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Wednesday, 07 November 2012

The British Healthcare System

By Ian Bertram of Panchromatica

I know that health care is a big issue in the U.S. and one of Ronni's abiding concerns, so I'm sharing my experience of a recent illness to show how things work out here in the U.K.

For a variety of reasons, all linked to a birth condition, I'm prone to infections in my foot. These can get quite serious - on one occasion amputation being a possibility. The last of these was in August/September of this year and led to me being admitted to hospital with a temperature of 39.6°C (104F).

I kept a log of the various treatments and consultations with doctors and others that I have summarised below.

• Attendance by ambulance and paramedic car - via 999 (arrival within 15 minutes) [NOTE: 999 is U.K. equivalent of 911]
• Taken by ambulance to hospital
• ECG by paramedic
• Blood sugar and urine tests by paramedic
• Review by nurses in A&E
• Review by Doctor in A&E
• Chest X ray in A&E
• Transfer to ward
• Two days oral flucloxacillin
• Blood tests (x5)
• Two weeks vancomycin 14 days x 2 doses/day
• MRI scan of foot
• X-ray of foot
• Echocardiogram
• Ultrasound scan of foot
• 16 days general nursing care/accomodation/food/routine dressings, etc.
• 16 days daltaparin
• 16 days other routine medications – painkillers/omeprazole, etc.
• Insertion of cannula (x6)

Consultant visits bed-side:
• Gastroenterology (x2)
• Microbiology (x2)
• Orthopaedics (x1)

Other medical attendance:
• Doctor (x20)
• Podiatry (x1)
• Tissue viability nurse (x2)
• Nurse practitioner (x2)

Insertion of PICC line requiring:
• Consultant radiologist
• Nursing staff (X2)
• Utrasound
• X-ray

After care comprising:
• Daily home visit by nurse to administer IV antibiotics (x18)
• Teicoplenin (x18)

All of this was without any requirement to provide evidence of insurance cover, details of insurance providers, hassle to get approval for specific treatments. I was simply admitted, doctors assessed my needs and the treatment was given.

No payment was required at the time nor will it be required if it all happens again. In fact this was the second such episode this year - I was admitted to the same hospital in May for the same problem.

Nor will this have any implications for insurance payments in the future. So long as my income remains liable for income tax, I will have to pay that, and for all my working life I paid into the state run National Insurance scheme, although since I have now retired I no longer make such payments.

I actually have no idea of the cost of the treatment I received although based on such scant information as I have been able to find, I would not be surprised to find the two incidents costing around £75,000 - £100,000 (US$120,224 - $160,299).

Looking at such information as I can find online about U.S. costs, they seem to come out at something like three times the UK equivalent.

I should point out that foreign nationals receive the same level of care when emergencies arise.

If this sounds partisan, that is because it is. The U.K. National Health Service (NHS) is the subject of much moaning but it is like moaning about the weather and very few people would want to lose it.

It protects everyone in the country for about one-third the cost of the U.S. system which, of course, leaves some 60 million people uninsured. When US politicians tried to use the NHS as a political football around the time of the last presidential election, this generated much animosity here.

In an insurance-based system such as in the U.S., because my problems relate to a birth condition, while I may have been covered as a child on my parents health insurance, once I reached 18 I would have been on my own. Certainly at some point I would have become liable for my own insurance payments.

Even assuming I survived to my 50s, as the problems I describe above (and a few other related issues) became more severe, insurance costs would have escalated. As a pre-existing condition I'm not sure how long I would have been covered but I'm convinced that in a system like the U.S., by now I would have been bankrupt or dead - probably both.


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Posted by Ronni Bennett at 05:30 AM | Permalink | Email this post

Comments

Thanks for sharing this. Our family members in Germany have had experiences similar to yours. The system there is insurance-based, but much different than the U.S. non system.

The log you kept in the hospital is very revealing. That is a huge amount of health-care for the cost, and the cost in U.S. dollars seems low to me.

One huge problem in the U.S. is that there seems to be no way to get even a ball-park estimate of the cost of surgery which is essential but not an emergency.

In addition, even if a person goes to a hospital in his insurance network, not every doctor who treats him may be in the network.

For example, the surgeon in in the network, but the anethesiologist is not. That will make a big difference in the bill the patient gets.

This is very much like our experience with the Canadian Health Care system. My husband, who has not only a form of Muscular Dystrophy but an inherited bleeding disorder, broke both the bones in his lower right leg in 11 places. The ambulance arrived in four minutes, he was stabilized in our local hospital and transferred to the regional hospital where he had 11 hours of orthopedic surgery. He ended up with a long hospitalization because of his genetic problems and it cost us a grand total of $50, and that was because we chose to have him brought home by ambulance. My sister-in-law in Texas spent seven hours in the ER being "observed" after she fainted, not even a blood test or an aspirin dispensed and the BILL was $7,000!!!
Can't believe the stories the "Right" makes up about our health care system.

Not long ago, I heard a similar story from a couple who had been traveling in Europe from their home in Chicago, USA.
The wife had, had a serious health emergency in one of the countries they were traveling, and had to go to the hospital. They kept waiting for someone to ask for their insurance card but no one did. The following day they began to worry that they were not going to be able to use their USA insurance if the hospital did not have the information. They asked an official at the hospital. He explained they did not need the information because as long as they were traveling in that country, health coverage would be free, as it always is for citizens of the country.
They went on to say that the wife was in the hospital receiving tests, care, etc. They were very impressed with the level of care and didn't pay a dime. I Wish our government would do some research of countries where it is working. It is important that health care is available for everyone in our country,

I am happy for you but an anecdote like yours is not representative of your system. I know personally of doctors who have escaped this system by moving to the USA, Canada and Australia. I also know stories of unhappy patients subjected to this type of system.

About the time my daughter tore her ACL, her future brother-in-law tore his. Only he was in Germany, studying architecture as a foreign student from the U.S. Our insurance allowed only day surgery, and she was set up at home that afternoon with a morphine pump which failed the first night. I--untrained in lifting a muscular gymnast daughter from a regular bed, not a hospital bed--hurt my back lifting her in and out of bed. Her future brother-in-law stayed in the hospital five days, at no expense to him. Despite what was considered very good insurance, we most certainly incurred heavy expenses paying our portion of her surgery costs.

Wonder what would happen if we had a "worldwide health system," as we are all increasingly interconnected.
Then travel would be a non-issue.
Of course that would require supreme co-operation and since we cannot even cooperate with our neighbors, I guess it is a dream. But disease control would be better, and healthier living possible.

Jackie - I've been using the UK system all my life - as I said I have a birth condition that has made me very familiar with how it works. I know of course many others who have also used it. I'll take my own direct experience and that of friends and relatives over the past 66 years as being pretty representative of how things work here. You may believe otherwise, but I live here, I use it and I experience it daily.

Could it be better? Of course. Do I want to switch to a US style insurance based scheme? Never!

How many drunks do you see in an ER in the USA when there is co pay of $100+ for treament there?

I'd rather not pay for the care of the majority of people who are obese and live unhealthy lifestyles. Like many social programs in the UK its wide open to abuse.

I've used both and prefer the American system although it does need some work. Don't forget the american health care inductry has developed most of the worlds drugs and often other countries send patients here for surgery. Ever heard of someone going from the USA to UK for an operation?
And NHS hospitals are fithly germ ridden places.

Interesting discussion. However, unless we in the US figure out a way to make sure the working age person can cheaply and completely receive excellent health care, we lose more and more people to death and disability who would otherwise be working and contributing to the system. It's ridiculous and the time has come for change. Our US health care system is financially crippling working families and it must change! Thanks for your input everyone.

Let me remind everyone that on this blog, no accusations may be made without sources for your information.

Yes, I'm talking to you, Rob. What is your citation for you last sentence?

Ronni. Its common knowledge, MRSA and superbugs are all to common in NHS hospitals.
There have been several cases of people getting infected with MRSA at NHS hospitals.
Even Chief executive Mike Stone, Department of Health's Patient Involvement Action Teams admits there is a problem and says "There needs to be a whole culture of cleanliness in the NHS"
There have been several surveys done, one in which said 27% of patients felt there homes were cleaner. NHS hospitals were recently condemned in a European Commission survey as posing the highest risk in Europe for MRSA.

Rob, following lifted from the cdc website:

Quote
MRSA is now endemic, and even epidemic, in many US hospitals, long-term care facilities (6), and communities
Unquote

And

Quote
The Centre For Disease Control (CDC) estimate that there are about 90,000 deaths per annum related to Hospital Acquired Infections (HAI's) most commonly MRSA, also known as Staph infections.
Unquote.

So, criticize the NHS all you like, but don't stick your head in the sand and think it can't happen here. It can, and it is.

I lived with the NHS for the first 35 years of my life, and the US "system" for the last 15, and there is absolutely no competition whatsoever - the NHS wins hands down every time.

And to address your other point - yes, I can list literally dozens of people that I know/am aware of that have repatriated to the UK from the US primarily due to the affordable, readily accessible quality healthcare.

It is stunning the ignorance displayed in this country (the USA) of medical systems elsewhere in the world, normally by people who have never experienced anything other than the US system.

Thank you, Mike.

Rob, without the links to the information you cite, you're just blowing smoke and we don't believe a word you say.

I live in the U.S.A., all my life. My husband got MERSA in a U.S. hospital. 2 years later he was diagnosed with brain cancer. Yet, 2 out of 3 visits to the hospital in the next three years was for MERSA infection and surgery. In the last 2 years of his life on those two hospital stays, he was treated like a leper, and ignored by nurses, even though he'd contracted MERSA in the hospital. The last time he had surgery I had a bed brought in next to his so I could be his "nurse".

Point: Other than the fact of insurance, the cost of insurance, even if you are lucky enough to have insurance, and despite the enormous co-pays that are involved; the U.S. system is the most "judgmental" system in the world. The most costly. The most confusing and non-responsive to patient needs. Actual patient need, takes a back-seat to patient insurance coverage. PERIOD.

I am 63-When I was born in small upstate N.Y hospital I got a MRSA infection in my rt foot,specifically near the ankle back toward the heel. I was in hospital 3 weeks.This area has bothered me all of my life=numerous infections,sprains,weak ankle etc.,my Achilles heel I guess. MRSA contines to be a world-wide,often drug-resistant bacterial infection not limited to UK/Europe.It certainly is not the patient's fault.

MRSA is endemic in the community. It is probably on the skin of about 50% of the population. It was created because of indiscriminate use of antibiotics leading to resistant strains of bacteria. Incidentally, the USA is still a big offender in this respect with thousands of TONS of antibiotics fed to livestock every year.

MRSA is not, contrary to popular belief, something peculiar to hospitals. It isn't even a particularly significant cause of death in the UK - just 364 in 2011 (http://www.ons.gov.uk/ons/rel/subnational-health2/deaths-involving-mrsa/2007-to-2011/stb----mrsa.html) Road deaths by comparison were 1901 in 2011 (http://www.dft.gov.uk/statistics/releases/reported-road-casualties-gb-main-results-2011/)

The idea that UK hospitals are incubators of infections like this is silly. The suggestion that they are a consequence of the NHS is farcical. The wide spread dissemination of such myths fits too well with the world view of those who would hand us over lock stock and barrel to the big corporates to be accidental. I think there is a de facto conspiracy to undermine the successes of state backed health care like the NHS because it offers too small an opportunity to make money out of it.

As ever follow the money and see who backs those politicians - on both sides of the Atlantic - who persistently and loudly make unsupportable claims about the excellence of US health care. I'm sure it is fine if you are Donald Trump, but ask an unemployed car worker in Detroit or a farm worker in Arkansas and you will get a different story.

"...people have access to health care in America,” said President Bush in “After all, you just go to an emergency room. (http://economistsview.typepad.com/economistsview/2007/07/paul-krugman-th.html)

And straight from uninsured US blogger Arthur Silber - http://powerofnarrative.blogspot.co.uk/2012/10/with-apologies-for-interruption.html

Use of antibiotics in Agriculture

http://www.theecologist.org/News/news_analysis/897405/overuse_of_drugs_in_animal_farming_linked_to_growing_antibioticresistance_in_humans.html

In the winter issue of our medical society publication
in 2009, I wrote a book review of T. R. Reid's THE
HEALING OF AMERICA, which surveyed health systems across
the globe.

Here is what I wrote about the
British National Health Service, or the NHS.

"The NHS established in 1948 during the time of Lord William Beveridge and Aneurin Bevan typifies the perfect model of a single-payer, pure socialized system of medicine.
It has remained unchanged since its launching, copied in some respects by a few smaller countries like HongKong. Some call it the worst in the industrialized world, though the Brits may not necessarily agree with that bloody assessment.

Funding is through general revenues from taxes, with the remaining 10% covered by private insurance.

The NHS is known mainly for the long queues to see doctors,denial and rationing of care, the virtual absence
of physician choice, and NO
bills for all kinds of services except for small payments for drugs, dental and optical care. For those with the means, private insurance eases some of these difficulties, with better access to the system and the availability of choice. Michael Tanner observed last year (2008) that "750,000 are on waiting lists for hospital admissions; 40% of cancer patients are never able to see an oncologist; and there is explicit rationing for services like kidney dialysis, open heart surgery, and cure for the terminally ill."

Doctors, 70% of whom are general practitioners and practice independently, are paid quite poorly by the NHS.
They act as gatekeepers to the specialists to keep costs down. But specialists, no matter how well-trained, are in short supply because of the low compensation. It's not surprising then that it's hard getting a doctor at night or on week-ends.

Despite PM Gordon Brown's efforts to pump more money into the system, not much has changed in terms of easier access to doctors and availability of various drugs and service that are either
delayed or denied to patients.

Yes, there is universal access, with no payments from patients, but the discontent remains pervasive. Is it any surprise that the British model has become the face of what is worst in medical care? Socialized medicine, ineed, has become anathema almost everywhere."

Ian - and others with personal stories, anecdotal evidence is not scientific and will not stand up as justification for any overall health care system.

In re: MRSA, I don't know what this has to do with any health care system.Individual hospitals are responsible, using their infectious disease control management.

Dr Lacsamana – UK General Practitioner income in 2009/10 was on average £105,700 (before tax) – hardly lowly pay.

http://www.ic.nhs.uk/news-and-events/news/gp-earnings-relatively-static-at-105700

By comparison median household income in January 2011 was £23,244 (after tax).

http://www.aviva.com/data/report-library/Family_Finances_Report_5_Jan_2012.pdf

In the US, according to a study for Congress in 2007 specialist doctors are paid approximately $50,000 more than would be predicted by the high U.S. GDP. General practitioners are paid roughly $30,000 more than the U.S. GDP would predict, and nurses are paid $8,000 more.

According to that same report - “However, research comparing the quality of care has not found the United States to be superior overall. Nor does the U.S. population have substantially better access to health care resources, even putting aside the issue of the uninsured. Although the United States does not have long wait times for non-emergency surgeries, unlike some OECD countries, Americans found it more difficult to make same-day doctor’s appointments when sick and had the most difficulty getting care on nights and weekends. They were also most likely to delay or forgo treatment because of cost.”

http://assets.opencrs.com/rpts/RL34175_20070917.pdf

Jackie – I agree that anecdotes are not enough, but so far I'm the only commenter who has offered both personal experience and data. Your own comments and those of Dr Lacsamana are themselves anecdotal.

Lets look at some more data though. For simplicity I'm just going to use US/UK comparisons, but the sources I quote are generally world wide in their scope. A good summary however is this report from the Commonwealth Fund.

http://www.commonwealthfund.org/~/media/Files/Publications/Chartbook/2007/May/Multinational%20Comparisons%20of%20Health%20Systems%20Data%20%202006/Cylus_multinationalcomparisonshltsysdata2006_chartbook_972%20pdf.pdf

Let's look at some key indicators.

One key factor surely is coverage. According to the US Census 48.6m US citizens had no health insurance in 2011 – that's 27.7% of the population.

http://www.census.gov/prod/2012pubs/p60-243.pdf

According to another Census Bureau report (http://www.census.gov/prod/2012pubs/acsbr11-11.pdf ) young adults have historically had one of the highest uninsured rates.

In the UK of course the system gives 100% coverage.

Another factor is cost. According to OECD data the total health expenditure per capita in the US (2009) was $7960 (17.4% of GDP). For the UK the figures were $3487 and 9.8%.

How about mortality rates?

Infant mortality – USA 6% in 2012/UK 4.56% in 2012

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

Ischemic Heart disease – USA 129/100,000/UK 110/100,000

“Since 1980, IHD mortality rates have declined in nearly all OECD countries. The decline has been most remarkable in the Netherlands, the Nordic countries (Denmark, Norway, Sweden and Iceland), Australia, the United Kingdom and Israel, with rates being cut by two-thirds or more.”

http://www.oecd-ilibrary.org/sites/health_glance-2011-en/01/03/index.html;jsessionid=1icu970depqup.delta?contentType=&itemId=/content/chapter/health_glance-2011-6-en&containerItemId=/content/serial/19991312&accessItemIds=/content/book/health_glance-2011-en&mimeType=text/html

Lung Cancer USA 57/100,000/UK 48/100,000 (2009)
Prostate Cancer USA 17.5/10,000/UK 23.3/100,000 (2009)

http://www.oecd-ilibrary.org/sites/health_glance-2011-en/01/04/index.html?contentType=/ns/Chapter,/ns/StatisticalPublication&itemId=/content/chapter/health_glance-2011-7-en&containerItemId=/content/serial/19991312&accessItemIds=&mimeType=text/html

Life expectancy at birth USA 78.49/UK 80.17

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

In terms of survival rates for a wide range of illnesses, the data consistently shows that the US does not have the commanding superiority often claimed.

The bottom line from that Commonwealth Fund report? Almost universally the USA pays more for less - more per capita for fewer hospital beds, more per capita for fewer ICU beds, and more for ICU stays despite patients staying for fewer days. The US has far fewer long term stay facilities, spends more on fewer practicing physicians per capita, and for all that performs worse in indices of mortality, and control of chronic disease.

Of course cross-country comparisons are riddled with difficulties, but those difficulties apply equally to those denigrating the UK system in favour of the US insurance based approach. For me however the most damming single fact is this: The cost of the US system as a % of GDP is the highest in the OECD and yet leaves 28% of the population uncovered. That is data.

Sorry Ronni - one last link, about the way in which political attacks on the NHS have affected public perception.

http://www.guardian.co.uk/society/2012/jun/12/public-satisfaction-nhs-thinktank

From the report:

"John Appleby, the [King's] fund's chief economist, said the drop could not be attributed to rising expectations or an actual reduction in the quality of NHS service.

He said hospital-acquired infection rates had remained stable and larger patient surveys, of two million or more, showed no large change in patient experience.

"It's hard to say that the drop in satisfaction reflects a fall in NHS service quality," he said, noting that the BSA found only slight drops in satisfaction with inpatient, outpatient and accident and emergency services.

The King's Fund, which took over funding the survey after the coalition stopped commissioning it last year, said the period when it was carried out coincided with a febrile political atmosphere when there was intense negative coverage of the coalition's health reforms.

Ian, for the sake of preserving the integrity of this website, devoted to senior stories- not politics, religion or controversial subjects-I will confine my remarks to one comment. Nothing I said was anecdotal.

Okay, I'm stepping in here. First, Jackie, certainly, this comment of yours is anecdotal:

"...I know personally of doctors who have escaped this system by moving to the USA, Canada and Australia. I also know stories of unhappy patients subjected to this type of system."

"I know personally..." is, by definition, anecdotal.

I am at a loss to explain why so many commenters feel the need to attack Ian. It will not be allowed to happen again.

Lastly, it's my blog and although in general I allow no religious stories here for many good reasons, politics and controversy have never been banned.

What is banned as of this moment, however, are any more comments on this story.

The comments to this entry are closed.