Ask a question: 'socialised' medicine

[Laura Corin]

Dear all

 

I'm happy to answer any questions about how national health care works in Scotland and (to the extent that I know) in England.  I will only talk about my own experiences and those of people I know personally - not news articles (pro or anti).  If you wonder how it works (for me and those I know), please ask away.  

 

As this is on the Chat Board rather than in a private group, please do not start talking about the US situation, political parties or policies.  

[Dicentra]

I'm sure there are many Canadians who would be willing to share their knowledge and/or experiences, as well, if Laura doesn't mind our participation. :)

[Guest]

Can you tell us a bit about how much the average middle-class family pays in taxes?

[Greta]

I have a reasonably good chance of getting a same-day appointment with my doctor (general/family practitioner) when I'm sick, or within a month for something non-urgent. But for specialists, like my OBGYN or my neurologist, it takes six weeks to three months before I can be seen. Certain specialties are even worse. I had a friend with melanoma who had to wait six months for a follow-up appointment. Do you have similar waits before you can get appointments?

[Laura Corin]

I'm sure there are many Canadians who would be willing to share their knowledge and/or experiences, as well, if Laura doesn't mind our participation. :)

 

Sounds great.  Why don't we mark our posts CA or UK at the beginning (or something) so people don't get confused?

[AimeeM]

I have a reasonably good chance of getting a same-day appointment with my doctor (general/family practitioner) when I'm sick, or within a month for something non-urgent. But for specialists, like my OBGYN or my neurologist, it takes six weeks to three months before I can be seen. Certain specialties are even worse. I had a friend with melanoma who had to wait six months for a follow-up appointment. Do you have similar waits before you can get appointments?

I have a similar question, but kind of opposite. Our wait time for sick visits is same day, but our wait time for GP non-urgent matters is only a week or so, typically, as long as you are an existing patient. Similar for specialists, with a couple of exceptions. If my son needs to see his pulmonary or cardio, the can typically get in same day for an emergency or within a week or two for non-urgent matters; his endocrinologist seems to take longer for non-urgent matters. MRIs, x-rays, and blood work can be had the same day or within a week or two (this largely depends on whether sedation is needed for the MRI, it seems). When he had his lung and vascular surgery, it only took us a month (which included all pre-op procedures and diagnostics and included appointments with his pulmonary, ped's surgeon, and cardio) from diagnosis to surgery date. 

 

In a socialized medicine setting, would my son continue to have the fairly quick access to his specialists as he has currently? I'll admit that I've heard wait-time horror stories.

 

Also, what is your dental health system like?

[Laura Corin]

Can you tell us a bit about how much the average middle-class family pays in taxes?

 

UK. The income tax bands are on this page:

 

https://www.gov.uk/income-tax-rates/current-rates-and-allowances

 

Tax is individual, rather than joint, although I believe that you can transfer part of your tax-free allowance to a spouse.  In addition, there is a tax similar to sales tax of 20% on 'non-essentials': basically everything except grocery store food purchases, children's clothes and books.  There is high tax on cigarettes and petrol.  All of these contribute in some measure to the NHS; most people don't have health insurance costs on top, although top-up insurance is available.

 

Local tax is based (very roughly) on the size of your house.  An example of the local tax bands is here:

 

https://www.fifedirect.org.uk/topics/index.cfm?fuseaction=service.display&p2sid=9CEF404F-F1D0-CED5-C2ACE1DE15167C3F

 

Local tax goes to support local services, including social care (largely old people who need looking after rather than medical care as such)

 

 

I have a reasonably good chance of getting a same-day appointment with my doctor (general/family practitioner) when I'm sick, or within a month for something non-urgent. But for specialists, like my OBGYN or my neurologist, it takes six weeks to three months before I can be seen. Certain specialties are even worse. I had a friend with melanoma who had to wait six months for a follow-up appointment. Do you have similar waits before you can get appointments?

 

At my doctor, if I have an urgent need (UTI, sudden back pain, etc.) I can get a same day appointment at the GP's practice if I call first thing in the morning.  For some things I will be booked with a nurse practitioner rather than a doctor.  If I insist on a doctor, then I may not be able to get such a quick appointment.  For less urgent things, I will be able to see a GP within the week.  

 

To see a specialist, I need a referral from my GP.  Typically, I will then get a letter from the hospital telling me to expect an appointment, then the appointment letter will come.  In my experience, I will see the specialist in two to three months from the referral.  Cancer referrals have shorter targets, but I (luckily) haven't had experience of that.

Edited January 30, 2017 by Laura Corin

[ktgrok]

I have a similar question, but kind of opposite. Our wait time for sick visits is same day, but our wait time for GP non-urgent matters is only a week or so, typically, as long as you are an existing patient. Similar for specialists, with a couple of exceptions. If my son needs to see his pulmonary or cardio, the can typically get in same day for an emergency or within a week or two for non-urgent matters; his endocrinologist seems to take longer for non-urgent matters. MRIs, x-rays, and blood work can be had the same day or within a week or two (this largely depends on whether sedation is needed for the MRI, it seems). When he had his lung and vascular surgery, it only took us a month (which included all pre-op procedures and diagnostics and included appointments with his pulmonary, ped's surgeon, and cardio) from diagnosis to surgery date. 

 

In a socialized medicine setting, would my son continue to have the fairly quick access to his specialists as he has currently? I'll admit that I've heard wait-time horror stories.

 

Also, what is your dental health system like?

 

wherever you are, don't move! Here an endocrinologist is at least a month, often several months. Lab work is quick though. Dermatologist....the one I went with got me in within 2 weeks, others had several months wait. And I'm in Florida. 

[Laura Corin]

I have a similar question, but kind of opposite. Our wait time for sick visits is same day, but our wait time for GP non-urgent matters is only a week or so, typically, as long as you are an existing patient. Similar for specialists, with a couple of exceptions. If my son needs to see his pulmonary or cardio, the can typically get in same day for an emergency or within a week or two for non-urgent matters; his endocrinologist seems to take longer for non-urgent matters. MRIs, x-rays, and blood work can be had the same day or within a week or two (this largely depends on whether sedation is needed for the MRI, it seems). When he had his lung and vascular surgery, it only took us a month (which included all pre-op procedures and diagnostics and included appointments with his pulmonary, ped's surgeon, and cardio) from diagnosis to surgery date. 

 

In a socialized medicine setting, would my son continue to have the fairly quick access to his specialists as he has currently? I'll admit that I've heard wait-time horror stories.

 

Also, what is your dental health system like?

 

UK.  Once you are signed on to a specialist, then the call-backs ETA should be at appropriate spacing, and they should be available for emergencies (I don't have experience of how quickly you could see your specialist in an emergency, however).  It's the initial appointment where there is usually a wait.  

 

My mother was referred to a specialist and saw him within a couple of months, then the next appointments were booked at the specialist clinic and were at appropriate spacings.  That would be the case for a chronic illness - my old boss was called in regularly to the diabetes clinic and Husband is called to the asthma clinic.  My friend's son who had juvenile arthritis went to the Scottish specialist hospital at regular intervals, and I believe also went if he had a flare-up, but I'm not sure about that.

 

The problem would come if, for example, you were referred for an illness, saw the specialist and were deemed cured, then had a relapse.  Then you would probably need to get referred again, with a new waiting time (except in emergency).

Edited January 30, 2017 by Laura Corin

[scholastica]

I keep reading on the BBC about shortages of GPs leading to long waits to get appointments for illness and long waits in A & E departments in the NHS, also mismanagement of funds in some areas of the U.K. Is this widespread across the system or localized?

[Laura Corin]

I forgot to answer about dental care.  This is only semi-public and therefore the picture is quite different.  There are NHS dentists who charge fixed rates for procedures.  A check up with them is free in Scotland, and procedures are pretty cheap:

 

https://www.scottishdental.org/public/treatment-charges/

 

If your NHS dentist thinks you need braces, you can be referred to an NHS orthodontist.  If the braces are deemed medically necessary (rather than cosmetic) then you won't have to pay for those.  I didn't have to pay for either of my boys' braces.

 

The problem is that fewer and fewer dentists are providing NHS services, so in some areas it's hard to get onto an NHS list.  I'm lucky where I am, but it's really variable.

[Jane in NC]

Can you discuss prescriptions?  Many Americans can get generics for free or at low cost but name brand or newer drugs can be very expensive. Do you have out of pocket costs for prescription pharmaceuticals?

[Laura Corin]

I keep reading on the BBC about shortages of GPs leading to long waits to get appointments for illness and long waits in A & E departments in the NHS, also mismanagement of funds in some areas of the U.K. Is this widespread across the system or localized?

UK That's the kind of thing I really can't answer - I can only speak to what I see.  

 

However, I asked a friend who is a senior civil servant in the Dept of Health whether the improved care that my mother gets in Scotland compared to at her previous home was an Scotland/England difference or an countryside/inner-city difference.  She was pretty sure that it was the latter: as in any country, inner-city problems have a direct effect on health.  It's also harder to get excellent doctors to work in tough inner-city practices - my mother's previous GP practice seemed to have a high turnover of doctors.

[Laura Corin]

Can you discuss prescriptions?  Many Americans can get generics for free or at low cost but name brand or newer drugs can be very expensive. Do you have out of pocket costs for prescription pharmaceuticals?

 

We don't pay for prescriptions in Scotland.  I order my mother's medications from her GP practice, they send the repeat prescription through to whichever pharmacy I choose, and I pick them up.  No money changes hands.

 

Laura: In addition, there is a tax similar to sales tax of 20% on 'non-essentials': basically everything except grocery store food purchases, children's clothes and books.

-----------------------------------------

Can you give an example of how much something would cost, that is non-essential? Let's say a sofa is $1000. What would it be after that sales tax and local tax?

 

_________________________

 

Also, my son is a type one diabetic. Do you know what they may pay for insulin, needles, etc?

_________________________

 

Thanks!!

 

Your sofa would cost $1,200 - that's the national 'sales' tax (it's actually called VAT and isn't exactly a sales tax, but it comes to the same thing in this case).  The only local taxes are based on the size of your house, not your shopping.

 

There would be no charge for insulin, needles, etc. in Scotland.  There is a prescription charge in England - about USD10 per item.

[Jane in NC]

We don't pay for prescriptions in Scotland.  I order my mother's medications from her GP practice, they send the repeat prescription through to whichever pharmacy I choose, and I pick them up.  No money changes hands.

 

 

Your sofa would cost $1,200 - that's the national 'sales' tax (it's actually called VAT and isn't exactly a sales tax, but it comes to the same thing in this case).  The only local taxes are based on the size of your house, not your shopping.

 

There would be no charge for insulin, needles, etc. in Scotland.  There is a prescription charge in England - about USD10 per item.

 

So if a doctor deems a non-generic necessary, there is no charge?  How wonderful!

 

How is mental health counseling in the UK?  Is this covered by National Health?

 

[Laura Corin]

So if a doctor deems a non-generic necessary, there is no charge?  How wonderful!

 

How is mental health counseling in the UK?  Is this covered by National Health?

 

Yes, the doctor can prescribe a non-generic, but I think there's strong pressure to try generics first.  There is also a list of drugs that can be prescribed, based on their cost-effectiveness.  This is a tough thing to consider, but as it's a system for everyone, if a single drug to keep someone alive an extra week is the equivalent cost of hundreds or even thousands of other procedures, it will probably not be available.  

 

There's nothing to stop a patient choosing to go outside the NHS, either by paying cash to a private doctor or by buying top-up insurance.

 

I read that mental health services are very patchy and inadequate, but I don't know.   My employer contracts for subsidised private mental health services outside the NHS in order to deal as necessary with workplace stress.

[Laura Corin]

I'm off to bed now.  I'll try to pick up any other questions in the morning.

[Lady Florida.]

most people don't have health insurance costs on top, although top-up insurance is available.

 

 

 

Do most people not have top-up insurance because the NHS coverage is good and therefore the extra is unnecessary, or is there another reason?

 

We don't pay for prescriptions in Scotland.  I order my mother's medications from her GP practice, they send the repeat prescription through to whichever pharmacy I choose, and I pick them up.  No money changes hands.

 

 

 

 

Are any medications denied? Do doctors have to try cheaper ones first? For example I currently have an ongoing issue and my doctor prescribed a newer medicine because she feels it will work best and because most of the others have side effects contraindicated with some of my other conditions. Insurance denied it and said first I have to try one of the others for at least 3 months, then I can file an appeal (with no guarantee they'll end up covering the one she wants me to have). Is there any such tier system with the NHS or do you get whatever the doctor prescribes?

[SparklyUnicorn]

Ok.  Are people forced/required to be tested or treated for anything?

 

 

[Laura Corin]

Do most people not have top-up insurance because the NHS coverage is good and therefore the extra is unnecessary, or is there another reason?

 

 

Are any medications denied? Do doctors have to try cheaper ones first? For example I currently have an ongoing issue and my doctor prescribed a newer medicine because she feels it will work best and because most of the others have side effects contraindicated with some of my other conditions. Insurance denied it and said first I have to try one of the others for at least 3 months, then I can file an appeal (with no guarantee they'll end up covering the one she wants me to have). Is there any such tier system with the NHS or do you get whatever the doctor prescribes?

 

Most people don't feel the need of top up insurance or can't afford it.  It's sometimes offered as a perk of employment.  Some people have an ideological distaste for the idea of paying to get better/quicker healthcare.

 

I think we were posting at the same time - I talked above about generics and denial of medicines.

[Laura Corin]

Ok.  Are people forced/required to be tested or treated for anything?

 

No.  I get called in for mammograms and other screening, but there's no requirement.  Doctors will push pretty hard on vaccines, but it's not required.  You don't have to show a vaccination record for school/university, although they will ask when you last had a tetanus injection in case of accident. There have been stories about treatment being denied to people who didn't do x, y and z, but I sometimes wonder what the full story is.

 

My eldest brother was in great pain.  He needed an operation for it.  The doctor said that he couldn't refer for the operation because my brother was too fat: it wasn't that he was worth less because of his weight, it's just that the operation wouldn't work because of the pressure of his extra weight.  

 

My brother went away, lost the weight, ran a half marathon, went back to the doctor pain-free to be told that he no longer needed the operation.  

 

You could say that he was 'denied the operation because of his weight', but that's not exactly what was going on.

[Greta]

 

 

 

At my doctor, if I have an urgent need (UTI, sudden back pain, etc.) I can get a same day appointment at the GP's practice if I call first thing in the morning.  For some things I will be booked with a nurse practitioner rather than a doctor.  If I insist on a doctor, then I may not be able to get such a quick appointment.  For less urgent things, I will be able to see a GP within the week.  

 

To see a specialist, I need a referral from my GP.  Typically, I will then get a letter from the hospital telling me to expect an appointment, then the appointment letter will come.  In my experience, I will see the specialist in two to three months from the referral.  Cancer referrals have shorter targets, but I (luckily) haven't had experience of that.

 

 

Thank you!  Sounds very reasonable.

[saw]

I'm in the UK and we had 4 A&E visits last summer, so I can speak to our experience, which has been mixed.

First visit was sick child who has bad anemia and was sent home from boarding school because she was so unwell. We couldn't get in to our GP so went to A&E and waited for four hours until an orthopedist told her to eat more. The blood tests were not for the correct tests, although we'd requested the tests we knew she needed, and so the orthopedist had nothing to go on.

 

Second visit was child with serious abdominal pains, to the point where she couldn't walk. Ambulance and around four hours in A&E. A&E doc couldn't speak English. He ridiculed our questions. Finally taken up to pre-surgery as a result of wonky blood tests, but an ultrasound was inconclusive and we were sent home. 

 

Third was child with blood spot in eye -- wanted to be sure it wasn't serious. Again, went to A&E because we cannot get to the GP on the same day unless we call at 8 a.m. Were questioned about our nationality and where we lived and whether we had a right to the NHS. A couple of hours later saw an opthamologist who said all okay. Neither impressed nor unimpressed. 

 

Fourth visit was me with really bad tachycardia and other cardiac symptoms. Waited two hours to be seen. Sat in a waiting room with really ill people, including one who was crying from pain but wasn't seen to. After I was seen and given an EEG I waited in a corrider for two more hours with drunks. The A&E messed up and didn't call my name and so it took over five hours to be seen. Apparently there is a rule that if a patient isn't seen within a specific time frame ( I believe four hours), the A&E gets fined. That night the A&E got hit with fines for at least six patients.

 

I don't think our experience has been unusual and matches what my friends have told me of their experiences.

 

In summary, some of the specialists we saw were really good. Some were horrible. Nurses and medical assistants are almost always fantastic. Admin stinks. The good is that I have never and will never see a bill for any of this (outside of my National Insurance contribution in my taxes). My son's cleft team has been amazing (although the surgeon was not trained in England, which may be why he is so awesome). We did have to wait over a year to see the ENT though. The bad is that some of the doctors are atrocious and that you really need to know your stuff and tell them what tests they need to run and what referrals you want. 

 

We live in an area with a high poverty rate that is being gentrified. The local GPs are generally awful, with a few pretty good ones thrown in. The practice is large, with around a dozen GPs. It takes around three weeks to get an appointment and you never see the same GP twice. They have 10 minutes to see patients and so don't really do exams. They are rushed and have no time. I bet they don't like never seeing the same patient twice. We've had a few dangerous experiences -- a GP who prescribed my teenage daughter a drug that the FDA has specified is not to be prescribed to adolescents because of the link to suicidal ideation, eg. If you get blood tests they may or may not let you know if the results are okay or not. My approach now is to do my own research, call the doctors in my family, and go to the GP only to tell them what I want from them. It works out okay. I have to say though that I did tell my premed kids that I would support them in any university in the world and in any course of study -- unless they chose to study medicine in the UK. 

 

Sorry so long -- maybe a bit more than you wanted to know!

 

 

I keep reading on the BBC about shortages of GPs leading to long waits to get appointments for illness and long waits in A & E departments in the NHS, also mismanagement of funds in some areas of the U.K. Is this widespread across the system or localized?

 

[TranquilMind]

To see a specialist, I need a referral from my GP.  Typically, I will then get a letter from the hospital telling me to expect an appointment, then the appointment letter will come.  In my experience, I will see the specialist in two to three months from the referral.  Cancer referrals have shorter targets, but I (luckily) haven't had experience of that.

 

Everything you have explained sounds quite reasonable but I don't like this one at all.  You could die waiting, or at least be very sick for a long time.   I can see a specialist at his first opening without a doctor having to pave the way, in most cases.    This saved one of my kids. 

 

Edited January 30, 2017 by TranquilMind

[TranquilMind]

No.  I get called in for mammograms and other screening, but there's no requirement.  Doctors will push pretty hard on vaccines, but it's not required.  You don't have to show a vaccination record for school/university, although they will ask when you last had a tetanus injection in case of accident. There have been stories about treatment being denied to people who didn't do x, y and z, but I sometimes wonder what the full story is.

 

My eldest brother was in great pain.  He needed an operation for it.  The doctor said that he couldn't refer for the operation because my brother was too fat: it wasn't that he was worth less because of his weight, it's just that the operation wouldn't work because of the pressure of his extra weight.  

 

My brother went away, lost the weight, ran a half marathon, went back to the doctor pain-free to be told that he no longer needed the operation.  

 

You could say that he was 'denied the operation because of his weight', but that's not exactly what was going on.

Well, that sure worked out great for your brother!  What an encouraging story. 

[saw]

Do most people not have top-up insurance because the NHS coverage is good and therefore the extra is unnecessary, or is there another reason?

 

 

 

We have private medical insurance -- mine is around 30 GBP a month and a 1,000 deductible. I also have a second policy through my work that has a lower deductible and my employer pays 800 pounds a year for that. My kids also have private insurance -- it means my son did not have to wait a year to see the ENT. I think the value add varies hugely depending on where you live. Where I live, most people I know have private health. In other areas of the country, I imagine it may not add much to the coverage. For us, it makes a huge difference.

[TCB]

I used to live in the UK and have lived in the USA for the last 10 years, so my UK experience may be out of date. I have found that I wait the same amount of time for GP and specialist appointments here in the US as I used to in the UK. I lived in a rural area of the UK, and I live in a rural area here in the US. Getting things like scans etc seems to be quicker here in the US. I don't have much experience using the ER, but have experience working in hospitals in both countries, however worked in an inner city ER in UK and rural in US. The rural US ER had somewhat shorter waits, but both had loads of people using them inappropriately and I think that contributed to the waits in both countries.

[TechWife]

Everything you have explained sounds quite reasonable but I don't like this one at all.  You could die waiting, or at least be very sick for a long time.   I can see a specialist at his first opening without a doctor having to pave the way, in most cases.    This saved one of my kids. 

 

 

I don't want to derail, this is a very interesting thread, but I do want to point out that waits for specialists in the US can be lengthy as well. It is dependent upon the specialty needed and location. I live in an area with an abundance of medical resources and my immediate family has experienced the following wait times for first time visits to specialists: 

 

Nephrologist (with diagnosed kidney disease that GP needed another treatment opinion on) - three month wait

Dermatologist (for a painful rash after PA had treated for four months without resolution) - 2 1/2 month wait

Developmental Pediatrician (with detected developmental issues) - seven month wait

 

i imagine that in an area with fewer resources the wait times would be even longer or there would be travel involved. All of these medical practices referenced above are within a 20 minute drive of our home. 

[Laura in CA]

 

We live in an area with a high poverty rate that is being gentrified. The local GPs are generally awful, with a few pretty good ones thrown in. The practice is large, with around a dozen GPs. It takes around three weeks to get an appointment and you never see the same GP twice. They have 10 minutes to see patients and so don't really do exams. They are rushed and have no time. 

 

 

(This is second-hand, so Laura, I will delete it if you'd like me to. It is a "funny" story, which I heard directly from a good friend whom I visited last summer.)

 

 

A good friend of mine, who lives in Lincolnshire, was having a lot of vague, unusual symptoms. Her NHS doctor (I think it was a specialist) was brusque, rude, uncaring, kept losing her test results, and basically told her she would probably die. (He said she would need to enter the hospital, and there was a good chance she wouldn't come out.) So that she would be able to communicate via email while in the hospital, she bought an iPhone (it was so funny seeing my old-fashioned friend with an iPhone :) when I visited her last summer). She was fairly distraught, as you might imagine, and decided to see a private doctor, which cost about £100. The private doctor was thoughtful, caring, helpful, and listened to her. The kicker? It was the same guy!   :lol: 

 

 

Her take (she is a nurse) is that the NHS system forces doctors to be rushed. For routine things such as eyeglasses, pregnancy, broken legs, ear infections, even common cancers and heart problems, the system works well, but for any mysterious illness, there simply isn't time for them to investigate it.

[wendyroo]

I'm curious about other social services freely available to people.

 

I hear internet friends talking about home nurses checking on babies.  While to my American sensibilities that sounds weird and intrusive, I can certainly see the value in that service.  What else does your government do to help you be healthier (other than strictly medical procedures)?  Dietary counseling?  Respite care for the elderly or mentally ill?  Physical therapy, speech therapy, occupational therapy, etc?  Psychiatric counseling?  Things that are so outside my frame of reference that I would never even think of them?

 

Thanks.

Wendy

[rose]

In Canada, we do have fairly high personal taxes (I don't know the rates) but we also have a child tax credit that is quite a lot of money for low income families. They'll give out up to $6400 per year for children under 6 and $5400 per year for children 6-17 years old. This can add up quickly and offsets the tax burden. Even moderate income families can receive some child tax benefit. You can see what your family would get here: http://www.cra-arc.gc.ca/benefits-calculator/ . We also pay a mandatory amount per month of about $130 for our family. This is waivered for low income families.

 

The thing with the long waits and necessary referrals is that during an emergency things are different. If I have a head trauma for instance I would go to the emergency department and the ER doctor would see to it that I would see any specialists that day that I needed to see. If follow up was needed the specialist would not make me wait. Also, a referring dr can press a specialist to see you sooner if it's urgent but not emergent. For example, my brother was having weekly seizures and his gp got him into a neurologist far quicker than someone with a more minor condition would have seen them.

 

Doctors usually prescribe drugs by their generic names. Low income families can have all or most of their costs of drugs covered. Some drugs are not normally covered but if all cheap options have been tried then the doctor can fax in a request for the more expensive drugs to be covered as well. Ambulance ride are also out of pocket.

 

Dental care is not socialized.

 

My dh really likes working in the Canadian system as a gp (he only does ER work) because he feels like he is not under pressure to worry about billing patients and doesn't have that as a conflict of interest in his care. He can say no to people when he feels like it's in their best interests without losing money. There is also no benefit to ordering needless tests. He believes that the care here is better because of that. There are certainly some downsides though. People here will go to the ER for the stupidest reasons, like diaper rash at 2 in the morning. This is not an exaggeration; he actually saw this. They forget how much it costs the system. There are also drug seekers who lie about pain to get opioids for free.

 

The way that he gets paid is that every time he sees a patient he submits a bill to the gov't. He get about $50 per visit but it varies some based on the time of day and whether or not he had to come in from home to see them. This puts the pressure on to see more patients. Greedy doctors will sacrifice quality to see more than they can handle. Walk in clinics are notorious for this problem. On the other hand, if they're given a flat rate they probably wouldn't see enough. Human nature is what it is.

[rose]

I should add that mental health here is covered. Even our really small rural community has mental health services. We also have public health nurses available for home visits for new babies or for some elder care.

 

Also, funding is provided for developmental disabilities care and therapy.

[AimeeM]

UK.  Once you are signed on to a specialist, then the call-backs ETA should be at appropriate spacing, and they should be available for emergencies (I don't have experience of how quickly you could see your specialist in an emergency, however).  It's the initial appointment where there is usually a wait.  

 

My mother was referred to a specialist and saw him within a couple of months, then the next appointments were booked at the specialist clinic and were at appropriate spacings.  That would be the case for a chronic illness - my old boss was called in regularly to the diabetes clinic and Husband is called to the asthma clinic.  My friend's son who had juvenile arthritis went to the Scottish specialist hospital at regular intervals, and I believe also went if he had a flare-up, but I'm not sure about that.

 

The problem would come if, for example, you were referred for an illness, saw the specialist and were deemed cured, then had a relapse.  Then you would probably need to get referred again, with a new waiting time (except in emergency).

Can you explain "appropriate spacing"?

[wendyroo]

Not Laura, but I believe she means 'spacing according to patient's health needs as determined by her doctor'.

 

In AU, that can be anything from 'I want to see you tomorrow' to 'come in next week' to 'three months time please' to 'I'll see you next year'.

That would be a pleasant change.

 

DS's psychiatrist will normally say she wants to see him in a month, and on our way out, the scheduling desk will say that that is a pipe dream. They end up finding us an opening 9-12 weeks later, and I end up having to call monthly to beg for more meds to last DS for the extra month or two.

 

Wendy

[Corraleno]

I lived in the UK for 10 years, and my son was born there. Overall, I found the level of care and the wait times fairly comparable to my experiences here in the States.

In the UK, there were 6 or 7 doctors at the clinic we were zoned for; a couple were really great, a couple were duds, and the others were average. Generally we saw whichever doc was available, but I could also request a specific doctor if I was willing to wait a bit longer. I could generally get in to see a GP the same day for something urgent, or within a couple of weeks for a nonurgent appointment. One specialist appointment for DS was booked about 3 months out, but was moved up to one month when I pushed for it. A referral for a breast lump biopsy for me was originally set for 5-6 weeks, but after about 10 days I called the clinic in tears explaining that I had a 2-month old baby and couldn't handle the wait, especially since the GP had been very pessimistic and really freaked me out. They told me to come in at closing time the next day and the doctor would see me after hours. They were extremely kind and helpful.

​DS's birth in the UK involved an ambulance ride and a C-section, all of which was completely free. Prenatal care was also free; I was unlucky in that I got a really lousy midwife, but that was not typical. The woman who did the baby well visits at home was great. Prescriptions involved a small copay, I think it was about £5 at the time. I did not have any top-up insurance when we lived there, and never felt the need to pay privately to "jump the queue" or get better service or anything like that.

 

When we first moved back to the US, my kids had a wonderful pediatrician, but I never found a decent doctor for myself in the 10 years we lived in that state. One was truly an idiot, one was a complete jerk, and the third was OK but he didn't last long and I only saw him once. In the 10 years I lived there I saw a doctor 4 times, because there really wasn't any point in going. My ex also had a horrible experience with an orthopedic surgeon there, which ended up costing us a huge amount of money, caused years of pain, and eventually required additional surgeries.

In my current state I have a terrific doctor, and I can usually get in to see her within a couple of weeks for general appointments, and often the same day for more pressing issues. There is also an urgent care clinic in the same building where you can be seen almost immediately. Referral to a dermatologist for skin cancer took 6 weeks, then another 6 weeks to see a surgeon. Our insurance premiums are crazy high, though. 

 

 

[LucyStoner]

I don't want to derail, this is a very interesting thread, but I do want to point out that waits for specialists in the US can be lengthy as well. It is dependent upon the specialty needed and location. I live in an area with an abundance of medical resources and my immediate family has experienced the following wait times for first time visits to specialists:

 

Nephrologist (with diagnosed kidney disease that GP needed another treatment opinion on) - three month wait

Dermatologist (for a painful rash after PA had treated for four months without resolution) - 2 1/2 month wait

Developmental Pediatrician (with detected developmental issues) - seven month wait

 

i imagine that in an area with fewer resources the wait times would be even longer or there would be travel involved. All of these medical practices referenced above are within a 20 minute drive of our home.

Yes- here in the US, with good insurance, we have waited 6 weeks to more than 6 months for certain specialists. Not because of our insurance but because even in our metro area, there are some things where the waiting list is just that long. We've never had to wait long for something acute but many things that one sees specialists for aren't really acute. Often times we have been placed on a 6 month list but been seen sooner because I make it clear that we will take any cancellation, on as little as 1 hour notice, lol. Edited January 31, 2017 by LucyStoner

[LucyStoner]

Can you explain "appropriate spacing"?

I'm assuming it's same as here- whatever followup schedule is deemed necessary. My father sees his neurologist every 2 months but his heart specialist about once a year. The spacing between appointments is shorter or longer depending the severity and need. I see a dermatologist every year or if something changes significantly, I call and say "um, when can you see me?" and they get me in sooner.

[LucyStoner]

How does getting a second opinion work? For instance, one doctor told my mother that it wasn't worth sending her to an oncologist because he deemed her health too poor (yes, really) and I took her to another doctor who wanted her to see an oncologist immediately and got her into the best that same week.

 

If a patient wants a second opinion as to treatment options, dx or prognosis is that simple to obtain?

Edited January 31, 2017 by LucyStoner

[Mergath]

Can you discuss prescriptions?  Many Americans can get generics for free or at low cost but name brand or newer drugs can be very expensive. Do you have out of pocket costs for prescription pharmaceuticals?

 

Do you mean after insurance pays? Because my dh takes a med for his bipolar disorder that would be something like $600 a month before insurance, and that's for the generic. Thankfully, his insurance plan has great prescription coverage and he gets it for $12 a month.

[rose]

How does getting a second opinion work? For instance, one doctor told my mother that it wasn't worth sending her to an oncologist because he deemed her health too poor (yes, really) and I took her to another doctor who wanted her to see an oncologist immediately and got her into the best that same week.

 

If a patient wants a second opinion as to treatment options, dx or prognosis is that simple to obtain?

 

It's as easy as going to an another GP. If you have trouble with a specialist you can either report the issue to referring physician and appeal to them for a new referral or you can go to another GP and ask for a referral and hope they suggest a different specialist. You can actually concurrently see as many GPs as you want. The provinces keep track of prescriptions to ensure that you're not getting morphine from four different doctors or conflicted medications. The pharmacists are required to look up your information to check on what you're being prescribed. 

 

If you're getting prenatal care (in BC) then you can pick between a GP or a midwife. If you want a second opinion you just make an appointment to see the other. You're just expected to be primarily seeing one or the other.

 

[Corraleno]

How does getting a second opinion work? For instance, one doctor told my mother that it wasn't worth sending her to an oncologist because he deemed her health too poor (yes, really) and I took her to another doctor who wanted her to see an oncologist immediately and got her into the best that same week.

 

If a patient wants a second opinion as to treatment options, dx or prognosis is that simple to obtain?

 

There were a couple of times when I wasn't totally onboard with the opinion or diagnosis of one particular doctor (he was quite young/new), so I just made another appointment with a more senior doctor. I'm not sure how it would work if you wanted to get a second opinion from a specialist, since I never needed to do that, but I assume you could just ask one of the GPs for another referral. 

[Audrey]

How does getting a second opinion work? For instance, one doctor told my mother that it wasn't worth sending her to an oncologist because he deemed her health too poor (yes, really) and I took her to another doctor who wanted her to see an oncologist immediately and got her into the best that same week.

 

If a patient wants a second opinion as to treatment options, dx or prognosis is that simple to obtain?

CA.

I asked the dxing oncologist for a second opinion on treatment options and his nurse arranged an appointment with the other doc. I could have gone into one of the cities to see someone else, but I really just wanted opinions on options, not the actual dx.

[Audrey]

Can you tell us a bit about how much the average middle-class family pays in taxes?

CA.

I can tell you that, as a family, we personally pay less in federal and provincial taxes than I, as a single person in the US, paid for healthcare premiums alone. I'm not sure if we fit the definition of middle class or not, though.

 

Tax rates are listed here, though, for your own reference. Federal rates are the same across the board, but provincial rates vary a lot. http://www.cra-arc.gc.ca/tx/ndvdls/fq/txrts-eng.html

[Audrey]

Ok.  Are people forced/required to be tested or treated for anything?

CA.

No. IME, I've never come across anyone who was forced or required to test or accept treatment. The Public Heath Nurse/Office does send reminders for vaccinations, well-baby checks, mammograms, pap smears, and prostate exams, though. And, flu shot clinics are well advertised every year.

[Audrey]

Can you discuss prescriptions?  Many Americans can get generics for free or at low cost but name brand or newer drugs can be very expensive. Do you have out of pocket costs for prescription pharmaceuticals?

CA.

My province has a drug plan you can opt into that covers costs based on income. I think most (maybe all??) provinces have something similar. Our drugs are much cheaper, in general, though.

 

Also... just thought I should mention that, in Canada, healthcare is run by each province individually, not by the federal government. Monies are distributed by the fed earmarked for healthcare, but provinces use their own tax revenue to fund healthcare, too. So, although they are mostly similar, not all provinces have the same processes, service programs and costs.

[lailasmum]

I'm curious about other social services freely available to people.

 

I hear internet friends talking about home nurses checking on babies. While to my American sensibilities that sounds weird and intrusive, I can certainly see the value in that service. What else does your government do to help you be healthier (other than strictly medical procedures)? Dietary counseling? Respite care for the elderly or mentally ill? Physical therapy, speech therapy, occupational therapy, etc? Psychiatric counseling? Things that are so outside my frame of reference that I would never even think of them?

 

Thanks.

Wendy

In the UK you mostly have maternity care from midwives. That care continues after birth for a few weeks so they will visit you at home to check on you and the baby. It switches to a health visitor after those few weeks and where I am you usually get a home visit from them too. After that you normally take your baby to sessions at a local healt centre/GP to get them weighed or checked for developmental stuff. All that is still with the health visitor. Health visitors are nurses.

 

There aren't any services for health forced upon us in the UK but in our communities are things like physiotherapy, self referred mental health counselling, doctor referred exercise groups and quit smoking support, people have access to other therapies/advice if referred to them. I believe there is respite care but my knowledge of it is fairly out of date. My dad had dementia when I was a teenager and he did have a few periods of respite care. He had some in home care provided too but this was in the 90s.

 

It does vary within the countries though. My experience is England. There can be extra thing in cities too.

Edited January 31, 2017 by lailasmum

[lailasmum]

UK

In my rural bit of the UK access to doctors is reasonable. Certainly better than when we lived in London. The doctors are a mixed bunch. I think they are forced to see us so quickly and not spend money that they can be hesitant to do tests to see what is going on in a more vague case. However my mum was very sick last late 2015 and had amazing treatment. If you have an obvious life threatening issue then they are very good, can be difficult once you slip down the priority list. Having said that the experience of being scheduled in for follow up appointments has always worked smoothly but usually does involve some waiting at appointment times. They're never on time.

 

Our experience of A&E is mixed. Great if you are ambulanced in but difficult outside that particularly at peak times. Long wait times in cramped waiting rooms. Having said that I haven't been there longer than 6 hrs total.

 

Maternity care in hospital is pretty terrible but good in community midwifery (run in places further from hospitals). I made the mistake of having my second child in hospital, I really wish I'd had another home birth.

 

Dentistry is a total mess and where I live has minimal access to adult NHS dentistry. Its an area where funding it yourself really helps. I'm hoping to get an NHS dentist in March. I haven't had one for years. Wealthier more built up areas have less issues with access.

Edited January 31, 2017 by lailasmum

[Laura Corin]

I'm curious about other social services freely available to people.

 

I hear internet friends talking about home nurses checking on babies.  While to my American sensibilities that sounds weird and intrusive, I can certainly see the value in that service.  What else does your government do to help you be healthier (other than strictly medical procedures)?  Dietary counseling?  Respite care for the elderly or mentally ill?  Physical therapy, speech therapy, occupational therapy, etc?  Psychiatric counseling?  Things that are so outside my frame of reference that I would never even think of them?

 

Thanks.

Wendy

 

Social care (for the disabled and elderly) is free in Scotland but is means tested (free to those on low incomes) in England.  The problem can be accessing it: care workers are very low paid and the availability and quality varies enormously.  

 

My father was in free respite care at a hospice when he had cancer and was being nursed by my stepmother at home (the rest of the time the hospice nurses came to him for free).  I don't know the situation with psychiatric counselling - I suspect it's hard to come by.  My mother has been referred for physio and my son had free speech therapy.  Apart from that, nothing really startling: smoking cessation clinics, lots of advice on diet and nutrition on the website, and there's an advice line. ETA: Oh, ambulances are free too, as are air ambulances - the latter are weirdly a charitable concern.  I don't quite know how that fits in.

 

Can you explain "appropriate spacing"?

 

In my experience: the spacing that the doctor thinks is clinically appropriate.  

 

There are some procedures where the waiting times get much longer, however: I believe that hip operations can be a long wait after you have seen the specialist, which can leave the patient in pain and difficulty.  I don't have experience of this, however.

Edited January 31, 2017 by Laura Corin

[lailasmum]

(This is second-hand, so Laura, I will delete it if you'd like me to. It is a "funny" story, which I heard directly from a good friend whom I visited last summer.)

 

 

A good friend of mine, who lives in Lincolnshire, was having a lot of vague, unusual symptoms. Her NHS doctor (I think it was a specialist) was brusque, rude, uncaring, kept losing her test results, and basically told her she would probably die. (He said she would need to enter the hospital, and there was a good chance she wouldn't come out.) So that she would be able to communicate via email while in the hospital, she bought an iPhone (it was so funny seeing my old-fashioned friend with an iPhone :) when I visited her last summer). She was fairly distraught, as you might imagine, and decided to see a private doctor, which cost about £100. The private doctor was thoughtful, caring, helpful, and listened to her. The kicker? It was the same guy! [emoji38]

 

 

Her take (she is a nurse) is that the NHS system forces doctors to be rushed. For routine things such as eyeglasses, pregnancy, broken legs, ear infections, even common cancers and heart problems, the system works well, but for any mysterious illness, there simply isn't time for them to investigate it.

My friend had the same experience with getting a less than helpful NHS doctor and then seeing a smiling helpful private doctor who was the same person. Neither would do what she wanted because it was unnecessary plastic surgery but it was an interesting experience to see how much diffently he behaved. Edited January 31, 2017 by lailasmum

[Laura Corin]

How does getting a second opinion work? For instance, one doctor told my mother that it wasn't worth sending her to an oncologist because he deemed her health too poor (yes, really) and I took her to another doctor who wanted her to see an oncologist immediately and got her into the best that same week.

 

If a patient wants a second opinion as to treatment options, dx or prognosis is that simple to obtain?

 

It's easy to get a second GP opinion - just make an appointment with another doctor at the practice.  I was offered a second specialist opinion once when I was unhappy about something, but I decided not to go ahead with that, so I don't know how easy it would have been.