I went to visit my 93year old grandmother today. One of her carers told her the doctor would be visiting later. She gets confused and immediately started worrying that she didn't have enough money to pay the Doctor. We reassured her but it got me thinking about the UK's system of health care.
On July the 5th 1948 the UK government introduced a system of health care that was free to all dependent only on citizenship. Care was unlimited and treatment was on diagnosis rather than financial means. The UK at that point desperately needed change as disease was rife and the poor were dependent on the charity of some doctors or worse still the workhouse. Hospital care was refunded but had to be paid upfront.
The NHS has not been without it's problem's primarily because it is chronically short of cash but 60years later it does mean that any patient regardless of age, financial status, employment etc will receive equal care on the basis of diagnosis.
I realise that worldwide there are many differences. I recently had a fantastic American patient in the UK on holiday - he had chest pains so needed, baseline assessment, chest xray, bloods, ECG and a doctor's consultation all of which as an emergency are free which he couldn't believe. On the flip side I went to India recently and although hospital care is free patients need to pay for medication and the cost of this often is prohibititive meaning that the mortality rate amongst the poor remains unacceptably high.
I would be so interested to hear of how other countries provide health care and what works about these systems and also what doesn't. Maybe we can come up with a worldwide effective system that promotes equality and inclusion :)
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
JoPACURN, I don't doubt the commitment of your vascular institute. However, with the exception of very small numbers of patients enrolled in very select clinical trials and privately funded programs ... the amazing techniques are likely being provided only to patients who can PAY, or whose insurance has agreed to PAY.
Because we have worked for large employers, my spouse and I have had relatively affordable access to "Cadillac health insurance" for our entire adult lives. We have each once been denied coverage for a procedure or test ... and we are both healthy without any chronic conditions. If you are purporting that the current US system of health insurance provided largely through employers does not restrict access to care -- I must respectfully disagree.
I find it very worthwhile to always remember the economic basics about insurance. The insurance industry exists to attempt to quantify the risk of loss of a valuable asset. Insurance firms collect premiums as a hedge against possible future payouts. The profit in the business is to collect more in premiums than is paid out. This works pretty well for tangible assets like property, and even less tangible "assets" like an individual's life.
It does not work so well for health care -- one of the best ways to avoid catastrophic health care costs is to utilize health care for primary care, diagnostic screening, and management of chronic conditions. This basic concept illustrates perfectly, albeit simply, why the concept of "health insurance" is bound to ultimately fail. The out of pocket cost of even basic preventative and acute care is out of reach for many American consumers. What we are seeking in "health insurance" is not insurance at all, just a way around having to pay completely out of pocket at the time that care is needed.
Speaking generally, health insurance companies are not being deliberately evil when they deny coverage -- they are simply carrying out the stated intent of their business.
I'm not implying that so let's make sure that's clear.
What I am saying is that the hospital system I work in--doesn't do an all out discrimination based on ONE bottom line. They are pushing forward the technologies because of the POTENTIAL of being in the forefront of advanced work. Whether they "lose" out on one--monetarily--doesn't stop them from offering the treatment because of the potential of getting more of "those" who will pay.
Hospitals-, even MY non-profit one, NEEDS to be on the plus side of moneymaking to CONTINUE to support the MINUS side of the caregiving.--however..the money DOES not go into the pockets of the CEOs...instead, it MUST be returned to the community and EVERY dollar accounted for.
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
Your hospital may be offering all kinds of wonderful, exotic, "OFF the GRID" procedures, but that doesn't mean that most people's insurance coverage will pay for them. US insurance companies have routinely, for many years, gotten out of paying for people's treatment by claiming that it's "experimental." There is usually fine print in the insurance policy paperwork that specifically states that they will not pay for any experimental treatments -- and they define "experimental" as broadly as possible.
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
i can understand your concerns completely, so i will try to explain how it works.
in your scenario, if that treatment had been proven to extend life for a few months in a number of cases, and has good quality evidence to support it then yes it would be offered, remember nice offer recommendations, if your treating physician feels that they do not want to follow the guidance then they can prescribe it. there are a few cases where this can be overturned, which will be the ones you have seen in the news, and this would be decided by the chief medical officer, and pharmacy advisor to the health board. yes it does happen but not as often as the media would have you think.
you also asked in a previous post how are we dealt with if we don't meet targets, we are fined which takes even more money away from patient care. we have the same things here. if there are "targets" that are missed, pay is withheld.also you said about the 18 week wait, if you had a virus then that would be treated as an emergency, you'd see your gp and if you needed urgent treatment you'd be seen very quickly. however if you have biliary colic and are waiting to see a surgeon about a lap chole then your going to have to wait that time, if your in pain and suffering then your gp can list you as urgent which means your care gets expedited but it's still a long time to be in pain, with this i absolutely agree with youit's like a time bomb though isn't it...hoping that it doesn't end up in pancreatitis or gangrenous gallbladder?
someone also asked about complaints, our patients complain and they are listened to. we have something called the patients charter which is at every bedside with details of how and who to complain to. the complaints are dealt with locally initially to gain resolution but if this fails it is taken to the ombudsman (who is independent from the nhs hospitals) who look at the complaint and the response and then tell us what we need to do to improve. when i worked as a senior nurse i spent most of my time dealing with complaints and responding to them, changing practice and implementing policies as a result of them.most legitimate patient complains are taken very, very seriously. some are, of course, if ostentatious and ridiculous...well...we do our best...
jo i agree with you, the nhs has major flaws, and in your shoes i would probably feel the same but i have no understanding of how healthcare in the us works, just what i hear in the news about patients who can't afford treatment, people die because they have been refused cancer treatments because it's not in their insurance policy exactly as you have heard horror stories about the nhs
you mentioned "non profit hospital" and magnet status, could you explain a little more about these please and what they mean for you as a nurse and your patients.our not for profit status is tax protected. every dollar the hospital makes must be returned to the community...there are no stockholders to please....magnet hospitals are designated by a group...i honestly do not know the source, but it's been around for a few years. these hospitals are supposed to be one of the best places for nurses to work because of the ability of nurses to have a say in their work environment, policies, etc., my system honestly follows these core beliefs. if this system were hypocritical (i have seen much hypocrisy in my many years), i wouldn't continue to work in it. they have a credo they follow, and everyone--and i mean everyone is expected to follow it. human resources is very, very readily and easily accessible...and heaven help a physician that misbehaves...especially if they work for the system. i've seen it happen already. and doctors are very, very (for the most part) well-behaved and respectful.
also i have no idea how medicare works if someone could explain that i'd be grateful. my weakness--i can only tell you that there is a lot of fraud and the doctors are not happy with the decreasing reimbursement.
also how your emergency services work, if you pitch up to the emergency unit, are you treated then payment sorted out or do you have to prove that you can pay, or have insurance to be treated. you can go into any er and be treated and it is against the law to turn you away, regardless of ability to pay. i know these may seem like idiot questions but i really have no idea
your questions are very valid. i enjoy "conversing" with you.
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
I apologize for my part in going OT. Here is how these things work in the US:
For the most part, healthcare in the US is treated as a business like most any other. Hospitals are either "for-profit" or "non-profit," which is mostly about tax status. "For-profit" hospitals pay property taxes on their land and facilities and corporate income taxes on the profits they make, and they are traded on the stock market and have shareholders who make money (they hope!) from owning stock in the company that operates the hospital. "Non-profit" hospitals still have to bring in more money over the course of a year than they spend, or they'll go out of business :), but they are exempted from paying taxes on their property and facilities in return for providing more services to the community and putting any extra money they end up with back into the facility or into community service. Also, they do not pay dividends to stockholders (they don't trade shares on the stock exchange). Many non-profit hospitals are operated by religious denominations, universities, and other kinds of charitable groups, or are paid for and run by the community (city or county) in which they are located. Non-profit hospitals operate to provide a service to the community; for-profit hospitals, by definition, operate to turn a profit for their shareholders first and foremost, and delivering healthcare is just their mechanism for doing that. Whether a hospital is for-profit or non-profit doesn't make a great deal of difference to people receiving care there (probably, most people receiving services in a hospital aren't even aware of whether it's a for-profit or non-profit facility); it may or may not make a lot of difference to people working there. There are some threads on this site discussing folks' opinions about and experiences of working for the for-profit hospital chains.
"Magnet" status is a voluntary accreditation offered by the American Nurses Credentialing Center, a division of the American Nurses Association that also offers many of the specialty certifications for individual nurses in the US. Meeting the standards and getting the "Magnet" designation is supposed to mean that the facility is providing a highly desirable working environment for nurses (i.e., it's a "magnet" for nurses in the area :)), but, in "real life," it may or may not mean much. Now that "Magnet" accreditation is being seen by hospitals as a great marketing tool, lots of facilities are "going through the motions" and jumping through the hoops necessary to meet the standards just long enough to get the 5-year accreditation, and then going right back to "business as usual."
Medicare is a single-payer system (like the Canadian system), run by the Federal government, for the elderly and disabled. Everyone pays taxes (withheld from their paychecks) into the Medicare program, and, at age 65, most people become eligible for Medicare -- and those who are permanently disabled become eligible for Medicare two years after becoming permanently disabled -- and Medicare pays for their healthcare needs (they are able to choose the physicians and facilities of their choice). Most of the people who are on Medicare are very happy with the program, compared to how the rest of us feel about our healthcare coverage (if we even have any ...). It was started up decades ago because the private insurance companies didn't want to cover the elderly (so the Federal government stepped in). You may also have encountered the term "Medicaid" (different from Medicare) in discussions of US healthcare. Medicaid is a program that is a joint venture between the Federal government and the individual US states that is supposed to be providing healthcare coverage for the poor. The Federal government chips in part of the money, and the state chips in part of the money, and the state gets to decide what requirements/limits to set for coverage (within some general, minimum guidelines established by the Federal government). Because so many states are in serious financial trouble for a number of years now (and that's just getting worse), the Medicaid programs in many states are in serious trouble, and only able to cover a limited number of the people who need coverage.
The Federal government has passed laws that require emergency departments to evaluate anyone who presents and stabilize emergency conditions, and they are not allowed to delay treatment in order to find out how you are going to pay for it (these laws were passed because, back in the day, many hospitals used to refuse to treat people until they found out whether or not you could afford treatment, and, if you couldn't, they'd put you back in the ambulance and ship you to another hospital). However, that does not mean the care is free! You will get billed for the care, unpaid bills will be turned over to collection agencies, and, if you have any assets (house to seize, wages to garnish), those can be taken by a court to pay for your hospital bills. And it does not mean that EDs are required to treat non-emergency conditions (more and more EDs are starting to turn those people away). If you get brought in to the ED in a really bad way (e.g., via ambulance, seriously injured), you will get treated before anyone asks how you're going to pay. If you have to wait in the ED because you're not a high priority, they will go ahead and ask for your insurance card or how you plan to pay while you're waiting anyway, because doing that is not delaying your treatment.
This is just a v. casual, basic overview, but I hope it's helpful. I would be glad to respond to any other specific questions. :)
Very clear information, much better than mine. As for the hospitals that jump through hoops to be a "fake" magnet...that's just sad.
I am only speaking as a patient here, so take this for what it's worth.
One of the problems that I see in the US is that it is very easy to get caught in an insurance limbo and end up without access to care.
For example, my parents were both laid off in the last 2 years. They are 58 and 60, in this economy, nobody wants to hire them. (My Dad is a newspaper editor, so he's REALLY out of luck). Anyway, they don't have insurance through their jobs anymore. They don't qualify for Medicare because they aren't old enough. They don't qualify for Medicaid because they don't fit the categories Medicaid covers (mostly low-income families with children in my state). They are living on my father's unemployment, he has diabetes, my mother has chronic bronchitis and is headed for COPD and they have no insurance.
I had to buy my own insurance as a self-employed single mother years ago, and there were many times when paying my insurance premiums and deductibles for my daughter's care meant that I couldn't pay my electric bill or put gas in my car. At the time, I was told that I made too much money to qualify for medicaid.
One of the problems in the US is that if you are relatively healthy and have been covered by employers' health plans for most of your life, you might never see the ugly side of the system. Because it is essentially a for profit system, created by health insurance companies, it works very well for the people they like to sell to.
In my opinion, the problems in US healthcare are pretty simple:
1. For-profit insurance companies make decisions about who gets coverage, who doesn't, and which treatments you can have.
2. There is no consistent safety net for people who get kicked out of the for-profit system unless they are permanently disabled or over 65. That leaves a pretty significatn portion of the population on shaky ground.
If you have good insurance, the problems are pretty minimal.
In my experience here in the good ol' USA, is as follows:
1. Many of our patients have no health care coverage. Even if they work full time (many work full time at one job, part time at another) no health insurance means they do NOT go to the doctor because they cannot afford it. Eventually, some health crisis strikes and they must go to the hospital, then file bankruptcy because they cannot afford to pay the bill.
2. Many of our patients cannot afford medications. At least once or twice a week, I encounter patients who can't afford their Plavix, which causes their stents to clot off, leading to a massive MI.
3. My cousin Gary (as a typical example) has no health insurance and a genetically bad heart. His choice was: die, or go to the ER with chest pain and get a CABG (this is what he did) while realizing that there is no way in hell he could ever pay that bill.
4. Diabetics who cannot afford to buy a vial of insulin, so they show up in our ICU repeatedly in DKA. Also we have patients who cannot afford their blood pressure medicine, so they end up in our ICU with a massive stroke.
5. Those of us who do have health insurance, by virtue of working at a place that offers health insurance, pay out the yin-yang for said insurance. I pay a few hundred dollars each month for health insurance that I don't use, which helps to cover the cost of uninsured people.
6. Those of us who do have health insurance have crappy health insurance. For example, my insurance does not cover the cost of my medications, so I pay for it out of pocket, and I'm lucky to be able to afford it. Basically, I manage this by buying very little food. I must have my medications in order to be functional enough to work so I can pay my health insurance premiums.
7. I distinctly remember giving a medication to a dying old lady (who was really dying, and her situation was hopeless) and this medication cost $37,000 per dose, q6hrs. I was terrified I'd drop the IV bag, knowing that the contents were worth more than my take-home pay. Her family acknowledged that the medication was very expensive and wouldn't help anything, but hey, medicare was paying for it, so why should they care?
If you have good insurance, the problems are pretty minimal.
On the other hand, having bad insurance can be worse than having no insurance. Hubby has 2 jobs and no insurance. My job offers CIGNA, which is evil incarnate. I had them for a while in college, when I was covered by my father's plan. They were evil then, too. They refused to pay for follow-up to my sister's emergency surgery because she was attending college in another city. They wanted her to fly from New Orleans to Boston to have a rod removed from her thumb. New Orleans has hospitals.
I pay $400 a month for a plan with a $2000 deductible, 80% coverage after that, and no prescription drug coverage. For the past 3 months, we've been trying hard to get CIGNA to pay for some surgery Hubby had in November. They say he had a pre-existing condition; 67 days without insurance. Very few doctors here will see patients without insurance. Basically, I pay $400 a month to argue.
I've been avoiding doctors because I'm afraid to use my insurance. The few times I've needed care, I went to Urgent Care and asked about income-based and payment plans, in case CIGNA decides not to pay for it.
One of the problems in the US is that if you are relatively healthy and have been covered by employers' health plans for most of your life, you might never see the ugly side of the system. Because it is essentially a for profit system, created by health insurance companies, it works very well for the people they like to sell to.
In my opinion, the problems in US healthcare are pretty simple:
1. For-profit insurance companies make decisions about who gets coverage, who doesn't, and which treatments you can have.
2. There is no consistent safety net for people who get kicked out of the for-profit system unless they are permanently disabled or over 65. That leaves a pretty significatn portion of the population on shaky ground.
If you have good insurance, the problems are pretty minimal.
Very well put (except that I would say that very few people in the US nowadays have what any sensible person would consider "good" insurance ...)
PostOpPrincess, BSN, RN
2,211 Posts
I'm not implying that so let's make sure that's clear.
What I am saying is that the hospital system I work in--doesn't do an all out discrimination based on ONE bottom line. They are pushing forward the technologies because of the POTENTIAL of being in the forefront of advanced work. Whether they "lose" out on one--monetarily--doesn't stop them from offering the treatment because of the potential of getting more of "those" who will pay.
Hospitals-, even MY non-profit one, NEEDS to be on the plus side of moneymaking to CONTINUE to support the MINUS side of the caregiving.--however..the money DOES not go into the pockets of the CEOs...instead, it MUST be returned to the community and EVERY dollar accounted for.