subdural hematoma, an ab bleed as big as your fist, and a shoulder joint bleed as big as a football pad which could have cost him his arm.

No private insurance company would cover my son except under an employer's group policy. If in the future my son does not have coverage, it is my understanding that the local county cannot afford prophylaxis though it may provide emergency treatment if bleeding occurs. However a bleed normally requires multiple treatments 12 hours apart.

Would this medication be provided under the UK system? As prophylaxis? Also, do they cover most kinds of chemotherapy?

Thanks.

[Shaka]

I have several questions...

1) What are the salaries for health providers?

2) What are the waiting times for procedures needed, on average?

3) What are the working conditions...i.e. nurse/patient ratio, hours worked on average, acuity of patients cared for in a patient mix?

4) Is there a cap for some health problems...i.e. alcoholism, drug addiction, psyche diagnoses?

5) How much are taxes in the UK and how much goes to health care?

6) Are you in the UK working? and if not why? (don't mean to be personal) just want to know.

Thanks for your perspective...

[colta]

This is a very interesting thread topic. Coming from Canada, we have socialized health care as well, but I do not believe that it is a comprehensive here as it is in the UK.

But kudos to the author of this thread for the brilliant idea.

[limestone]

I'm Canadian. The best thing about our health care system is that in your daily life, you never have to think about affording care or not. You see your doctor or receive hospital care and you never get a bill. Our health care covers us no matter what province we are in when we need the care.

Catastrophic injury or illness? Same thing--you receive the care and no bills.

As nurses, we are paid well. And we don't have to worry about our patients' insurance covering this or that--we just look after them.

No system is perfect--there some community services that should be covered, especially for the elderly who need help with ADL's but I think that will come eventually. We could use better coverage for dental and drugs than we currently have, but people can get private insurance plans for that at relatively low cost.

Where health care is FOR PROFIT, that's when it becomes exclusionary and expensive. That's when it becomes an expense like any other in daily life. I would be so afraid to live in the USA where my coverage was a matter of ongoing concern.

[gonzo1, ASN, RN]

My GERD is acting up really bad due to the economy and work related stress. I got the ER doc to write me a script for nexium because it works really well for me.

When I went to get it filled the cost would be 178$ for 30 pills. I don't have any insurance right now and can't afford that. So it is OTC pepcid for now.

This is just rediculous.

I'm in between travel jobs right now and per diem shifts have dried up. I never thought I would have this problem as a nurse.

I do believe everyone should have access to free healthcare. I think we would see a big improvement if people were receiving preventive care instead of patch up the leaks care.

[Mimi2RN, ASN, RN]

I'm from the UK, so I appreciate the fact that you don't have to worry about getting medical care.

My biggest worry about retirement is paying for a supplementary policy for my husband and myself, as well as as prescription plan. Of course, Medicare costs as much as my insurance right now for both of us. We won't have any dental or vision coverage. My brother and his wife came here to live, and left after two years because they couldn't deal with medical bills.

I wouldn't mind paying more in taxes if we didn't have to pay for our health care. At least we wouldn't be support big business. Insurance companies are not non-profit!

My youngest son has never had health insurance since he grew up. He has always worked, but most restaurants don't provide benefits. We need socialized medicine, and the sooner the better!

[XB9S, BSN, MSN, EdD, RN, APN]

ambermichelle said:

would this medication be provided under the uk system? as prophylaxis? also, do they cover most kinds of chemotherapy?

thanks.

yes your sons treatment would be covered in the uk, the nhs tends to be proactive when it comes to preventative and prophylaxis treatments.

chemotherapy is covered, but we are guided by something called the national institute for clinical excellence, this is an organisation made up of clinicians who review current literature and evaluate new treatments before recommending them. you may find some of the very expensive cancer drugs (the life prolonging drugs) are not covered because they are not always effective and because nhs resources are limited cost effectiveness is considered. this does not mean that you are not treated if you need chemo, what it means is there are a few expensive and rarely used drugs that will not be recommended for use because of cost effectiveness

shaka said:

i have several questions...

1) what are the salaries for health providers? depends on expereince and what job you do, a nurse can earn from £20,710 as a newly qualified nurse on the lowest band to £39,000 as a ward manager / charge nurse. senior nurses and lead nurses / specialists can earn from £39,000 up to £60,000 per year. we have 29 days paid holiday a year and 8 paid bank holidays. we get full sick pay for up to 6 months should you need it and then half pay for the next 6 months.

2) what are the waiting times for procedures needed, on average? we have waiting time targets, so your emergency care would be seen and treated straight away, there is a target of 4 hours in the emergency units for non urgent pateints and if your classed as a catagory 1 then you must be treated within the hour. urgent treatment (so for cancers for example) you must be seen, assessed diagnosed and treated within 31 days. for elective procedures which are non urgent (hernias, gall bladders, some orthopaedic surgery) there is a target of 26 weeks, so this would be from gp referral to outpatient appointment to definative treatment.

3) what are the working conditions...i.e. nurse/patient ratio, hours worked on average, acuity of patients cared for in a patient mix? we work 37.5 hours a week, this is the standard contract for a nhs nurse, you can if you want work extra but there are no implications for you job if you choose not to. nurse / patient ratio depends on where you work. in icu you will get a 1:1 ratio, on hospital wards it can be anything from 7 :1 in some good areas to 15:1 in others. it really does depend on where you work.

4) is there a cap for some health problems...i.e. alcoholism, drug addiction, psyche diagnoses? no

5) how much are taxes in the uk and how much goes to health care? if i earn £40,000 per year i pay £10,000 in deductions in income tax and national insurance. (i think this is about 30% )

6) are you in the uk working? and if not why? (don't mean to be personal) just want to know. madwife doesn't work in the uk, but i do

thanks for your perspective...

[Shaka]

sharrie said:

Yes your sons treatment would be covered in the UK, the NHS tends to be proactive when it comes to preventative and prophylaxis treatments.

Chemotherapy is covered, but we are guided by something called the National Institute for Clinical Excellence, this is an organisation made up of clinicians who review current literature and evaluate new treatments before recommending them. You may find some of the very expensive cancer drugs (the life prolonging drugs) are not covered because they are not always effective and because NHS resources are limited cost effectiveness is considered. This does not mean that you are not treated if you need chemo, what it means is there are a few expensive and rarely used drugs that will not be recommended for use because of cost effectiveness

I appreciate the information Sharrie, I am not familiar with pounds vs dollars, maybe someone could convert it for me.

Shaka

[madwife2002, BSN, RN]

€1= $1.40 (aprox it depends on the exchange rate)

I work in Arizona I worked in the Uk for 16 years I came to live and work in America because I have family here and I wanted to live close to them, but laugh they live in Ohio so we are still living a long way from them. My dh and dd love Arizona so we are here to stay.

I miss my job in the Uk I find many restrictions here in the US but I work with a great bunch of people so I am lucky.

I do get concerned re the the financial side of medical care here in the US and the worries families have re affording care, something I had never experienced before especially as pts have enough worry with coping with their illnesses without worrying about money.

[talaxandra]

madwife and others have spoken about the uk system. from an aussie perspective:

the australian red cross blood service manages blood products. employees are paid according to their award; donors are vounteers who are not paid (unless you count a snack and juice). all blood products are free.

i have several questions...

1) what are the salaries for health providers?

it depends on the usual variables, like experience, level of qualification, and shifts worked. pay rates vary from state to state but awards cover all public service employees with the same conditions within the state/territory, and private hospital conditions are similar. check payscale for a more accurate guide to median wages.

because public hospital care in the norm, most health care providers work within the public health care system, either wholly or primarily. this includes nurses (i have several friends who work part time at my hospital and part time at a nearby acute private hospital) but also consultants.

2) what are the waiting times for procedures needed, on average?

data from the latest released australian institute of health and welfare data.

obviously there's huge variation across specialties and states.

across the country the median waiting time for all elective surgery was 28 - 32 days from 2002 - 2007. in 90% of cases patients were admitted within 226 days (2006-7), with 3.1% waiting more than 365 days. ophalthamology had the longest median time 71 days), followed by orthopedics (50 days), while cardiothoracic waiting times were the shortest (12 days). median cags waiting time - 17 days; total knee replacement - 162 days.

3) what are the working conditions...i.e. nurse/patient ratio, hours worked on average, acuity of patients cared for in a patient mix?

victoria was the first place in the world to have mandated nurse/patient ratios. i work in an acute tertiary hospital - i have 4 patients by day and 8 overnight. every shift has a supernumerary resource nurse (this is not aways the case of nights). it is illegal in victoria acute hospitals to pay unregistered staff to perform nursing duties, so we do not (in principle) have pcas.

on my ward we allocate geographically. tonight, for example, i have the first eight beds, which is the (primarily) id area. my patients include:

- a patient on 6/24 antibiotics through a hickman's for a a spinal abscess;

- a new admit with ?sbe ?aids-defining illness on triple antibiotics

- an esrf patients in isolation after contact with a h1n1 patient

- a new admission with ?h1n1

- a new admission with ?tb

- a renal patient with peritonitis on intra-peritoneal antibiotics

it's 01:30, i'm up to date on my charting and medications, all my patients are asleep (i'm still waiting on one of the admits), everyone else is under control, the resource nurse is on a break and i have time to chat on allnurses, so the acuity's fine for now. we certainly have frantic shifts, but getting extra staff when the work load's ridiculous isn't usually a problem. for example, our transplants are specialled for 24 hours post-op, rounded up to the nearest shift (so that if they arrive from theatre at 3am they get a special until the end of the next night shift). if the transplant patient's unwell, though, we can get an extra to special for another shift without any drama.

i work 38 hours a week. on occasion i run over my shift by half an hour or so, which is paid. if i want to work overtime i can make myself available but work never call asking me to work. if there's a shortfall, for example for the next shift, i'll be asked if i can work but there's no pressure to do so. if i do work a double shift and have to then miss my rostered shift i get paid for it. so if i was supposed to work a pm (1300 - 2130) then an am (0700 - 1530) but do a pm/nd double i get paid: 8 hours usual rate, 2 hours time and a half, 8 hours double time, then 8 hours usual rate for the missed shift. that's 18 hours work and 35 hours pay.

4) is there a cap for some health problems...i.e. alcoholism, drug addiction, psyche diagnoses?

no.

5) how much are taxes in [australia] and how much goes to health care?

i earn mid-tier wages ($34,000 - $80,000 pa). my taxes are calculated at $4,200 + 30c for every $1 over $34,000, less salary packaging and deductable expenses, like those for work, self-education and charitable contributions. tax is taken out of my pay every fortnight; at the end of the financial year i lodge a tax return with all my deductable expenses and either owe the government (has happened once in 20 years) or get a refund.

healthcare funding comes from the medicare levy is an additional 1.5% tax, calculated on my taxble income. if my annual salary were $65,000 that works out to $975. as i have chosen not to take out private health insurance, i would also pay an additional surcharge of 1%. which comes to another $325.

i fully support universal health care. if i were seriously ill i would vastly prefer to be in a public hospital, where i believe the care is better even if the surroundings and food are less aesthetically pleasing. i have twice had elective orthodontic surgery in private hospitals, where i paid my own way. i didn't have to wait, the service was fine, and though expensive my overnight stays were reasonably priced.

i've also had non-elective surgery, for a broken, finger, in the hospital where i work. two hours after presenting to ed i'd been: assessed by a triage and a fast-track nurse; x-rayed; seen by resident, registrar and surgeon; fitted for a splint by hand therapy; and booked in for surgery. i had a k-wire inserted the following week, had outpatient plastics and hand therapy follow up for 3 months, and just had a two year check up. the whole thing cost me about $30, for a box each of endone and paracetamol, and a course of antibiotics.

eta: to convert currencies you can visit www.xe.com - it provides real time excahnge rates and converts any quantity, very valuable for those of us planning an overseas trip :)