# Britain's NHS



## BeaBea (Jul 14, 2007)

_*Moderator Note: These posts have been moved from one thread to this one. While not Hyde Park material, this thread is insightful into the workings of the NHS, and will remain on the Health Board*_



Sandie_Zitkus said:


> My suggestion to you if they say you need surgery. Find a bariatric surgeon. I would even do that now if I were you so you have the info if you need it. Then if you need it - do what I did - go see him or her and tell them you need their expertise working with supersize people. You do not want WLS (if they say that) and that right now you just want your gall bladder out and you think that takes priority over WLS.
> 
> And if you have to have surgery - laparoscopic surgery is the way to go.




I'm sorry babe but the system here just doesn't work that way. Within the NHS you cant just find your own surgeon and get a consultation. Any referral like that has to be done within the system which means the GP sends you to a Consultant and s/he decides whether they will do your surgery. If they dont want to proceed they can also choose to send you on to a hospital with specialist bariatric facilities and a Surgeon with experience in the field. 

If you want to follow the route of finding your own Surgeon then there are many who are all too willing to see you - but as it'll be outside of the NHS then you need to do it privately and, just like in the US, it gets very expensive.

My recommendation on how to handle it would be to wait until your GP refers you to the Consultant and then ask what experience they have had with Supersized patients. At that point you can ask if a referral to a bariatric specialist is possible and you can (persistently) push to ensure it happens. DONT turn down any appointment your GP offers you for further consultation even if it isn't with a specialist - these appointments are your entry into the system! 

If you get as far as the Consultant then stress your concerns again and ask again for a referral to a Bariatric specialist as I'm sure you will get it. Put very bluntly, Surgeons death rates are monitored -extremely- carefully and no Doctor will take on a case which needs skills beyond what he is capable of for fear of damaging his percentages.

I know your faith in the system has taken a beating and any supersize patient, heck, any patient of any size, would be feeling every bit as angry and scared as you must be right now. For the sake of your health and your own peace of mind please try to let the previous problems go and work with the system to ensure the best possible treatment from here on in. I realise I'm probably suggesting the impossible but try to move forward and continue your healthy improvements. I wish you had a better experience of the NHS but sadly none of us can change what happened in the past. We are all here for you to try to help you through the next stages though...

Tracey xx


----------



## Sandie_Zitkus (Jul 14, 2007)

I'm just gonna say wow - just wow.




BeaBea said:


> I'm sorry babe but the system here just doesn't work that way. Within the NHS you cant just find your own surgeon and get a consultation. Any referral like that has to be done within the system which means the GP sends you to a Consultant and s/he decides whether they will do your surgery. If they dont want to proceed they can also choose to send you on to a hospital with specialist bariatric facilities and a Surgeon with experience in the field.
> 
> If you want to follow the route of finding your own Surgeon then there are many who are all too willing to see you - but as it'll be outside of the NHS then you need to do it privately and, just like in the US, it gets very expensive.
> 
> ...


----------



## SocialbFly (Jul 14, 2007)

dont be surprised by what Tracey said, she is right, and in fact ALL surgeons have their numbers monitored, it is how they pay malpractice insurance for one thing, plus numbers are often published, go through a bad run (everyone has some bad luck now and again, and i hate to put it like that, but sometimes it is just that, bad luck) i know too, i wouldnt wnt to be the one when they have bad luck, but sometimes it happens...that being said, you can call and find out a hospitals infection rate, rates of infection from IV lines, rates of infection from breathing machines....i could go on and on...when a doc takes you on as a patient, dont think that what goes on through their heads...dont think that for one minute when you walk in a doc doesnt think about what their chances are for a lawsuit...do you know how many american docs, trained in ob wont deliver babies anymore??? cause of all the lawsuits...i just took care of a baby, the mom had NO prenatal care, didnt know she was pregnant, was taking multiple drugs, and her baby is a mess....but wanna bet who she will try to blame? it wont be herself, she will say she didnt get adequate care in the hospital, or that the drugs she took were addictive and no one told her...and te hospital, not herself, is responsible for why her baby is going to be devestated.

we, in america, and indeed the issue is spreading to other countries...we have a responsability to take care of ourselves, we have a responsibility to take care of our health, use our common sense, call the doc for problems, keep them informed of the good and the bad in our lives...let them know what we take med wise, cause drugs interact with other drugs, even over the counter meds...and they have a responsibility to care for us, to further their knowledge and not judge us, they have the right to question us, to ask us to be responsible for our own health while they help us...that means we try to eat right, we try to exercise a little, we try to keep our care current...

we are so busy blaming other people, when some of the problems are a direct result of the health care monster WE helped create...i am tired of if a parent doesnt get their way, the first thing they do is threaten to call the media, suddenly, even if the person was wrong, now they are suddenly 100% right...not right, not fair, not the right way to do things....

am i saying that there are some people who are not missed or overlooked and thereby victims of the healthcare issue, no, i am absolutely not saying that, but i AM saying we all share in the problems and the cure....

and Donni, i am not saying you were not a victim the first time, but you learned a lesson, now what you take from that, in trying to take care of yourself and get things followed up on, is more on you...we are the only person who will absolutely 100% look out for us...so learn to work with the system cause you can't change it, all you can do is work within it...get educated, read up on the problem, and keep notes, anytime someone takes out a notebook and writes, i know how serious they are about the issue....

hopefully this post will be taken as it was intended...nothing personal against anyone...we have the choice everyday when we wake up, to take care of ourself or not, i choose to...


----------



## SocialbFly (Jul 14, 2007)

i forgot to add, that i just got my health insurance for when i move to australia next month...it is $200 a month for EVERYTHING (i have to pay, not the country)....i pay almost that much for just me WITH employer support here in the USA....why do you think it is sooo expensive...lawsuits and un needed testing...

we need healthcare reform...NOW


----------



## loren_a_e (Jul 15, 2007)

Sandie_Zitkus said:


> I'm just gonna say wow - just wow.



Not to be argumentative in my first posting, but being uninsured in America means you have far less choice than in the UK. I know, as I was foolish enough to travel in the country without insurance of any kind and spent my holiday budget on a stupid injury. Back home I go private and have access to the doctor I want when I want, but I pay. 

This is not a case of private vs. private, but public vs. private. The public system will lose out every time, but it's at least available to everyone.

Now, regarding the original case, is it possible to have an outside advocate? Unfortunately, people like us, and our partners, have our opinions about our health ignored just because we're fat or have the "bad luck" to be married to a fat person. Perhaps a solicitor? Just someone who can do things the British way, and not be dismissed because of any emotional connection they may have with you. I understand that if you can't afford to go private, hiring someone to advocate may be expensive, but just for one doctor's visit, to state your case, to present internet research and relevant stories from family and friends that may help you make a case for the tests you believe you need.

Good luck with the system.


----------



## Sandie_Zitkus (Jul 15, 2007)

I wasn't comparing the 2. I think the way Donni is being treated is disgusting. You may have a free system - but it isn't very easy to get help - seems to me. I was seriously sick with an enflamed gall bladder about 6 weeks ago. If I had to wait like Donni - I might have been dead before I ever got to see a doctor. 







loren_a_e said:


> Not to be argumentative in my first posting, but being uninsured in America means you have far less choice than in the UK. I know, as I was foolish enough to travel in the country without insurance of any kind and spent my holiday budget on a stupid injury. Back home I go private and have access to the doctor I want when I want, but I pay.
> 
> This is not a case of private vs. private, but public vs. private. The public system will lose out every time, but it's at least available to everyone.
> 
> ...


----------



## loggamatt (Jul 15, 2007)

Sandie_Zitkus said:


> I wasn't comparing the 2. I think the way Donni is being treated is disgusting. You may have a free system - but it isn't very easy to get help - seems to me. I was seriously sick with an enflamed gall bladder about 6 weeks ago. If I had to wait like Donni - I might have been dead before I ever got to see a doctor.



No, you wouldn't... because you clearly have enough money to be able to afford good health insurance. So if you lived in the UK and had similar income to your current income in the US you would be able to afford health insurance and private treatment.

That's the point here, you're not comparing like for like. The UK has private healthcare just as the US does, it's just that unfortunately Donni can't afford it.


----------



## Sandie_Zitkus (Jul 15, 2007)

You're not getting my point. Nevermind.  




loggamatt said:


> No, you wouldn't... because you clearly have enough money to be able to afford good health insurance. So if you lived in the UK and had similar income to your current income in the US you would be able to afford health insurance and private treatment.
> 
> That's the point here, you're not comparing like for like. The UK has private healthcare just as the US does, it's just that unfortunately Donni can't afford it.


----------



## SamanthaNY (Jul 15, 2007)

I think it's important to note that they do have emergency care in the UK, just as they do in the US, and Donni knows that's at her disposal if she needs it. I don't think she would be made to wait if her case was severe and needed emergency treatment. 

It's not as if they just let people die while waiting in the UK, it's just a very different method of assessment and treatment, and that's probably due as much to it being public healthcare as it is to it being a different country and culture.


----------



## Sandie_Zitkus (Jul 15, 2007)

SamanthaNY said:


> It's not as if they just let people die while waiting in the UK, it's just a very different method of assessment and treatment, and that's probably due as much to it being public healthcare as it is to it being a different country and culture.



I wasn't saying that Sam. I think telling her to give it a month when she's in pain is wrong. JMO. But I shall bow out of this thread now.


----------



## loren_a_e (Jul 15, 2007)

Sandie_Zitkus said:


> You're not getting my point. Nevermind.



I'm just curious, but what is your point? I confess I don't really understand either.


----------



## loggamatt (Jul 15, 2007)

Sandie_Zitkus said:


> You're not getting my point. Nevermind.



No, I think I do get your point, and I accept it. You have received better treatment in the US than Donni has received here, I don't dispute that. But, you've paid for it  The fact is, if you hadn't been able to pay, you'd have received far worse healthcare in the US than Donni has received in the UK as it is very difficult to get free healthcare in the US.

Perhaps in a perfect world a superb level of healthcare would be available to anyone for free, but that doesn't exist here and it certainly doesn't exist in the US.

I think the key difference here is that there is a lack of choice in the NHS in comparison to the American system. In America, healthcare providers are businesses in competition with each other, so obviously you're free to approach whoever you want directly (as you are privately in the UK too, by the way). In the UK, it's a nationally managed system, with bureaucracy and protocols to be followed. The procedure is to see a GP, who will either treat you or refer you onto a specialist. There's simply no way of getting around that.

In the US, you wouldn't even get to see a GP if you couldn't afford it, so I have a hard time accepting that health care is better in the US. If you have money I'd imagine the system is very similar in either the UK or the US, if you don't have money the system is better in the UK, in my opinion.

But yes, as Samantha says, no-one's going to leave you dying... if things get that bad, call an ambulance, or go into A&E.

I hope you don't take offense at this... I love the US, and will happily agree that there are many areas of US life and government that are better there than the UK, but I just can't believe that people would think healthcare is one of them.


----------



## SamanthaNY (Jul 15, 2007)

Sandie_Zitkus said:


> I wasn't saying that Sam. I think telling her to give it a month when she's in pain is wrong. JMO. But I shall bow out of this thread now.


It's your choice to leave the thread, of course. But it seems rather ill-timed since others are responding to comments you're making, and asking you questions. 

I tend not to favor drive-by posting, but that's just my own taste.


----------



## Sandie_Zitkus (Jul 15, 2007)

Well, it just seems I don't know enough about the English health care system to comment. So I just meant I would stop posting and just read. That's all. 






SamanthaNY said:


> It's your choice to leave the thread, of course. But it seems rather ill-timed since others are responding to comments you're making, and asking you questions.
> 
> I tend not to favor drive-by posting, but that's just my own taste.


----------



## Sandie_Zitkus (Jul 15, 2007)

loren_a_e said:


> I'm just curious, but what is your point? I confess I don't really understand either.



My point is - if I was in Donni's situation here in the US or in England - with the emergency situation I was in 6 weeks ago - I might be dead no matter where I was.


----------



## Miss Vickie (Jul 15, 2007)

SamanthaNY said:


> It's not as if they just let people die while waiting in the UK, it's just a very different method of assessment and treatment, and that's probably due as much to it being public healthcare as it is to it being a different country and culture.



The health care system in the UK reminds me a bit of how our native hospital handles treatment; the native hospital is funded by the IHS, but instead of actually being run by the tribal health consortium up here, who uses the federal money to provide safe, humane care to our Alaska natives . Nobody dies waiting for care; however, if you go in with vague symptoms, they're not going to pull out the MRI or CT scan because it's financial, and medical, overkill. They will try cheaper, quicker ways of assessing what's going on and treat accordingly. I'm pretty sure that their mortality rates are equal to, or better than, ours. The US compares pretty poorly to the rest of the industrialized world in terms of infant mortality rates, so it seems all the fancy pants equipment and expensive care doesn't in any way guarantee us a healthier population.

My sense of why the US health care system is so quick to go to ridiculous lengths to treat minor problems is because we're litigious in nature. It's like doctors have to practice defensive medicine, planning for the possibility that the most obscure disease could be the culprit when it's most likely a host of more innocent, benign things. It's like instead of using Occam's razor as the basis for diagnostics, they use the "leave no stone unturned, and the more obscure the stone the better". This is good because it's less likely that the rare disease will be missed; however, in a system with a finite number of resources, it means that someone will go with NO care. I just don't feel that we always use our resources wisely, and I think that's one part of a very complex set of reasons of why our health care system is damaged.



loggamatt said:


> No, I think I do get your point, and I accept it. You have received better treatment in the US than Donni has received here, I don't dispute that. But, you've paid for it  The fact is, if you hadn't been able to pay, you'd have received far worse healthcare in the US than Donni has received in the UK as it is very difficult to get free healthcare in the US.



Well, or more likely she would have been seen and gone bankrupt from the cost. Hospitals here (I believe) have to at a minimum stabilize and treat someone; they can't just dump them out because they have no insurance or means to pay. The downside is that then the taxpayers (us) end up footing the bill. Emergency Departments are being used as primary care doctors, and it's costing us a TON of money. But when people don't have insurance or the resources to pay out of pocket, their only option is to wait until it's bad enough to go to the hospital.


----------



## loggamatt (Jul 15, 2007)

Interesting post Vickie... and I think that you're probably right and public health systems in rich countries that have them (or, in federal subdivisions of the state that have them in the case of a federal state like the US) are all relatively comparable. I guess whether you think it's better to be in a system more likely to catch rare medical problems, or in a system less likely to carry out unneccesary testing until it's ruled out the most likely problems depends on whether you happen to have a rare medical problem or not. If you're unfortunate enough to have a rare problem then you're better in private care, but I think most people play the percentages in life and assume they're not going to develop anything too unusual.

Where there is a difference between the US and the UK, is that I believe that there is a reasonable choice to be made between private or public healthcare over here. The NHS, while far from perfect, is pretty good in most cases, and at the very least provides good emergency care. So many people who could afford to go private choose not to. I'm America, that choice doesn't really exist.

You're right though, of course it's not a case of emergency rooms in America refusing care, I over-simplified by suggesting that. But I have read enough about American healthcare to know that there's a lot of pressure to discharge patients without insurance (or the means to pay) as soon as they have been stabilised. Whereas in the UK, the NHS provides continuing care as the patient needs it.

I'm a bit confused as to what side of the argument you come down on though Vickie? You seem to suggest that the privatised nature of the US system has led to it being damaged, and it seemed to me reading between the lines that you would be in favour of a public health system. But then you say that the downside of the current US system is taxpayers having to pay for those who can't afford treatment. But, if the US developed its own version of the British NHS, that would obviously have to be funded through taxation and would cost a lot more. I'm just interested in what you would prefer as you sound knowledgable about this, and I wasn't quite sure what your preference is.

Just one other thing that occurs to me... I wonder if the litigious nature of the US in regards to healthcare is partly due to healthcare providers being profit making businesses? Maybe people feel that because you're paying directly for a service, it is more acceptable to sue if you're not happy with the service. In the same way that someone would be more likely to sue McDonalds for something disgusting in a burger that they've paid for than they would be to sue in a free soup kitchen. I don't know though, I guess people do pay for the NHS out of their own pockets indirectly through taxation, so perhaps people being litigious towards a healthcare system isn't related to the way the system is funded. I don't know... I'm thinking out loud really 

Anyway, I'm becoming aware that this may not be the correct place to have this debate... it's becoming quite a political discussion, and I suspect I'm going to be told off by the moderators for having this discussion here any minute now... lol. So I apologise if that is the case.


----------



## Sandie_Zitkus (Jul 15, 2007)

I'm a little confused by what Vickie and Diana are saying about unecessary testing. Can either of you explain more of what that would be??

When I went to emergencyI had symptoms of gall bladdrer disease - however they did these tests on me:

X-ray
EKG
Ultrsound
Blood work
Urinalysis

Should they not have dome some of these? I'm truly confused - I hope you can clarify.


----------



## Sandie_Zitkus (Jul 15, 2007)

Oh OK - now I get it. Thanks!! 




missaf said:


> Sandie, all of the tests you mention are standard for someone your age, and with your symptoms.
> 
> Unnecessary testing would be something like being in a car accident, not complaining of neck or back pain, and having them run a full set of x-rays of your back because the doctor doesn't want to be sued when you complain you weren't treated for whiplash.


----------



## Frankie (Jul 16, 2007)

Do the majority of people in the UK have private health cover to supplement the NHS? My company has offices in the UK, and it provides a private plan as secondary cover. I wonder if this is typical.

I'm in the US and have gold standard health insurance through my employer, but I shudder to think what would happen if I became unemployed for a long spell (especially after the expensive COBRA coverage runs out).


----------



## BeaBea (Jul 16, 2007)

Frankie said:


> Do the majority of people in the UK have private health cover to supplement the NHS? My company has offices in the UK, and it provides a private plan as secondary cover. I wonder if this is typical.


 
Hi Frankie, 

Absolutely not, the vast majority of people here rely solely on the NHS. 

I used to have Private Healthcare as part of my salary package when I worked at a large corporate company. It was a first class, all the bells and whistles service and wasn't dependant on any medical to be eligible. It was a benefit that came with seniority though and only kicked in when your salary reached around £30,000 pa ($60,000). 

If you want to fund your own healthcare plan you can and theres plenty of choice. The problem is though that if its affordable then there are so many exclusions that it makes it barely worth having - and if its an all inclusive plan then it's probably too expensive to contemplate. 

Like Matt I'm slightly cautious that this might end up in Hyde Park (although I hope not for Donnis sake) so if a Mod wants to delete my posts or any portion of them then I'm happy with that. To give a little background though: 

The NHS was set up in 1948 with the aims of providing a comprehensive system which was available to people of all classes and incomes. Its free at the point of delivery for everyone but is funded by direct taxation at around 6% from everyone who has an income. 

In basic terms the system works with patients being registered with a GP who will refer the patient on to a network of Consultants and Hospitals/Clinics as required. If you're not happy with your GP you can swap to another practice but you will be asked why you want to change and a Dr can refuse to take you on. You ARE guaranteed to get a GP service but difficult patients may not end up with a choice of supplier. (By difficult I mean abusive patients, not those that are a medical challenge) 

Like any complex system it has its problems - not least that successive governments have left it over-burdened with clerical managers and short of medical staff - but for the majority of people and for the majority of problems it works fine. There will always be exceptions to this but I've always found the staff in the NHS to be extremely professional and anxious to do the best possible job. 

Tracey xx


----------



## SamanthaNY (Jul 16, 2007)

I think a secondary discussion of US versus UK healthcare is useful for this thread, since it directly applies to the health situation Donni is experiencing. 

I personally find it very interesting, but when it turns away from Donni's health, and becomes a general discussion of the healthcare differences between countries/systems (as seems to be beginning here), it's perhaps better off in another thread. I invite any of you to start such a thread... it would be nice to see that within the Health Forum.


----------



## Emma (Jul 16, 2007)

I second the idea to start a new thread. Theres been a few bits I wanted to add but didn't for fear it would upset Donni if she thought I was relating it to her


----------



## Miss Vickie (Jul 16, 2007)

I'd love to discuss these issues are more length. As Sammie said (and I was thinking about on my way to work) perhaps this would be better discussed on another thread. However, I hesitate to start one in Hyde Park because of the contentious nature of HP, versus a health forum discussion which is, to my mind, more about helping us get better health care by navigating the various systems and a discussion of their similarities and differences, and relative strengths and weaknesses.

Do you guys think we should start a thread here about this? Or (and this would be my second choice) should we just move on over to the "Sicko" thread and talk about it there?


Oh, and Sandie, what Missaf said is right. Your tests seemed appropriate, given your circumstances. What is extreme is something like routinely doing a CT scan for any abdominal pain, or CT scans routinely done for a toddler who hits her head, even though she didn't have a loss of consciousness and shows no signs of neurological issues. This kind of thing happens a lot and a) exposes a patient to (unnecessary, usually) radiation and costs a small fortune.

Blood tests, EKG's and basic imagine like ultrasounds and x rays are easy peasy and cheap and will usually show a problem if one exists.

And in Donnie's case, it can't be easy to navigate a brand new system, when you're used to things working a particular way. Even in our system, with those of us who know it well, it can be hard to get the care you want/need. Heck, I'm an RN and I have trouble sometimes getting what it is I need. I can only imagine how hard it must be for someone who doesn't know the medical lingo, doesn't understand the system, and the like. Sometimes it's anything but user friendly.


----------



## Emma (Jul 17, 2007)

Questions about america:

When you get a job does that automatically come with health insurence? Donni said that had she been in America she would have had health insurence? So is it all jobs or just jobs that are well paid? 

If you're unemployed (or you don't get health insurence) is it expencive to buy? (You can buy it here too and it does come with some jobs as beabea noted)

If you don't have healthcare and you can't afford it, how would you be treated? 


Hear in the UK you have to option to buy the best treatment around. You can buy insurence that will cover you in the eventuality that you get sick. If you can't afford to or don't want to get it then you can be treated for free on the NHS. You may have to wait around a while if the doctor thinks your problems aren't that serious but when things are serious the NHS is very very good. 

A few years ago my mum went to the doctor saying she found it hard to breathe and whatnot. Within half an hour they'd admitted her to the hospital and were treating her for a collapsed lung. They didn't tell her to go away and wait because it was very serious they got her sorted right there and then. 

When I had a fracture on my ankle I was seen, x-rayed and treated within 3 hours of going to accident and emergency. 

When I suspected I had PCOS and went to the doctor, she sent me off to get blood taken at the walk in centre that very day and I had the results back within a week. However it did take about two months to get an apointment for a scan. 

If you can't see a doctor here or don't want to wait we have a place called the walk in centre. You can go there and see trained nurses there and then. There is normally a short wait of up to an hour but it's good to go if you're worried about something. They can put your mind at ease or send you up to the hospital if it IS something important. 

There are many bad bits too. They can play God with your life over such stuff as deciding who gets funding for drugs to treat cancer. If the drugs are very expencieve they may choose someone who they deem more deserving than you. A friends Dad was told they'd decided to give the drugs to a younger man with three young children and a wife. His mum had to remorgage her house but in the end they funded him but it must have been hell (i will find sources for this, it was in the newspaper loads)

thats all for now, coz nik had brought me a cream cake and i want it!


----------



## Zandoz (Jul 17, 2007)

CurvyEm said:


> Questions about America:
> 
> When you get a job does that automatically come with health insurance? Donni said that had she been in America she would have had health insurance? So is it all jobs or just jobs that are well paid?



No, health insurance does not always come with a job, and over the last 25 years or so, the number of jobs not offering or having lost health care coverage has skyrocketed. As of 2003, apx 45 million Americans (about 15.6% of the population) had no insurance, and that number was growing at a rate of about 1.4 million a year http://www.census.gov/Press-Release/www/releases/archives/income_wealth/002484.html



CurvyEm said:


> If you're unemployed (or you don't get health insurance) is it expensive to buy? (You can buy it here too and it does come with some jobs as beabea noted)



It is generally VERY expensive...My wife recently lost her job to overseas outsourcing...the monthly cost to continue the insurance coverage, paying it on her own (COBRA), would have been 74.4% of what her total monthly take-home pay had been.



CurvyEm said:


> If you don't have healthcare and you can't afford it, how would you be treated?



One just goes to the Emergency room for everything, even if not an emergency matter, because it's illegal for them to turn anyone away, then expect to be badgered and harassed by bill collectors, if not outright driven into bankruptcy.


----------



## Ruby Ripples (Jul 17, 2007)

loggamatt said:


> Just one other thing that occurs to me... I wonder if the litigious nature of the US in regards to healthcare is partly due to healthcare providers being profit making businesses? Maybe people feel that because you're paying directly for a service, it is more acceptable to sue if you're not happy with the service. In the same way that someone would be more likely to sue McDonalds for something disgusting in a burger that they've paid for than they would be to sue in a free soup kitchen. I don't know though, I guess people do pay for the NHS out of their own pockets indirectly through taxation, so perhaps people being litigious towards a healthcare system isn't related to the way the system is funded. I don't know... I'm thinking out loud really



I have a little experience of this Matt but in the UK. I worked in a private hospital here for six years, I subsequently worked in an NHS hospital. People in the private hospital behaved much worse than in the NHS. In the NHS people seem grateful to be receiving hospital care, and are patient patients, lol. However in the private hospital I was yelled at many a time for not being able to offer a patient an appointment to see their Consultant of choice that very day. Explaining to them that the consultants all worked in the NHS and only held clinics privately in their free time, made no difference. I also remember patients pretending jewellery had been stolen from their rooms, so they could sue and have their stay paid for. Some of the patients were just awful, they really did think that because they were paying, they could treat the staff like dirt. I have to say those were mainly people who had become wealthy. Real aristocracy and upper classes were lovely, and utterly unsnobbish. I have to say too that if I needed an op and my life depended on it, I'd go NHS, as I trust it more than private.


----------



## Frankie (Jul 18, 2007)

Thanks, Tracey. This was very informative.



BeaBea said:


> Hi Frankie,
> 
> Absolutely not, the vast majority of people here rely solely on the NHS.
> 
> ...


----------



## Frankie (Jul 18, 2007)

In my circle, most employers offer health insurance to their employees, but coverage can often be through a Health Maintenance Organization (HMO) rather than a a traditional indemnity plan. HMOs usually cost less for both the employer and employee, but they provide managed care that allows for less individual choice. You pay a small upfront fee for services, but there can be "gatekeepers" that restrict your access to more specialized physicians and services. Indemnity plans offer much more freedom but tend to cost more. You're free to see any physician of your choosing, but you'll likely need to pay the full cost of expenses upfront and then submit a claim to the insurance carrier for reimbursement.

My company provides employees with a self-insured indemnity plan. This means that the company actually pays for employees' claims; the carrier is paid for administrative services only. (Carriers are responsible for paying claims under fully insured plans.)

I think about looking for a new job, but I don't believe I could ever find a new employer with a comparable medical plan. What I'm about to describe is extremely generous coverage.

- There's no waiting period prior to eligibility.

- Employees must work 21 hours a week or more to be eligible.

- We don't have pre-existing condition exclusions.

- I pay nothing to participate in the plan. Employees with dependents pay no more than $25 a month to have coverage.

- I have a $100 annual deductible to meet before my plan will start reimbursing expenses.

- I have a $1000 annual out-of-pocket limit, which means that once I've paid $1000 to cover my portion of expenses, the plan will start reimbursing all expenses at 100%.

- My plan has no "reasonable and customary" limits, which means it doesn't limit reimbursements based upon predetermined "reasonable" rates.

- There's no lifetime maximum benefit.

- Expenses are reimbursed between 80% and 100%. Annual physicals and gynecological exams are reimbursed at 100%.

- There's vision coverage for routine eye exams, glasses, and contact lenses (often plans don't include this)

- Under the prescription drug plan, I can receive up to a 90-day supply of medication for a $5 upfront payment.

I am thankful every day to have this kind of coverage. Of course, my company is free to change the plan at any time, a possibility that may become reality as health care costs continue to increase wildly.

Individuals with very low income may qualify for Medicaid. I believe that states offer health plans to low income individuals. As Zandoz said, there are many, many individuals in the US who are uninsured or underinsured. Their employers may not offer a plan, or they may earn just enough income to disqualify for low income programs but not enough to be able to afford to buy insurance. A colleague's mother pays about $650 a month for an individual policy that provides very basic, no frills coverage. 




CurvyEm said:


> Questions about america:
> 
> When you get a job does that automatically come with health insurence? Donni said that had she been in America she would have had health insurence? So is it all jobs or just jobs that are well paid?
> 
> ...


----------

