Ask a question: 'socialised' medicine

[lewelma]

NZ has socialised medicine.  You can also buy private insurance and go to private hospitals if you wish.  We have private insurance and it costs us about $2400 for a family of 4 for the year. We have used it twice in 20 years. We have done everything else through the public system.

 

GP visits are same day.  You must be referred to a specialist, and then like the UK you get an appointment card in the mail varying from 2 weeks to 6 months depending on what the GP says is the priority.  I have gotten in to a specialist sports doc and gotten an MRI in 2 weeks; whereas my DS as a toddler got an appointment 6 months delayed when I was concerned with his feet turning inward but the GP was not worried.  I asked him to write the letter anyway knowing there would be a delay.  We could have gone private, but I felt there was no need.

 

My DH had a day of fainting spells last year, and he went to the ER.  He was seen within 20 minutes when he fainted in the waiting room.  When he fainted again in the hall with leads on him, and it looked like his heart stopped for 18 seconds, he was rushed to the Cardiac ward to a private room.  He stayed for a full week, and had every single test under the sun including MRI, blood tests, ekgs, ct scans, etc and finally they implanted a monitor in his chest for 6 months.  Finally, they did a tilt table test and found that he has neurally mediated synchopy, which means he faints sometimes.  So no heart problems at all!!! yea!  All this was 'free'.   We never saw a single bill or any sort of financial statement.  I'm sure it was over 30K. 

 

I think that mental illness is not cared for well here, having experienced it with my downstairs neighbor.

 

Dental is covered for kids under 18 for free.  Adults pay as far as I know.

 

Taxes here are reasonable, If you earn under 70K and have two kids, you pay about 10%, top bracket is 33% but we don't have state, local, or school district tax.  Just one tax.

 

We vote for our health board -- the people who make the decisions how to allocate the money (so do we want to spend more on premie babies or more on knee replacement surgery?) Thus, I feel like I have a say in how the money is spent and where the waiting lists occur.

 

Ruth in NZ 

 

 

Edited January 31, 2017 by lewelma

[lewelma]

Oh, forgot about drugs.  We have a government organization called pharmac that makes all the decisions as to what drugs they will cover.  They bargain for a nation wide discount with the drug companies because of bulk buying.  Many drugs are covered, but not all.  My private insurance covers some drugs that are not covered by the national health system.

[lewelma]

My husband ended up seeing his cardiac specialist privately after leaving the cardiac ward because the wait was longer than he wanted.  Most doctors work both in the public and private sectors. 

 

Copay for drugs is $5-10 per prescription.

 

We pay for GPs out of pocket.  Kids under 18 are free, adults are $60 for a 20 minute appointment. I have *always* gotten same day service. 

 

Car insurance is $400/year because there is no medical component to it. ALL medical accidents are paid for through the ACC program from the government.  No Fault.

 

We don't have all services in all locations. If you are not near one of the major cities, you need to travel for an MRI or surgery or specialists.  If your baby/child needs seriously specialized care, we only have one hospital that can handle it - its in Auckland.  I had a friend with a newborn that needed heart surgery and they got a 2 hour life flight to Auckland Children's hospital where then replaced a valve. All a part of the health service. They had to live up there for a month.  They stayed in the Ronald McDonald house. 

 

Most of our specialists seem to be foreigners - we have lots of Indians, South Africans, and Germans. So if you are a doctor and interested in coming to NZ, check the short and long term skills shortage list!

 

The government has finally approved HPV vaccine for boys to be covered!  whoo hoo.  I was going to pay and it was going to be $600/kid!!!!

 

 

 

Edited January 31, 2017 by lewelma

[Melissa in Australia]

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

Aus here

 

Physio therapy, Occupational therapy and Speech therapy for children under the age of 6 is called early intervention and is free. The twins access Occupational therapy and the therapist comes to our house. We use a private speech therapist and pay $100 per visit. we could get the free  intervention one but we prefer the private one. after the age 6 then those same services can be accessed for free through the public school system.

 

If you get a Psyc plan through a GP then you have access to 10 subsidised Psychologist visits for the year. there will be a copay of around $30+ per visit depending on the practitioner. Paediatricians are not used for general healthy children, but are for children who have a condition. they are free  but you can only access them with a GP referral.

 

Dietitians are free

 

respite care is on a sliding scale depending on your income/ assets. When I worked in aged care I did in home personal care and light cleaning. the patient would pay the Hospital $3.50 per hour if they were oon a pension card. veterans were free, people who did not qualify for an aged care pension ( because of too much assets) had to pay $23 hour. If an overnight stay was needed  ( to give a family member respite  from full time care) it was a flat rate of $40 per night

 

 

Dentists are not covered though children under the age of 18 can get $700 worth of dental care every 2 years for free

 

Ambulance is not covered, most people I know have ambulance insurance. it is only $90 per year for a family

[mumto2]

Just going to quickly add that in my area of England the waits for a gp appointment are done pretty fairly. If you truly need a same day it happens. Otherwise a week or two. We also have a couple of good walk in clinics that are great. Quick efficient treatment for minor injuries with good referral into the main system if you need ongoing treatment. Dh was home within two hours for a shoulder injury, with xrays. Totally impressed with his care.

 

My area is considered to be in one of the less well served areas by the NHS so we aren't in a great place NHS wise. Doctors and nurses do make home visits. It can be hard to get on the home visit list but once again it appears to be pretty fair. People who truly can't go to the office seem to be the ones with the visiting nurse to change bandages etc.

 

I know a lot of elderly people who have had hip and knee replacements. Lots of cataracts too. The outcomes seem to be great. A friend was out at her Christmas lunches in under 3 weeks with a walker after hip replacement surgery. If the wait is too long or it's an emergency they switch the patient to the private facilities in the area and the NHS pays. I'll be honest and say things don't appear any slower here than for friends and relatives on the other side of the Atlantic. The people who take longer are frequently trying to schedule around things and can't get the appointment exactly when they want it.

 

This is just an interesting side note a not elderly friend paid private for a knee replacement not covered by NHS roughly 8 years ago. I want to add that her knee replacement was pretty elective (sports related) and probably would not have been covered easily by an American heath insurance company either. We looked out of curiosity. All consultations, the physical therapy, operation, and two week stay in private hospital she calls the spa....£10,000. You are given the price upfront. Btw, friend is not rich. No private insurance. Solidly middle income.

 

The switch to private and back is interesting and people do at times use it to jump the queue. Your records all stay together and people seem to move pretty seamlessly between the systems. The doctors just pass you back and forth. With cancer, literally next day biopsies etc and back to the regular NHS for treatment. No one has gone private beyond biopsies, with or without private insurance. Treatments and timetables the same and with the NHS in our area it may all be closer to home.

 

One last comment, healthcare in the UK seems to be very sympathetic to the extremely elderly and the dying. If you are willing to have the treatment they do provide it even if major surgery will just extend life a few weeks at best. No rationing on MRI etc. which is something that I thoght happened before I moved here. My friend's 90yo mother has had numerous scans in the past few months tracking the degeneration of her hip joint. For various reasons a hip replacement isn't the best choice for her but they are willing if she wishes to try. She has decided not to. They keep doing the scans which surprises me but I am glad.

[Twolittleboys]

We live in Germany. Everyone has to have health insurance. How much you pay depends on your income level, employer pays half. If you make less than a certain minimum ("poverty level") your payments are covered by the government. You can either go through "public" insurance companies or "private" ones. Generally, private ones are considered to be a bit more comfortable (some specialists only take this, you may get treated faster, have your own room at the hospital etc.). Payments for private insurance can be lower than for public if you are young and healthy. I don't really know much about the private insurance as I have always been covered by the public which I think is perfectly adequate. Also, my children are covered under my insurance without me having to pay extra for them (I believe the same is true for ´spouses without income). You can of course also have public insurance and some extra insurance in addition to cover private rooms etc.

 

We are pretty healthy so I don't have a lot of experience with wait times. I think it depends on the individual doctor and how busy he is as well as how urgent the need. I think I can usually get in to see my GP on the same day. He refers you to specialists but I think you can also directly call up specialists. We had some visits with specialists when the kids were younger and there was a bit of a wait (maybe 4 - 8 weeks?) but it was nothing urgent so that was fine.

 

Visits to the doctor are free I think (there may be a small copay for adults?), definitely free for kids. Prescriptions are generally free for children unless they are things like tylenol etc. I believe there is a small copay for adults. If you just need the occasional aspirin etc. you don't save much but if you need something more expensive it is very helpful.

 

Dental isn't covered so well but they do pay for regular check-ups and most things for kids. You have to pay if you want things in addition or different to the official rules (e.g. a different narcotic, a different practitioner). Most things are covered if there is proven need (e.g. they pay for braces if teeth are really crooked etc. but not if it is just a small adjustment for cosmetic reasons).

 

As I said, we luckily have been pretty healthy but both of my parents were seriously ill before they passed (with several months in the hospital etc.) and there were few charges we had to pay.

 

It isn't perfect but overall I think it works fairly well and I am quite happy with it.

[Laura Corin]

One last comment, healthcare in the UK seems to be very sympathetic to the extremely elderly and the dying. If you are willing to have the treatment they do provide it even if major surgery will just extend life a few weeks at best. No rationing on MRI etc. which is something that I thoght happened before I moved here. My friend's 90yo mother has had numerous scans in the past few months tracking the degeneration of her hip joint. For various reasons a hip replacement isn't the best choice for her but they are willing if she wishes to try. She has decided not to. They keep doing the scans which surprises me but I am glad.

 

This is my experience with my mum: she has the right to choose treatment, but is given good advice on outcomes.  As an example: she has an ingrowing toenail.  The curative option is to do a minor op to remove part of the nail and cause it not to regrow.  We talked to the foot clinic about this and they were willing to do it for her.  However, they talked very sensibly about older people healing more slowly and it being really important to keep moving when you are 92, otherwise it's easy to get weaker and more prone to falls.  In the end, Mum chose to go in regularly for footcare rather than to have the op.

 

When my father was being treated for cancer, he was offered first standard and then experimental treatment.  After those two, he was offered more treatment if he wanted, but they did a good job of weighing up the pros and cons to more treatment with him.  He decided to stop there and spend what time remained with his family.

[J-rap]

How do things such as physical therapy work there?  With our family's insurance in the U.S., you first need a doctor to state a need for PT and refer you to a therapist.  Then, you make the initial appointment with a therapist (generally they can get you in within a week or two), who will mostly likely agree that it will be helpful and will propose a plan to meet with you a certain number of days over a certain length of time (partly defined by therapist, partly by particular insurance).  For example, it might be twice/week for six weeks.  It will need to be approved by your insurance company, but generally it is for the initial time period.  After that period, if proven progress is made, the therapist can request from insurance another stretch of time.  This continues until either a)  you have reached the maximum amount of therapy sessions allowed in one year (some insurance companies have a ceiling) or  b)  no more progress is being made, or needs to be made.

[Laura Corin]

How do things such as physical therapy work there?  With our family's insurance in the U.S., you first need a doctor to state a need for PT and refer you to a therapist.  Then, you make the initial appointment with a therapist (generally they can get you in within a week or two), who will mostly likely agree that it will be helpful and will propose a plan to meet with you a certain number of days over a certain length of time (partly defined by therapist, partly by particular insurance).  For example, it might be twice/week for six weeks.  It will need to be approved by your insurance company, but generally it is for the initial time period.  After that period, if proven progress is made, the therapist can request from insurance another stretch of time.  This continues until either a)  you have reached the maximum amount of therapy sessions allowed in one year (some insurance companies have a ceiling) or  b)  no more progress is being made, or needs to be made.

 

It's very similar in Scotland except it would take you longer to see the PT.  You are referred by your GP, then will see the PT for a period of time, during which s/he will work with you and you will do exercises at home too.  I think that six weeks is the normal initial period, but I'm not sure if/how that can be extended.  My mum has been referred twice for physio within the last year.

 

The problem comes if it's an acute problem.  I put my back out ten days ago.  If I had waited for the NHS, I probably would not have seen a physio for at least a month.  Instead I paid £45 to see one privately the next day.

 

Edited January 31, 2017 by Laura Corin

[lailasmum]

Some parts of the UK have a self referral service for physiotherapy but it's still limited.

[Laura Corin]

Some parts of the UK have a self referral service for physiotherapy but it's still limited.

 

In Scotland we have self-referral for podiatry.  I don't think that self-referred physio is in this area.

 

[Laura Corin]

Oh, I was asked up-thread about other services that are provided that might not be mainstream.  The NHS in Scotland funds eye tests for all and free glasses for children.  It also provides hearing tests and hearing aids - they are not the tiny in-ear ones, but the ones with the piece behind the ear, but Husband is pretty happy with them.

[Sarah CB]

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

 

Not the UK, but in Canada the nurse will come and do home visits after you have a baby. I never thought of them as intrusive. They weigh the baby, ask how breastfeeding and other things are going and they pay attention for signs of PPD. I can't remember how many home visits are done before those stop (probably depends...) but after that you can go in to the weigh in clinic and see a nurse there who will do the same things. I found the pre and post-natal care very supportive. 

 

I did have one baby in the UK and what I didn't like was that I wasn't assigned a single "midwife" for prenatal care - I had to see whoever happened to be working when I had my appointment. In Canada you have a primary care system where you see the same person (whether it's your midwife, doctor, or OB) for prenatal visits and then that's the person who delivers your baby. So, you can discuss your birth plans and really be on the same page with the person. In the UK (at least 14 years ago when I had ds) you had to see whoever happened to be working that day and then you delivered your baby with someone completely new. 

 

Canada also provides things like speech therapy to children below school age. One of my kids had a significant speech delay and we were able to get into a program at the local health clinic that was hugely helpful. Once ds reached school age we had to pay for private services instead which was too bad because the health clinic's group class was much more beneficial to us than our private therapist. In BC, eye exams for kids under 19 are also covered.

 

Another weird thing about the UK - I remember taking my kids to the dentist and being told that they didn't do routine cleanings for children under 10. As far as I can remember, they just looked in my kids' mouths and that was it. In Canada, dental visits are not covered, but my kids see the dentist for cleanings and check-ups twice a year.

[Twolittleboys]

Actually, it is kind of difficult for me to give any details because I just assume pretty much anything will be covered. We are generally healthy (as I said above) but the kids do get their teeth cleaned twice a year and they attend a special "toothbrushing session" to practise. They paid for having the back molars sealed (but I had to pay for some of the others). Both kids have braces. Certain check-ups are included but of course they will also pay if you go because of some problem. We have seen specialists (cardiologist, urologist, dermatologist) but that was only one time things so no follow up needed. Younger son had a problem with some sounds so got speech therapy. When he had an accident at his nursery school, the ambulance ride/emergency doctor and hospital was free (actually there may have been a small charge for the hospital but quite minor). Eye exams are free as far as I know and glasses for kids. Younger son also had a year of weekly therapy because he was a bit late in starting to walk (well, he was also selectively mute at the therapy but nowhere else).

 

None of the wait times were excessive in my opinion. We have a long wait for the kids' dentist but that is because the office specializes in children and is very busy.

 

You know, I have been feeling a bit miffed lately because my premiums are quite high and we did have a case where they wouldn't pay (doctor had refered us to a podiatrist that used to be covered but was no longer and I didn't want to change/have to travel for one) but thinking it over I think we don't have it so bad after all.

[lailasmum]

Not the UK, but in Canada the nurse will come and do home visits after you have a baby. I never thought of them as intrusive. They weigh the baby, ask how breastfeeding and other things are going and they pay attention for signs of PPD. I can't remember how many home visits are done before those stop (probably depends...) but after that you can go in to the weigh in clinic and see a nurse there who will do the same things. I found the pre and post-natal care very supportive.

 

I did have one baby in the UK and what I didn't like was that I wasn't assigned a single "midwife" for prenatal care - I had to see whoever happened to be working when I had my appointment. In Canada you have a primary care system where you see the same person (whether it's your midwife, doctor, or OB) for prenatal visits and then that's the person who delivers your baby. So, you can discuss your birth plans and really be on the same page with the person. In the UK (at least 14 years ago when I had ds) you had to see whoever happened to be working that day and then you delivered your baby with someone completely new.

I think the midwife thing depends where you are in the UK. I always had community midwifery prenatal care in a rural area with a dedicated midwife who would be the person who delivers the baby in the case of a home birth and then a second midwife that I was familiar with in case my main midwife was unavailable for some reason. I had the same midwife both pregnancies. I believe if you get your prenatal care in a hospital or big clinic it's more likely to be whoever is on duty because I've had friends comment about that and they all live in urban areas. Edited January 31, 2017 by lailasmum

[Laura Corin]

 

 

Another weird thing about the UK - I remember taking my kids to the dentist and being told that they didn't do routine cleanings for children under 10. As far as I can remember, they just looked in my kids' mouths and that was it. In Canada, dental visits are not covered, but my kids see the dentist for cleanings and check-ups twice a year.

 

My boys weren't small when we moved to Scotland, so I don't know about that.  In general, though, cleanings are done for medical rather than cosmetic reasons - I go for a check up every six months but am not offered a cleaning every time.  Of course I could pay to have one if I wanted.

[TranquilMind]

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. 

 

No, you are right, there can be long waits, depending on specialty.

 

I can get in to a dermatologist quick, but don't know anything about those others.

 

I did have a year wait once for one doctor that is here in town but for whom patients came in from several states.   Someone had to cancel and we did get in faster though. 

 

[mumto2]

Pretty sure kids on the NHS dental plan get two cleanings a year. It seems right with what friends do. My kids weren't on NHS and since they didn't need braces we didn't put the effort into finding a dentist where they could be.

 

Eye exams and glasses are free to under 19's here too.

 

Regarding the midwifes...One of my close friend's husband worked for National Rail when she was pregnant with her first. They were apparently very bored waiting for her to deliver so grabbed her hospital bag and used their train pass to go a far as possible every time he had time off. No worries about delivering away from home, I think she actually wanted to but didn't.

 

The different midwife idea doesn't seem to bother people, although it is generally within a practice. It's rather like going to a practice with 8 ob's and being required to have one office visit with each.

[Bluegoat]

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.

 

This may change in the future.  In my province, they are finding younger doctors don't want to run/own their own clinics, and they prefer to be on salary.  So the newer models of care seem to be heading in that direction.

[Mbelle]

For one of my medications I must take the brand name, because in this particular med the generic doesn't work as well.  

My MD states that on the prescription.  Would that work the same way?

 

 

If we want to start our own business, we will pay about $24K out of pocket for our health insurance, due to preexisting conditions.

How much would we pay where you are?  Do you have a 2 tier system in which you can buy additional private insurance?  How much woud that be?

[Laura Corin]

For one of my medications I must take the brand name, because in this particular med the generic doesn't work as well.  

My MD states that on the prescription.  Would that work the same way?

 

 

If we want to start our own business, we will pay about $24K out of pocket for our health insurance, due to preexisting conditions.

How much would we pay where you are?  Do you have a 2 tier system in which you can buy additional private insurance?  How much woud that be?

 

UK.  

 

If the branded medication is on the list of effective medications maintained by the NHS, then it could be prescribed.  There will always be pressure to prescribe the generic, but the other should be available too.

 

I gave tax levels at the beginning of the thread.  There are no charges for pre-existing conditions in the NHS.  You can buy top-up insurance if you like: you would normally still go to an NHS GP, but then could be referred more quickly to a specialist.  It looks as if, for a healthy person of my age, it would cost between £50 and £100 per month, but would presumably be a lot more with pre-existing conditions.

[rose]

This may change in the future.  In my province, they are finding younger doctors don't want to run/own their own clinics, and they prefer to be on salary.  So the newer models of care seem to be heading in that direction.

 

Actually, it's like that here too. In the rural areas the province attracts doctors by offering them salaried positions that pay very well. They do this partly so that people don't have to make a commitment to work in the rural location. They can do a year and then just walk away. All the patient records stay in the clinic and are used by the rest of the doctors remaining. My dh worked this way for a couple of years. He now does ER work which is handled fee-for-service. I really can't see the specialists moving over completely. A hybrid model will probably be in the future.

 

[Laura Corin]

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. 

 

 

GPs can make urgent referrals if necessary.  Of course that doesn't work if the GP misses that the case is urgent - I'm sure that happens.

[Twolittleboys]

For Germany: I have never heard of paying extra for pre-existing conditions with "public" insurance. I think "private" ones might have different premium amounts and they may be able to refuse insuring someone (not sure though). It used to be that if you left "public" insurance for "private" you couldn't get back in (to discourage people from paying less for more when they are young/healthy and then switching back). Not sure if that still applies though.

[Splash]

My daughters drug is not covered in most parts of Canada and the UK though some areas have paid for it for a limited time.  It's also not covered in Australia or India.  It is extremely expensive but life saving and necessary. Those in other countries are left with plasma treatment as only option at this time. (dd had anaphylactic reaction to plasma treatment and would have died had she not already been in the PICU at the time. so no plasma for her.)

[Shellydon]

How are things like speech, physical and occupational therapy handled for children?  Are services available for free in the schools or via a clinic?  How long is the wait to receive therapy services?

[Laura Corin]

How are things like speech, physical and occupational therapy handled for children?  Are services available for free in the schools or via a clinic?  How long is the wait to receive therapy services?

 

Mostly via the doctor.  I can't remember how long it took until we were able to get speech therapy for Hobbes.  I don't remember thinking it was a long time, but I can't be sure.

 

Hobbes also needed physio when he had 'growing pains'.  That was a referral from the doctor.  Maybe a month or six weeks later he saw the physio?  I can't really remember.  It wasn't an urgent situation.

[lailasmum]

Pretty sure kids on the NHS dental plan get two cleanings a year. It seems right with what friends do. My kids weren't on NHS and since they didn't need braces we didn't put the effort into finding a dentist where they could be.

 

Eye exams and glasses are free to under 19's here too.

 

Regarding the midwifes...One of my close friend's husband worked for National Rail when she was pregnant with her first. They were apparently very bored waiting for her to deliver so grabbed her hospital bag and used their train pass to go a far as possible every time he had time off. No worries about delivering away from home, I think she actually wanted to but didn't.

 

The different midwife idea doesn't seem to bother people, although it is generally within a practice. It's rather like going to a practice with 8 ob's and being required to have one office visit with each.

NHS dentist isn't 2 cleanings a year it's usually 2 checkups a year. Though in practice it's however many they need. My son has been every 2-3 months since he got teeth. He'll have his first 6 monthly one this year.

[bethben]

Having dealt with a small fraction of socialized medicine due to my son with special needs, I feel like we all need to be comparing a country similar in scope and size to the United States.  Scotland has less than 2% of the population of the US.  Canada has about 11% of our population.  I believe that due to the sheer size of the United States, socialized medicine will never work here the way it may in much smaller countries.  Just saying.

[Laura Corin]

Having dealt with a small fraction of socialized medicine due to my son with special needs, I feel like we all need to be comparing a country similar in scope and size to the United States.  Scotland has less than 2% of the population of the US.  Canada has about 11% of our population.  I believe that due to the sheer size of the United States, socialized medicine will never work here the way it may in much smaller countries.  Just saying.

 

It could be state-by-state, just as the EU countries have different systems alongside each other. 

[Jann in TX]

My middle dd is in grad school at the University of Lancaster (UK).

 

She has been on thyroid support for the past 14 years.  The UK does not recognize her condition and you cannot purchase thyroid support.  Dr's are pressured (to not write prescriptions for it).  We found a pharmacy in California that will mail her the thyroid meds without a prescription (legal as long as they do not mail to USA).  Apparently the majority of this pharmacies customers are from the UK...

[Audrey]

Having dealt with a small fraction of socialized medicine due to my son with special needs, I feel like we all need to be comparing a country similar in scope and size to the United States.  Scotland has less than 2% of the population of the US.  Canada has about 11% of our population.  I believe that due to the sheer size of the United States, socialized medicine will never work here the way it may in much smaller countries.  Just saying.

I don't believe anyone in the thread was trying to compare US to other countries. The thread was framed as a way to ask how it worked in other countries, not to judge efficacies or try to apply solutions elsewhere.

[mumto2]

My middle dd is in grad school at the University of Lancaster (UK).

 

She has been on thyroid support for the past 14 years. The UK does not recognize her condition and you cannot purchase thyroid support. Dr's are pressured (to not write prescriptions for it). We found a pharmacy in California that will mail her the thyroid meds without a prescription (legal as long as they do not mail to USA). Apparently the majority of this pharmacies customers are from the UK...

No problems obtaining levothyroxine which I believe is the common treatment. I know many people taking it so treatment isn't a problem. It's actually a condition where if forms are completed ALL prescriptions are free from the NHS for life. Same thing for people with many other things that require lifelong meds.

[Dicentra]

Having dealt with a small fraction of socialized medicine due to my son with special needs, I feel like we all need to be comparing a country similar in scope and size to the United States.  Scotland has less than 2% of the population of the US.  Canada has about 11% of our population.  I believe that due to the sheer size of the United States, socialized medicine will never work here the way it may in much smaller countries.  Just saying.

 

I'm curious about this, if you don't mind a question. :)  I'm trying to envision why the number of people in the country would matter in terms of socialised health care.  Maybe I haven't done enough reading on the topic (which is probably true :) ) but I can't picture why more people would mean it wouldn't work.  Why would the population size of the US preclude socialised medicine?

 

[Bluegoat]

How are things like speech, physical and occupational therapy handled for children?  Are services available for free in the schools or via a clinic?  How long is the wait to receive therapy services?

 

I'm in Canada.

 

This is a little different in each province.  While all provinces are required to meet a standard, they have some leeway within that to decide how best to provide care.  And the provinces run the universal health insurance - if you use a health service in another part of Canada either they will charge the province themselves or you get reimbursed (the former is more for emergency/very serious cases, the latter for just a small thing like a walk-in clinic.)

 

Here in NS, these kinds of therapy are generally covered for children.  There are some specific differences that come up - my province doesn't provide funding for some specific thing my friend's does, for example, or the ages may be different.  Often this happens when something is new, especially.  Or they set it up differently.

 

I have the most experience with speech.  Here, there are speech centers which follow kids before school-age, and also homeschooled kids.  With school age kids it is done at school.  I found them to be very good, though there can be a wait.  The big problem they have is the number of workers.  This is a two-fold thing, partly it is that they don't fund as many positions as they should, and partly to do with a lot of retirements. 

 

We can also access private therapy, which can be paid for with private insurance or out of pocket.  Though, most plans don't give a ton of $$ toward this.  So, for my son, my insurance would pay for $200 a year for speech - that's only two visits.

 

What you tend to find, I think, is that different provinces tend to have different strengths in terms of funding.  My province has a lot of old people, and I suspect that is why our services for kids aren't always as good as some others - there is more call for senior's care, and they have more votes as well.  It is transparent, though - the people who make the decisions have to justify them and sell them to voters.

[Bluegoat]

I'm curious about this, if you don't mind a question. :)  I'm trying to envision why the number of people in the country would matter in terms of socialised health care.  Maybe I haven't done enough reading on the topic (which is probably true :) ) but I can't picture why more people would mean it wouldn't work.  Why would the population size of the US preclude socialised medicine?

 

 

Yeah, I don't get this either.  I mean, #s and density will affect how you will decide to administer things - maybe you break people up into smaller groups, like state-sized ones..  But there are very population dense places that have socialized medicine.  There are large countries, distance-wise, too.  I can't think of any way this would really make a difference, other than that sort of thing.

[kiana]

I'm curious about this, if you don't mind a question. :)  I'm trying to envision why the number of people in the country would matter in terms of socialised health care.  Maybe I haven't done enough reading on the topic (which is probably true :) ) but I can't picture why more people would mean it wouldn't work.  Why would the population size of the US preclude socialised medicine?

 

 

I would say that (according to the op's stated request) this would probably be better in a spinoff thread as I can foresee it degenerating into political discussion quite rapidly and I would prefer this very interesting thread to stay unlocked. 

[Dicentra]

I would say that (according to the op's stated request) this would probably be better in a spinoff thread as I can foresee it degenerating into political discussion quite rapidly and I would prefer this very interesting thread to stay unlocked. 

 

Ah - sorry about that.  I didn't realize there was a political aspect to this.  I thought it would be more of a demographic/geographic type of answer.  Mea culpa. :)

 

[Audrey]

Ah - sorry about that.  I didn't realize there was a political aspect to this.  I thought it would be more of a demographic/geographic type of answer.  Mea culpa. :)

I saw it that way, too. I was wondering why it mattered because more people = more tax base which balances out the cost factors.

 

But... it's harder and harder to tell what will strike a political chord these days, so better safe than sorry, perhaps?

[Deb in NZ]

NZ here, but I have lived in Fiji & the Marshall Islands as well, both of which have some form of socialised medicine.  

 

In the Marshall Islands most people went to the hospital for treatment.  The mornings were for sick people.  You went & took a number & waited.  The afternoons were dedicated to different special cases.  One day was for prenatal, another for leprosy, another for nuclear disease, etc.  One day I went because I found a lump in my breast.  I was able to have it removed the very next day.  I can't remember exactly if we had any co-pay, but if we did it was less than $10.  I had all my prenatal care for dd in the Marshalls & her well-child visits for her first year.

 

In Fiji hospital care was free, but there were private doctors as well if we chose to go that route (about $20 / visit).  I had my prenatal care for ds#2 in Fiji & well child visits for dd & ds#1 in Fiji.  

 

In NZ hospital care is free & visits to your GP are free for children, adults have a small co-pay, depending on what health centre you belong to.  In my province we pay $17/visit for adults.  Medications are $5 / prescription for Pharmac approved medicines.  All hospital & specialist care is free if you go through the public system.  Depending on the day / time / urgency of your complaint wait times can really vary in A&E (the Emergency Room)  The longest I've had to wait is 8 hours (from arrival to departure) for my broken arm.  I believe it was about 4 hours waiting in the waiting room after registering that time.  The quickest I've been seen is 10 seconds (when I passed out right next to the stroke doctor when visiting my m-i-l in the A&E after she had a stroke)  Most times I took my boys they were in a bed in less than 2 hours.  We can usually get an appointment with the GP the same day, if we aren't fussy as to which doctor we see.  If it's not urgent, we usually can see our main GP that same week.  Referrals for specialist care are usually with-in six week, but sometimes we've had an appointment with-in a week to 10 days.  

 

Dental care if free until age 18.  Young children visit the school dental nurses for a yearly check-up.  Fillings & cleanings are done on a as needed basis.  Highschoolers are seen at participating dentists' offices.  Low income adults can get urgent dental care at the hospital, but this has long wait times & little choice in procedures(i.e.  they like to pull teeth instead of doing root canals )

 

Quality of care I've received in countries with socialised medicine is at least as good as what I've received growing up in the States.  In some cases I'd even say it was superior.  In NZ where my boys were born I was in hospital for a week (c-section births) & for the next 6 weeks a Plunkett (baby) public heath nurse visited us at home to check on me & the baby.  Dd was born in the States (c-section as well)  After 3 days they wanted to discharge me, even though dd was in NICU & I was having problems with an infection in my c-section wound.  Thankfully my hospital bill for dd was covered by Dr. Dinosaur in VT as it was over $20k.  My hospital bill in NZ for both my boys' births was $0.

 

 

Edited February 4, 2017 by Deb in NZ

[Laura Corin]

UK.  I should have said: with regard to health visitors coming to your home after you give birth - you absolutely have the right to refuse that.  Calvin was born just before Christmas and the nurse offered to come every day, including Christmas day.  I told her that I was fine, and she just popped in one more time after Christmas (with my agreement).  In my case, Calvin had a mild case of jaundice, and having her popping in at the beginning meant that I didn't have to keep going back to the clinic to get him checked.  

 

They don't care if the house is tidy or the dishes washed.  And they are not just checking the baby - they are there to listen to any worries you might have, to answer questions, and to watch out for signs of post natal depression.  I think it's brilliant.

[ktgrok]

UK.  I should have said: with regard to health visitors coming to your home after you give birth - you absolutely have the right to refuse that.  Calvin was born just before Christmas and the nurse offered to come every day, including Christmas day.  I told her that I was fine, and she just popped in one more time after Christmas (with my agreement).  In my case, Calvin had a mild case of jaundice, and having her popping in at the beginning meant that I didn't have to keep going back to the clinic to get him checked.  

 

They don't care if the house is tidy or the dishes washed.  And they are not just checking the baby - they are there to listen to any worries you might have, to answer questions, and to watch out for signs of post natal depression.  I think it's brilliant.

 

That is wonderful. My homebirth midwives here in the US come out at 2 days post partum, then again at 2 weeks, but that's it. And if you give birth in a hospital no one every comes to check on you. 

 

Oh, and since I'm having some prenatal depression this time my midwife is going to be calling me by phone every other day or so for those first few weeks, to check on me. 

[Laura Corin]

That is wonderful. My homebirth midwives here in the US come out at 2 days post partum, then again at 2 weeks, but that's it. And if you give birth in a hospital no one every comes to check on you.

 

Oh, and since I'm having some prenatal depression this time my midwife is going to be calling me by phone every other day or so for those first few weeks, to check on me.

I'm sorry you are having a tough time. Best wishes to you.

[ktgrok]

I'm sorry you are having a tough time. Best wishes to you.

 

Thank you. It's actually getting a bit better...I've started going to the dog park in the morning, when the sun is bright, and that seems to really help. I swear I'm photosynthetic. 

[scholastica]

I thought of this thread this morning when I read this article: http://www.bbc.com/news/health-38853709. The fact that the target is 18 weeks -over 4 months - to wait for surgery is surprising and then to see that they can't even meet that target is even more disturbing. Why are the waits so long and what is being done to address it?

[Laura Corin]

I thought of this thread this morning when I read this article: http://www.bbc.com/news/health-38853709. The fact that the target is 18 weeks -over 4 months - to wait for surgery is surprising and then to see that they can't even meet that target is even more disturbing. Why are the waits so long and what is being done to address it?

 

As I said at the beginning of the thread, I'm not qualified to talk about policy - just my own experience.

 

[Bluegoat]

I thought of this thread this morning when I read this article: http://www.bbc.com/news/health-38853709. The fact that the target is 18 weeks -over 4 months - to wait for surgery is surprising and then to see that they can't even meet that target is even more disturbing. Why are the waits so long and what is being done to address it?

 

There are a few important things to understand about wait times, in general.

 

The most important point:

Wait times are a problem in the US too, and wait times there are worse than in many countries with socialized medicine.  That is even if you don't count the people who don't get treated at all because they have no insurance.  The idea that somehow the private system in the US is better  for wait times is just not true.

 

More specifically about causes when it happens:

 

The first is that these are not for emergency treatments.  People in those kinds of situations get treated first.

 

Typically, when there are longer wait times than is ideal, there are a few basic causes.  This is the same everywhere, not just in England or socialized medicine settings.  The most common reasons are that there aren't enough doctors in the right place, or there aren't the surgical facilities, in the right places.

 

There are all kinds of reason these two things happen, and it's honestly difficult to tie either of them to socialized medicine in any direct way.  There are for example shortages of doctors, or sometimes specific types of doctors, in many places.  It isn't most typically related to pay, more often its quality of life, especially in the most modern contexts,  Younger doctors don't like to work the long hours older doctors did.  There are a lot more women doctors now, but they typically work fewer hours than male doctors.  Doctors tend not to want to settle in rural locations - especially because it can be difficult to provide enough back-up for doctors in rural locations so that they have a good quality of life.  Medical students may be choosing specialties which aren't the most needed.  Insurance (in the US more than in Canada) means that some doctors avoid some states.  Demographic changes mean the population isn't any longer where the hospitals are.  In a remote region, it is just tricky to get people to where the doctors are.

 

And the big, number one issue in western countries is that the population tends to be ageing, and there are more means available to do things for them, and this is taking up more and more money.  And no one, anywhere, has the money to do this infinitely. 

[ktgrok]

WEll, part of why wait times are longer in a country with socialized medicine is that EVERYONE gets treated. So more volume. In the USA, only those that can afford it get treated. That's great if you can afford it - shorter line! But that shorter line is the result of many people that need care doing without entirely. 

[Bluegoat]

WEll, part of why wait times are longer in a country with socialized medicine is that EVERYONE gets treated. So more volume. In the USA, only those that can afford it get treated. That's great if you can afford it - shorter line! But that shorter line is the result of many people that need care doing without entirely. 

 

I don't know that this is entirely true.  Wait times in the UK and Canada can be, on average, a little longer than the US.  But if you look at places like France, or Norway, they seem not to be.

 

Though, in actuality it is really hard to compare wait times between countries - there are too many variables and differences in data collection.

 

 

I think that actually a much better approach is to not worry about wait times so much - instead look at patient outcomes.

[Mbelle]

I saw this BBC news in my FB feed.

https://www.facebook.com/bbcnews/videos/10154376768372217/

 

I have just been through 3 surgeries with DH in December here in the USA.  I will say the overcrowding was scary and at a fairly new hospital.  He had to end up having surgery 3x all 10 days apart, and the last one was the scariest.  There were not enough beds.  At one point he was moved out of his pre-op curtain cubicle and another lady from surgery rolled in.  At that point he no longer had a bed or a chair.  DH walked to the bathroom and then walked to the actual OR room, where everyone was scrambling to get things ready. I saw all of this. I heard them calling out for various items and saw people rushing around to get them.  This is after a 5 hour delay for the surgery.  My mom was a career RN  and worked in surgery and ER and I told her about it just to make sure I wasn't being  overly concerned and she said it was ridiculous and dangerous for the hospital as well because that's when things go wrong. I asked one of the nurses and she said they overbooked by 10 patients that day and some of the surgeries went over.  That is the hospital administrations fault.  As a lay person I find that very concerning ethically.  For sure in December everyone wants to have surgery so they don't have to pay the deductible next year, which is also seems unethical.  

 

So, I'm wondering if this whole overcrowding is something going on globally with an aging population?  Will that change some things in socialized medicine?

 I'm in favor of universal health care, but I don't for instance want my parents generation abusing my kids generation. It seems like my childrens generation are going to get stuck with a ton of problems right now.