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Three systems widely cited as examples of universal health care are the so-called single-payer systems in the UK, Canada and New Zealand.

These systems I would describe as “socialized”, and rely for the most part on taxation for funding. The system in Canada for instance, uses taxes to pay for health care administered by the individual provinces, and provided by a mixture of private and public hospitals and health care providers. Private health care is restricted in Canada, but is available in some provinces under publicly-funded private organizations called P3s. Private health insurance is limited in Canada but is available.

The UK’s National Health Service (NHS) similarly uses taxes but 8% of their population still utilizes private insurance to augment their national health care services. Services from the NHS are entirely free of charge for residents, and prescriptions have a nominal fee regardless of the cost of the medication. The government is the primary employer of health care professionals, and general practitioners (GPs), act as independent contractors employed by the NHS who serve as gatekeepers into the health system. A GP manages your health care and decides if you can see a specialist.

The New Zealand system is more decentralized with funding of community health boards to serve the needs of the population, primary care since 2001 has been subsidized by the government through Primary Health Organizations designed to allow broad access to primary care for a nominal fee and hospitals and other health services are funded through taxation. They also have a single payer drug service to subsidize prescription drugs and users pay a nominal fee for prescriptions.

How satisfied are patients with these systems, and what is their quality of care?

As shown previously, each of these systems costs a great deal less than that of the US system

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And satisfaction with the systems is on par with what is seen in other universal systems

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The main complaints against the British and Canadian systems is that of wait times. Wait times for elective procedures is excessive, and patients in the British system are known to purchase private insurance so that they can avoid long wait times, even over a year. Currently the British are trying to reduce all wait times to under 18 weeks. Wait times in New Zealand appear to be one of the lowest of universal systems. Rationing in these systems is by need and acuity rather than ability to pay, so non-emergent services tend to take the longest.

Despite these inconveniences most users of the system would prefer to have their national health care than the US system, and outcomes of ,mortality and health care-amenable diseases are far superior in these countries.

Based on the experience of the British and Canadians, it appears that having single-payer insurance without some outlet for more private spending on care may end up being more of a burden on the system. It seems that the systems that have had a mixture of public and private funding have enjoyed superior services and shorter wait times compared to the single-payer systems based entirely on taxation.

Comments

  1. #1 Fred
    May 29, 2009

    If you would like to help pressure Congress with your vote to pass single payer health care please join our voting bloc at:
    http://www.votingbloc.org/Health_Bloc.php

  2. #2 Doug
    May 29, 2009

    Here in the UK people complain about the NHS all the time. This is probably healthy, we need to keep them on their toes. However, we must love it because it’s impossible to get elected unless you pledge to maintain or increase it.

    For me the benefit is perhaps something that isn’t in the statistics above. I don’t need to think about insurance, I don’t need to worry if I’m covered for different types of operation or drugs. When it comes to health I know that it’ll just get sorted. This is a kind of peace of mind that is incredibly valuable to me.

  3. #3 DV82XL
    May 29, 2009

    What Doug said is true here in Canada as well. If we don’t keep at the system to improve it will start to decay because that’s just the way it is with these things. I might also note that the wait times for elective procedures is dependent on location as well, and while waits can be long in some locations, in the past these places might not have had this service at all.

  4. #4 Willow
    May 29, 2009

    The reason for the apparent popularity of the NHS in Britain is that it is the largest employer in the country, so its employees and their dependants tend to be very defensive about it. Whereas NHS ‘care’ is in reality so poor that most of the people who work in it avoid being treated by the NHS if they have the option. – ‘Nuff said!

  5. #5 Ramel
    May 29, 2009

    I’m almost willing to bet money that willow reads the daily mail…
    The NHS is generaly pretty good, the problem is that it gets constantly bad mouthed by opposition polititians and tabloids. The one area where it is truely weak is dental care, there simply aren’t enough dentists working for the NHS.

  6. #6 Ramel
    May 29, 2009

    Argh worse, obesity is caused by salt???? Willow is an altie nutjob, and even has a link to the evil Rath foundation.

  7. #7 Chris
    May 29, 2009

    Having first hand experience of both the New Zealand health system and the NHS, I have to say they’re both superb. I much prefer not having to pay for my life-essential prescriptions in the UK, but apart from that, I’ve found both services to be great.

    Ramel: Dental treatment isn’t part of the health system in New Zealand, and I was surprised that it was covered by the NHS in the UK.

  8. #8 Willow
    May 29, 2009

    You’d lose your money on your bet, Ramel. I don’t read the tabloids. I agree with you though that NHS dentistry leaves a lot to be desired.

    No – obesity is not caused by salt per se; it is caused by sensitivity to salt, and is reduced by cutting down on salt and salty food.

  9. #9 David
    May 29, 2009

    It should be pointed out that elective procedure wait times in Canada vary by location (as already noted by DV82XL) and more importantly by procedure. Thus hip replacement surgery wait times get very bad press because they are long, but hernia surgery wait times don’t get any press at all because they aren’t long.

    “Indeed, while waiting lists certainly do exist for certain non-emergent [sic?] procedures, it is not at all clear that the “waiting list crisis” that is so often talked about by the media and opponents of single payer actually exists.”
    [http://www.amsa.org/studytours/WaitingTimes_primer.pdf]

    This isn’t to say that long wait times are not a problem in Canada – they most certainly are – but to paint the entire Canadian system as being crippled by these problems is bogus.

  10. #10 jim
    May 29, 2009

    Ha. Here in the UK we whinge about the NHS constantly, because, well, it’s what we do. But just let Johnny Foreigner criticise it…

  11. #11 Bexley
    May 29, 2009

    “The reason for the apparent popularity of the NHS in Britain is that it is the largest employer in the country, so its employees and their dependants tend to be very defensive about it. Whereas NHS ‘care’ is in reality so poor that most of the people who work in it avoid being treated by the NHS if they have the option. – ‘Nuff said!”

    Willow, perhaps you could provide some evidence here that the care is poor? By evidence I maen more than just an anecdote.

    The link in Mark’s post shows that healthcare outcomes are better in the UK than in the US despite far lower healthcare spending in the UK.

  12. #12 Ramel
    May 29, 2009

    Sensitivty to salt causes obesity? That’s suposed to make more sense? I know too much salt can cause hart problems but diabetes? or most forms of cancer? really? Are you entirly serious?

  13. #13 Margaret Wilde
    May 29, 2009

    Hi Bexley

    I am Willow, here in my alter ego.

    I am a steroid victim. You could read about that on my webpage http://www.wildeaboutsteroids.co.uk/obesity_and_the_salt_connection.html

    There are many instances of poor NHS care I could tell you of, but I doubt they would alter your views because you will assess matters by your own experience, just as I assess matters by my own experience and that of the hundreds of people I have helped.

  14. #14 MarkH
    May 29, 2009

    And that is the fundamental flaw of your reasoning. We’re not interested in anecdotal data, or even anecdotal data in aggregate (the plural of anecdotes is not data). What we’re interested in is measures of healthcare quality and delivery.

    In these systems, there is a clear increase in waiting times for elective procedures. It is a major flaw. However, measures of access, primary care, healthiness, health-care amenable disease, and mortality, these countries are far superior to the US. That, and they provide care at half the cost, largely due to collective bargaining, centralized administration, and lower wages for health care personnel. Those are the facts. We can complain about horror stories in the NHS, but I’ve got horror stories about the US healthcare system. They’re not meaningful. Bad things happen in any healthcare system. Even the best system, arguably France, surely has stories of people who have had bad outcomes. That’s just medicine, bad things happen sometimes.

    The difference is the bad outcomes aren’t because people are uninsured, can’t afford care, or go bankrupt because of medical bills, like they do here.

  15. #15 Luna_the_cat
    May 29, 2009

    Yah, right, Willow.

    Neither I nor any member of my family am now or has been employed by the NHS. I have lived in both the US and the UK. I have immediate family, including a number of older relatives in poor health, on both sides of the Pond. I deal with both systems on an ongoing basis. And while the NHS has its problems, I tell you from direct personal experience that the NHS is infinitely less broken. There are areas which can definitely be improved, and the grievious lack of cancer specialists in Aberdeen is one of them. But I can assure you, the care does not suck.

    Recently, an online friend of mine living in Florida was turfed out of an ER with an unset broken leg, because they didn’t have the staff or the beds and she didn’t fight hard enough to get her care. If that had happened in the UK, the papers would be all over, calling for administrator’s heads to roll. In the US? Not the only time it’s happened, especially in south Florida apparently, and seems to barely get noticed.

    Three years ago, my father suffered his second massive stroke and was taken to a very good trauma hospital in Denver. Unfortunately the ER was filled to overflowing and understaffed, and when he went into convulsions, vomited, and started choking on his own vomit the family couldn’t find anyone to help. He lived through it because my sister-in-law was there and managed to get him into recovery position and get enough vomit out of him that he could still breathe until properly aspirated.

    One of my brothers was in a serious car accident and suffered head injury. Because he had no medical insurance, they made sure he wasn’t still bleeding inside his skull, but he was unable to get physiotherapy for his complete lack of physical coordination, inability to focus his eyes, and blinding headaches for the year after the accident. This was also in Denver.

    What can I offer from the UK?

    Well, my husband’s grandfather had to wait far too many weeks to start getting treatment for prostate cancer. There were what I consider to be unacceptable delays in his diagnosis.

    On the other hand — My father-in-law’s heart attack: dealt with immediately, competently, no hassle. My mother-in-law’s diabetes and angina: dealt with immediately and competently, followed up by doctors and health visitors. My brother-in-law’s head injury after being attacked on the street: dealt with immediately and competently, followed up by automatic physical assessments to make sure he was recovering properly. From other experiences here, physiotherapy is pretty much automatic and followed up.

    Why yes, all this is merely anecdote, not data, but anecdote seems to have more meaning for a lot of people than raw numbers. But here’s what it boils down to: Don’t lecture me about how care over in the UK sucks.

  16. #16 Willow
    May 29, 2009

    Hi Luna_the_cat

    I can’t say I’ve lectured you or anyone about care in the UK. The NHS has destroyed my life and my health and that of many people who were very dear to me. We all have our own experience.

    The NHS Complaints Procedures are designed to ensure that meaningful reform is unlikely. The surgeon who was responsible for my being more disabled after his surgery than before it, last December, told me it would be no use my writing a letter of complaint because no change would result. I noted that he expressed not a word of regret, apology or sympathy, not that I was looking for any.

  17. #17 Luna_the_cat
    May 29, 2009

    Willow — your first post, and I quote:
    The reason for the apparent popularity of the NHS in Britain is that it is the largest employer in the country, so its employees and their dependants tend to be very defensive about it. Whereas NHS ‘care’ is in reality so poor that most of the people who work in it avoid being treated by the NHS if they have the option.

    If that isn’t lecturing on how poor the care is in the UK, I don’t know what is.

    Now, while I am very, very sorry for whatever disability it is that you have suffered, and agree that a better way of addressing surgical malpractice in the UK would definitely be a good thing — that’s pretty much where it ends. The NHS works a hell of a lot better than the US system, and I would not willingly give it up. And I trust both the quality and the consistency of the care that I have gotten here over what I have gotten in the US, too.

    I’m genuinely sorry you had a bad experience. I’m sure it colours your view. I don’t think you understand that bad experiences are possible everywhere, and the only meaningful metric one can derive from them is how often they happen, in what ways, and to how many people. In that regard…the UK is still definitely better than the US.

    Also, as a side note: it does not help science-literate people take your concerns seriously when we see that you attribute obesity entirely or almost entirely to fluid retention, you are a climate-change denier, and you seem to find credibility in things which genuinely have no scientific credibility.

  18. #18 Luna_the_cat
    May 29, 2009

    Speaking of credibility, Willow –
    most of the people who work in it avoid being treated by the NHS if they have the option

    I would like to see a source for this, and what information backs the assertion up.

  19. #19 Willow
    May 29, 2009

    Hi Luna_the_cat

    YOU are comparing the British and the American healthcare systems. I am not. I have only experienced the British system, which in my experience, is very poor indeed.

    Here’s where I read that “most of the people who work in it avoid being treated by the NHS if they have the option”. http://www.telegraph.co.uk/news/uknews/1547086/Staff-wouldnt-be-treated-at-their-own-hospital.html

    I never state anything without evidence to back it up.

    If you’ve any more problems I suggest that you do your own research. My hands are very painful and I don’t want to waste them on fruitless argument.

  20. #20 Anonymous
    May 29, 2009

    @Willow: There is a huge difference between “most of the people who work in it avoid being treated by the NHS if they have the option” and

    More than a quarter, 27 per cent, said they disagreed or strongly disagreed with the statement: “I would be happy with the standards of care provided if I was a patient in my trust”.

    One is a blanket statement implying extreme dissatisfaction with the entire system, and the other is a small group that would be dissatisfied with the standard of care. To state, as you did, that they would avoid treatment under the NHS is at best disingenuous, and more likely flat dishonesty.

    I understand that you have a personal grudge against the doctor you feel disabled you, and by extension the entire system. That is why we do actual studies, to smooth out the spikes and irregularities in anecdotes. There is no room in this discussion for lies.

  21. #21 LanceR, JSG
    May 29, 2009

    Crap. I thought I was signed in. That ^^ was me.

    Still can’t get used to this $%*# Typekey.

  22. #22 Luna_the_cat
    May 29, 2009

    Indeed, from the Telegraph, the statement in question was:

    “I would be happy with the standards of care provided if I was a patient in my trust”

    To which the responses were:
    5% strongly agree “very happy” to be treated there)
    34% agree (“happy” to be treated there)
    33% unsure
    27% disagree/strongly disagree.

    First off, the question is about satisfaction with standards of care provided in their own facility, not “would you avoid being treated by the NHS.” NOT the same thing. The statement does not address overall standards of care under the NHS, nor whether they would prefer private treatments.

    Second, while the number of “unsure”s is a bit bad, it’s also a far cry from “most would avoid the NHS.” 27% of the respondents wouldn’t be happy to be treated as a patient in their own trust, that’s all you can say; and for all we know, or you know, all those 27% may have come from two or three really bad trusts, and would simply prefer to be treated under the NHS elsewhere. There is nothing in the detail which gives you any clue to that.

    Sorry, you are pulling out an interpretation that this genuinely doesn’t support.

    You made a definite statement, in your first post, that the only reason (emphasis mine) that the NHS was popular was that they are a big employer, and employees get defensive about it. I think many of the statements here, mine included, invalidate that assertion. The point of the comparison with the US system is that the standard (and availability) of care is actually another reason why some of us are genuinely grateful for the NHS, i.e. why it’s so popular.

    I’m sorry your hands hurt. I hope they feel better.

  23. #23 Tassie Devil
    May 29, 2009

    I worked in the NHS for many years. I did not have private insurance at any time as I was perfectly happy to be treated by the NHS. Apart from anything else, staff having private insurance is like politicians sending their kids to private schools. If you are responsible for the system you must show your confidence in it in a way people can respect.

    BTW, quoting the Telegraph as a reliable source for data on the NHS is ridiculous. They’ve been pushing for its destruction for years.

  24. #24 nurse annie
    May 30, 2009

    In the US, our health care system is broken. We have MILLIONS of people with no health care coverage of any kind. We have a baby boomer population entering our Medicare system (how we provide health coverage for the elderly), and, at least in my area, long waiting lists to find a provider who will accept Medicare. In many areas our Docs are leaving primary care and internal medicine fields because of poor reimbursement.

    I have worked as an RN all my career, and restructuring our system into a single payor system sounds like a good fix to me.

  25. #25 Jimaima
    May 30, 2009

    Jim “But just let Johnny Foreigner criticise it…”

    Beautifully and simply put Jim, well done. The difference between the American system and the NHS in Britain is like the difference between Sam’s cafe round the corner and Starbucks, every which way you look at, the NHS will always come tops!

    http://wistechnology.com/articles/6039/

    Maybe ‘we’ Brits should come round and help our American cousins fix there own …

    Hey guys, the Brits’ll fix it for you :-)

  26. #26 Anonymous
    May 30, 2009

    Jim “But just let Johnny Foreigner criticise it…”

    Beautifully and simply put Jim, well done. The difference between the American system and the NHS in Britain is like the difference between Sam’s cafe round the corner and Starbucks, every which way you look at, the NHS will always come tops!

    http://wistechnology.com/articles/6039/

    Maybe ‘we’ Brits should come round and help our American cousins fix there own …

    Hey guys, Ask Jim, he’ll fix it for you :-)

  27. #27 Jaywalk
    May 30, 2009

    “Dental treatment isn’t part of the health system in New Zealand” In NZ you get free tax funded dental treatment until the age of 18, after that you go privately or if low income and have access to a hospital nearby the dental department at the hospital runs emergency clinics and provides low cost treatments for adults. Optometrist care is completely private, but frames for children can be part funded by the government if low income. I think the health system is excellent if you require acute care, but there can be fairly lengthy waits to see a specialist and get surgery for non-urgent problems. The problem is somewhat hidden for some specialties where there are few specialists available, one of my relatives needed to see an opthalmologist for a non-urgent problem and was put on a six month waiting list to go on the waiting list to see the doctor. It’s not all bad though, I’ve required plastic surgery on my hands for a congenital defect and last time I went to see the specialist I got the surgery within six weeks of me seeing the doctor. There is some limitations on what is provided but there is some special funding for very expensive treatments that are not available here. Otherwise, you can normally get to see your GP within a day or two as when it’s busy they’ll always keep a few appointments free for people that need to be seen urgently and there’s after-hours medical available in most areas. Doctors and prescriptions are subsidised, but the charges aren’t huge ($NZ16 for my 9 year old last week with a $NZ3.80 prescription charge, I would pay $NZ15 for a prescription of a funded drug and about $NZ50 for a doctors visit – this is less if you are low income as this has a greater subsidy.) You can opt out with insurance (only for non-acute things like dodgy hips) and sometime it helps save a lot of time if you can pay to see a specialist privately and then get them to put you on a public hospital waiting list. The other thing is that we have ACC (a nationalised system for accident compensation) which means that if you are injured in something like a car accident levies that are already paid out of car registrations and income means you don’t have to sue someone to get compensation unlike overseas. It’s something very much preferred by pretty much everyone although there have been some problems from time to time and the odd person ripping off the system. Mind you this seems to happen in other countries as well that don’t have this system. Like the NHS in the UK we are all aware we pay for this through our taxes, and moan about it regularly as well to ensure everything stays on the straight and narrow.

  28. #28 SharonC
    May 30, 2009

    For me the benefit is perhaps something that isn’t in the statistics above. I don’t need to think about insurance, I don’t need to worry if I’m covered for different types of operation or drugs. When it comes to health I know that it’ll just get sorted. This is a kind of peace of mind that is incredibly valuable to me.

    Exactly, Doug (#2).

  29. #29 guthrie
    May 30, 2009

    Willow #4 doesn’t fit my experience or that of anyone else i know. I defend the NHS because having read blog posts like these I know it is better than the alternatives pushed by the usual vested interests and the current new labour government. (Said gvt has increased bureacracy and costs and tied health boards into inefficient and expensive contracts for hospitals)

    My sister and uncle and cousin work in the NHS, and none of them have used private medicine for treatment.

  30. #30 seks
    May 31, 2009

    In the US, our health care system is broken. We have MILLIONS of people with no health care coverage of any kind. We have a baby boomer population entering our Medicare system (how we provide health coverage for the elderly), and, at least in my area, long waiting lists to find a provider who will accept Medicare. In many areas our Docs are leaving primary care and internal medicine fields because of poor reimbursement.

  31. #31 Christina
    May 31, 2009

    Recently, an online friend of mine living in Florida was turfed out of an ER with an unset broken leg, because they didn’t have the staff or the beds and she didn’t fight hard enough to get her care. If that had happened in the UK, the papers would be all over, calling for administrator’s heads to roll. In the US? Not the only time it’s happened, especially in south Florida apparently, and seems to barely get noticed.

    Well, because we have people dying on the floor of the ER after waiting 15 hours to be seen, so a broken leg isn’t going to create a blip in that atmosphere. (BTW, there was video of that guy pacing in the ER waiting room where you could see the hernia poking out of his abdomen–on a crappy quality security video!)

    The way things are done here in the US is beyond stupid. For example, my PCP does not have privileges at any of the local hospitals. She’s on the list of doctors but can’t write orders or whatever–I don’t understand it, it’s all arcane nonsense to me. Whatever her status is, it’s a mere courtesy. Anyway, I need an IV antibiotic for a blood infection. I have insurance. I have not had this done because a-the copay for the ER is $100 and b-I have no time to devote a day to sitting in the ER, yet this is the only way for me to get this simple, inexpensive procedure done. None of the Care Now places do this type of thing, either. I called. So, how much cheaper would this all be if someone had some sense and it could be done in the office? Or there was some in between type care for this sort of thing that was not an ER? And, more important than my anecdote, how many other people are forgoing needed medical care because of this nonsense? AND, how many other procedures are taking up time in the ER that could be done cheaper and easier in a different environment?

  32. #32 R E G
    May 31, 2009

    I’ve enjoyed your various posts on this topic, but I think you have missed the “elephant in the room”.

    You can discuss costs, outcomes, life expectancy etc., but what is missing is a frank discussion of why other countries see universal health care as a basic human right, instead of a priviledge.

    Yes we in Canada, France and all complain about flaws in the systems, but overall we fully expect that anyone who needs healthcare should get it as required. Any failures are our common problem; I could be the next person to slip throught the cracks. Consequently, every policy decision is directed squarely at me, whether I am sick or not.

    This is what baffles the rest of the world about the American system. How can a country, whose individuals are among the most generous, not have the political will to extend that generousity to taking care of all its citizens?

  33. #33 Luna_the_cat
    May 31, 2009

    @Christina — yes. Yes. GOD yes. I think you have hit on a few fairly acute and real problems there. It’s an appalling system, especially for as “advanced” a country as the US.

    @R E G – ever since about 1948 (or around the time that the NHS was being set up), the American Medical Association has been running a concerted and extensive propaganda compaign on the “evils” of socialised medicine*, selling the storyline that not only does -your- money go to pay the medical care of a bunch of lazy, no-good bums who are sponging off your hard work, but that also when you need medical care you would end up waiting forever for rationed care and not get what you need. The AMA’s explicit premise in 1948 was based on the idea that government control of medical care would impact its members incomes adversely. That is still behind much of what they do, I think, but now they don’t say so out loud nearly as much.

    There are a large number of doctors in the US who are neither members of the AMA nor who support the explicit and implicit positions of the AMA, but they still hold a lot of political clout, and the narrative about socialised medicine has been sold to the American public on an ongoing basis for so long, that it has been internalised and the vast majority of Americans have no idea where it began — it’s just “common knowledge.”

    ———————
    *I have a number of journals and magazines from the late 40s/early 50s, and have seen bits of this campaign for myself, in the original.

  34. #34 SimonG
    May 31, 2009

    R E G: I’m British, and I don’t see health care as a basic human right. I look on the NHS as a practical choice made by the people of my country. Even if you put aside the benefits to society of having a healthy population, it’s just – demonstrably – a more efficient option for most individuals.

    My bemusement with the Americans is not that they don’t want to provide this service to everybody, but that they seem so willing to pay vastly more money for an inferior service.

  35. #35 Brain Hertz
    May 31, 2009

    As a Brit who has now lived in the US for several years (and my wife previously worked for the NHS) I’d have to say that the US system is broken in ways that the NHS clearly isn’t.

    Whilst I certainly couldn’t say that the NHS is perfect, nobody should imagine that there are no instances of screwups or poor care under the US system (assuming that you actually have coverage). Stuff like this just isn’t a function of where the money comes from.

    However, there clearly is a very significant difference between the two: in the US, we pay much more for healthcare, and actually getting it tends to be questionable. In my case, I work for a large company with a large group plan. Based on experiences of myself and friends, this is the only way I can possibly be safe. Working for a small company or (much worse) for yourself and buying your own health insurance you’re in an extremely precarious position in the event that you become seriously ill. The health insurance companies are massively incentivised to try to drop your coverage in such a case, and are frequently successful. What do you do then?

    Until this basic problem of being almost-but-not-really insured is addressed, there is no grounds for claiming superiority of the US system over any “socialised” system.

  36. #36 catgirl
    June 1, 2009

    While long wait times are a legitimate concern in other countries, I wonder how often people in the US wait too long for something simply because they can’t afford it. Does anyone have any data on this? I know I’ve seen surveys where people admit to delaying basic care due to cost. No system is perfect, but most are better than what we have now in the US. I’d rather wait too long for a less critical procedure than be forced to delay necessary care simply because of affordability.

  37. #37 tatil
    June 1, 2009

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  38. #38 katherine
    June 1, 2009

    Good to know the service here in NZ is pretty good. I disagree with the costs quoted by Jaywalk, I pay NZ$35 for appointments with my doctor, and before I switched doctors it was NZ$15. I am an adult with no discounts available. You must be living in a wealthy area or something, I have no idea how these costs are set.

  39. #39 Nico
    June 2, 2009

    I’m amazed how many americans I do talk to who think the canadian system entails the government telling you what doctor to see, and what procedure to get, where and when. I suspect they see our government as operating as a giant national HMO.

    In most cases, I pay less in tax, well, our household does, than many of my US cohorts do in health insurance, my care is determined between the doctor of my choosing and me, not the government, and while I’ve been on waitlists, they were never more than 8 weeks for relatively minor things.

    It’s not same day or next day surgery, but anyone who is expecting that sort of treatment would never be happy anywhere.

    Meanwhile I have friends in the US who haven’t had the means to see a doctor in years.

    It seems to me that the US “fear of socialism” has really worked it’s way in to the minds of the populace. There’s also this abject terror that the other guy will get more care, and leave you high and dry, or that everyone else will quit working to sponge off the free system while they work.

    These are concerns that americans have told me. But it hasn’t happened like that in countries with a non US system so why it’s ingrained there, I do not quite understand.

    I don’t expect it to ever change, however. Meanwhile, I wish I could sneak my friend up to canada so he could get properly seen and cared for. His insurance simply won’t approve a visit to a doctor in his area.

  40. #40 Jaywalk
    June 2, 2009

    “You must be living in a wealthy area or something, I have no idea how these costs are set”

    Nope, live in Lower Hutt, Wellington. We do have some wealthier areas but overall it’s just suburbia, at the last census the median income was $NZ27,300 – a bit above the national median but not hugely. As far as I am aware the patient subsidy is the same for everyone (possibly with some extra funding for some areas), but doctors being their own businesses can set their charges so this does vary depending. It’s like the free care for under 6 year olds, our surgery does provide it free but friends of ours pay over this (their GP’s surgery does offer longer opening hours though which might be the reason as they get more service). We are not eligible for a community services card either.

  41. #41 Francis D
    June 3, 2009

    Willow, I could respond to you – but others have done so. (The one thing I will say is that I’d be more than happy to be treated by my current hospital, but would be less happy to be treated by my previous one – which is one part of the reason my previous NHS trust no longer exists).

    The one thing I would ask you is why, if you had suffered malpractice on the part of a surgeon, why in hell’s name you believed him when he encouraged you not to complain? He would say that, wouldn’t he? And he’d be especially likely to want to convince you to not complain if the complaints procedure worked.

    As for delays to treatment for Prostate Cancer, it was a serious problem a few years ago. Now if it goes over 62 days from referral by a GP with suspected prostate cancer to the first treatment (and that includes diagnosis) there are huge alarm bells that start ringing and the CEO starts preparing for a grilling.

    (Oh, the NHS does in theory do dentistry. But too much of it got privatised for it to be a viable service).

  42. Hi Francis D

    I’ve suffered such a lot of medical (and, indeed, dental) negligence over many years and have tried in the past to get somewhere with the Complaints Procedures and found it impossible. Not only is it exhausting and futile, but in my experience complainants get sort-of victimised/punished further. I don’t want to exaggerate this. Maybe there are better words to use, but I’m in so much pain I can’t think of them.

    Years ago I remember a particularly unpleasant guy who had harmed me and he jeered at me, asking me what I was going to do about it, suggesting I write a letter. – “Much good it’ll do you,” he said, obviously confident that nothing would be done. – He was right. – I wrote about him and nothing at all was done. Nothing. And I’ve only complained either to improve the system or to obtain necessary treatment to try to undo the harm done to me. Neither has ever been done.

    Nor has anything ever been done about any of the others who have harmed me.

    I used to know Jean Robinson, who for years was Chair of the Patients Association, and later was a lay member of the General Medical Council. In the late 80s she wrote a book, “A Patient Voice in the GMC” was the title, if I remember correctly, and she sent me a copy of it. It was a damning indictment of the uselessness of the GMC in protecting the public from medical negligence – how it always favoured the doctors over the patients. It was very detailed. I don’t still have the book because I lent it to a bishop, David Jenkins, now retired, hoping he would try to get a better system, but not only did he not help, though he had said he would help, he also never returned the book to me.

    Anyway over her years of service to the public, Jean had heard from hundreds and hundreds of people damaged by health professionals. She said she knew of no-one who had found the complaints procedures satisfactory.

    As a steroid victim because of sustained medical negligence I am so ill and in such great pain and so very tired I’m too poorly to embark on any further futile battles. Instead I use my website and blog to try to save others from unnecessary suffering.

    My hands are so exquisitely painful I’ll have to leave it at that.

  43. #43 Francis D
    June 16, 2009

    Sorry I forgot to reply to this. And sorry that your story happened to anyone.

    The late 80s and early-mid 90s were the nadir of the NHS – Thatcher was trying to privatise it and starve it of resources. Things have improved a lot on almost all counts (except cost-effectiveness) since Labour started throwing money at the NHS.

    And while the GMC is undoubtedly institutionally biassed to the doctor, there were reasons your aquaintance only heard from disgruntled patients. They tend to be the noisy ones. And again, they’ve improved over time.

  44. #44 Amanda
    June 16, 2009

    I agree with many of the above comments – we whinge about the NHS all the time, but the vast majority of us are proud of it, and would clobber anyone trying to get rid of it.

    There is a rather interesting article here, “From a patient’s perspective – how the National Health Service actually works in practice” http://hubpages.com/hub/From-a-patients-perspective—how-the-National-Health-Service-actually-works-in-practice

  45. #45 DJ
    June 21, 2009

    Nice series of posts, I learned a lot. Just thought I would post here that there recently was a house subcommittee hearing on the practice of recission by insurance companies. When asked if they would stop the practice, all three executives present said no…

    This issue should be getting serious media attention right now, a surefire way to gain support for revamping the healthcare system in the U.S.

    I’d be interested in reading your thoughts on recission.
    Regards,
    DJ

  46. #46 jodyaberdein
    June 26, 2009

    I both work for the UK NHS and had exemplary treatment for my community acquired pneumonia last year. I am married to an NHS midwife who just delivered the baby of an NHS obstetrician.

    In my experience the UK private sector is used by those who don’t want to have to wait for their elective surgery, or for a specialist referral. As soon as illness becomes chronic, or at all expensive e.g. a surgical complication requiring an intensive care admission, or renal failure requiring ongoing dialysis, then the good old NHS comes to the rescue.

    The fact of the matter is that if I, or indeed anybody of any means who is entitled to care, becomes unwell where I live, they would be given treatment in a world class medical centre, and probably be cared for by internationally renowned experts in the field. Now I live in London, but the tertiary centres nationwide are open to all inter-hospital referrals, and we take our patients on the basis of clinical need and clinical need only.

    Just as an aside I prescribe quite a lot of steroids, and yes they have a fairly horrendous list of side effects. There is a difference however between steroid causing obesity and salt retention (true) and salt consumption causing obesity (false).

  47. #47 konteyner
    July 2, 2009

    The reason for the apparent popularity of the NHS in Britain is that it is the largest employer in the country, so its employees and their dependants tend to be very defensive about it. Whereas NHS ‘care’ is in reality so poor that most of the people who work in it avoid being treated by the NHS if they have the option. – ‘Nuff said!

  48. #48 oteller
    July 2, 2009

    The main complaints against the British and Canadian systems is that of wait times. Wait times for elective procedures is excessive, and patients in the British system are known to purchase private insurance so that they can avoid long wait times, even over a year. Currently the British are trying to reduce all wait times to under 18 weeks. Wait times in New Zealand appear to be one of the lowest of universal systems. Rationing in these systems is by need and acuity rather than ability to pay, so non-emergent services tend to take the longest.

  49. #49 haberler
    July 2, 2009

    The main complaints against the British and Canadian systems is that of wait times. Wait times for elective procedures is excessive, and patients in the British system are known to purchase private insurance so that they can avoid long wait times, even over a year. Currently the British are trying to reduce all wait times to under 18 weeks. Wait times in New Zealand appear to be one of the lowest of universal systems. Rationing in these systems is by need and acuity rather than ability to pay, so non-emergent services tend to take the longest.

  50. #50 MMO
    July 5, 2009

    The United States TODAY already spends more per person on Healthcare than any other country in the world and we DON’T Have universal coverage. What this means is that our government clearly is incapable of managing / running a good healthcare system. For failing to run a proper healthcare system, Obama’s solution, instead of AXING government healthcare all together, is going to increase government spending on healthcare… MASSIVELY. I don’t understand Obama’s logic.

  51. #51 Brian X
    July 8, 2009

    MMO:

    And who would you have provide universal health care if not a government agency? You’d have to have your head shoved pretty far up your ass to think that private health care in the US is anything less than an unmitigated disaster, and there’s plenty of evidence around the world that a properly-run government system works just fine.

  52. #52 psycholog
    October 19, 2009

    Having first hand experience of both the New Zealand health system and the NHS, I have to say they’re both superb. I much prefer not having to pay for my life-essential prescriptions in the UK, but apart from that, I’ve found both services to be great.

    Ramel: Dental treatment isn’t part of the health system in New Zealand, and I was surprised that it was covered by the NHS in the UK.

  53. #54 jaspreet
    April 12, 2012

    Agreed with the others. There is great emotional cost in performing unnecessary medical tests.

  54. #55 jaspreet
    April 12, 2012

    Agreed with the others. There is great emotional cost in performing unnecessary medical tests.

  55. #56 Marco
    May 20, 2012

    NHS in Britain is based discharging patients and denieing assistant when they are in need in order to save money, rudeness is the main feature among employes at the NHS, Doctor are very incompetent, there is the highest numbers about cases of medical negligence respect the rest of the world, the cost of the NHS goes mainly in the pockets of Managers and not for the service of patients, in Hospitals there is luck of hygiene every year more than 5,000 between patient doctors and nurse dies for MRSA, Doctors abuse agaist patients particularly who cannot defend himself, tempering medical records is a common practice between Doctors and other employies on the NHS, Doctors are constantly lieing when they are accused about some misconduct, in Britain the health system is crap!!!

  56. #57 Wow
    May 21, 2012

    “What this means is that our government clearly is incapable of managing / running a good healthcare system.”

    Clearly you think that your health insurance is to a government front agency in that case, as opposed to “reality” where your insurance is going to a private concern.

    It’s private industry who mange to do less with more.

    A government is incapable of managing private companies providing healthcare.

    So it should stop outsourcing.

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