Healthcare around the world

[Vince Twelve]

I'm an American who recently moved back to America after four plus years of living in Japan.  When I left America, I was a young single twenty-something recent-college-grad who was healthy and didn't bother with buying health insurance because I rarely got sick and didn't see the need to spend as much money as it would cost.  When I returned to America, I was a married nearly-thirty father (and now father of two).  So, clearly, it was time to invest in some healthcare.  In Japan, I didn't have to worry about it.  In America it became a huge issue.

In America, it is impossible to have civil discourse with people of opposing views on healthcare because it is such a heated issue.  Part of the blame lies on the media which fires up controversy for ratings and money, and as a result, fires up tempers and divides the country on issues such as this that are about coming together, not being torn apart.  For example, when one politician suggests changing healthcare in our country to be more like another country, another politician will throw about a bunch of loaded terms ("Socialism!") and recite talking points dealing with one or two healthcare horror stories originating in that other country.  (Completely ignoring the thousands of horror stories we have here every year.)

Recently, I watched a PBS documentary about health care in a few countries around the world.  You can watch the whole thing here:
http://www.pbs.org/wgbh/pages/frontline/video/flv/generic.html?s=frol02p101&continuous=1

I found that it was a particularly even handed examination of what was wrong and right with the health systems in these five countries.  And even though each of these systems had some negative points, I couldn't help but feel that they were still doing things way better than America.  Particularly telling was the way that the interviewer got laughed at in every country where he asked the question "How many people go bankrupt every year due to medical costs?" 

I wanted more, though.  I would really love to learn about even more countries' health care and here about the pros and cons.

I won't go deeper into my personal views about the American healthcare system, or how it has caused me great distress in the 11 months that I've been back in the States.  But I really want to hear some real, unfiltered descriptions about the pros and cons of the health care systems of different countries around the world.  And since this is such an amazing, friendly, international forum, I thought it would be a great place for a nice discussion on the various types of healthcare around the world.

What I'm hoping for is to hear a general idea of how healthcare works in your country, if there are any particularly good/bad points about it, how much you pay for it (whether through taxes or otherwise), how you would rate it against any experience you might have had living in another country, any personal happy/horror stories you might have, or whatever other comments you might have on the subject.

[Nacho]

In Spain everybody over certain age has a plastic card which allows you to go the the doctor, and be attended by him (Of course, if you are not that age, your parents take you there and you are identified with their card...). Everybody here who is "legal" has access to it. First aid is also guaranteed... Here we attend, and after that, we ask.

There are some cons: People coming from countries without social care overuse it. And I am not beig a "racist who hates people from poor countries"... Elderly people from rich countries with a non so open social security are always visiting the doctor... It's like a timekiller! The ratio of foreign people at the doctor' s office exceeds by far the ratio of foreign people in the streets. Nothing to worry about, since this happens something with consults about non-serious diseases (colds, headaches, flu...). If something is "serious" (Surgery, Chemio, etc...) the ratio of "national/foreign" people is exactly the same as in the streets, of course. A

s said, consulting the doctor for non serious things is something people gets used soon.

There are also some other cons. (Spanish) elderly people has medicines and drugs for free... Result: Everybody asks the doctor to put in the paper that it's grandpa who needs the medicine. And they do. Bad, bad...

Some other cons... In Spain we have 17 "counties". Social care is something that is not statal, the workers of Valencia do not pay the social care of the people from Madrid... BUT... they don't ask your origin when you need to be attended somewhere, so, a hospital from Valencia can be attending someone from Madrid. That is a problem for touristic towns... For example, 80% of the patients in my town are from outside. Doctors have to attend 100 people, but only 20 pay.

And you have to wait... Months... you can advance a lot in the queue if your disease is really dangerous, but sometimes it's too late. If the surgery is not for saving your life, but for improving your life quality (Repairing a wounded knee bone, for example) you are f***. You might have to wait like 3 or 4 years.

Hope it helps.

[Andail]

In Sweden you pay an administration fee of roughly 15 euros for any sort of examination, surgical operation, treatment or consultation. Whatever your issue is, that's the cost.
(There is a high-cost protection with a cap of 800 euros per year. Luckily I have never been close to this).

For operations that are not life-threatening but still complex, like the ones Nacho mentioned (hips, knees, etc) the queues can be very long, several months up to a year or more.

If you have a flu or something similar, there are clinics that can accept you outside of hospitals, they are covered by the same health insurance, with waiting times of a couple of hours.

Dental care is another story; it's not covered by the insurance, but instead there are several high cost protections, as well as a small yearly personal fund. Still, just having a root canal filled will cost you several hundred euros.

[Tuomas]

Having run from a hospital to another for a while now, I can tell you something abou the Finnish health care system, though it's not really clear to me still.

For an appointment, you call your personal doctor, who'lll see you once he/she has time. This might take a while, depending on how urgent it is. If you're only there to get recepies for allergies, it'll only take like 15minutes, and you'll get in soon. The fee for that is 26,50€ which is the common fee for everytime you visit the doctor.

For a surgery, that's not urgent, the lines can be up to one year, as in Sweden apparently, and some people go to a private hospital, if they have money. Once yuo go see the doctor, you pay the fee mentioned, and he appoints you to a surgery, the surgery will be free. All following measures will also be free, unless you make the appointment yourself.

If you move, change the region you live in, you'll have to check in again and pay the fee the first time.

I was under the impression myself, that it was all free in Finland. But apparently everytime you go there, it costs the fee. If the doctor sends you someplace, be it a surgery, or some medical mumbo jumbo, it'll be free at that point.

Prescribed drugs after a diagnose will be paid up to 40% afaik, by the state health care system. Other than that, you'll be paying yourself. allergy drugs are more expensive without prescription, and you get the -40% only to prescription drugs. Old people and croppled ones get their wheelchairs for free as far as I know.

And us university students: We have an annual 40€ fee that we pay to the student health care service, after which we get free health care, though the lines are WAY long. If you want your eyes checked or moles removed, it'll be a year's wait usually. But it's cheap. Dental care is free the first time. After that 5€ each time. about normal dental care, I have no idea what so ever.

I've got something in my eye. My mum, who's a nurse, thinks it's an infection, so I'm calling in tomorrow, seeing if I can get an apppointment. It'll be 26,50 or 25,60 again. Can't really remember which it was. The health care in my case is great if you have big problems, like a broken leg or epilepsy, but if you have the flu, it could get expensive.

[LimpingFish]

In Ireland, we have the Medical Card scheme. If your means are deemed sufficiently low, you qualify. You also qualify if you are on welfare or disabled.

Most health care services are covered by the card, as well as medication and such.

Everybody else has to fend for themselves. Without a card, a visit to your GP will cost you in the region of â,¬50. A&E will cost you â,¬100.

Not all GPs are part of the scheme though, and we're currently are in the middle of a dispute with participating pharmacies; most of whom have pulled the plug on their support over the lack of sufficient reimbursement from the government.

Hooray!

[Mr Flibble]

In the UK we have the infamous National Health Service. Funded through taxes providing you make enough money to be taxed, it provides health care for everybody who needs it. Some things aren't covered by the NHS, like physiotherapy and probably some other things too. I personally use a private dentist and optician, I'm not even sure if the NHS offers these (for "free" anyway).

Although my dental care/glasses HAS always been free (up to the age of 18 anyway) so I'm not sure if it's paid for by the NHS for children at least. Maybe somebody who knows better can tell you.

There aren't any cards or anything.

[SSH]

NHS dental care is free for under 18s  (and low incomes, old people, etc) and glasses are subsidised for under 18s, low incomes, etc but if you buy posh frames or reactions lenses etc you have to pay something on top. Dental care is subsidised for NHS dentists for over 18s, but it can be very diffuclt to find an NHS dentist who will accept new patients so many peiople use private dentists and/or dental insurance.

Maternity services in the UK are almost all on the NHS: its nearly impossible to go private for that kind of thing unless you live in London and are very rich: most private hospitals dont have brith facilities.

There is private medical insurance schemes in the UK, most paid for as part of someone's job. Hoeever, most private doctors are actually moonlighting NHS doctors (except in London again) so the level of care is about the same and the only difference is that you get to jump the waiting list queue.

All EU countries have reciprocal agreements that let other EU citizens have a certain level of free medical treatment but you may need to do a lot of paperwork and its worth having travel insurance for things like repatriation costs, etc. bven if travelling within the EU.

[Stupot]

One little known fact* I found out recently. In the UK, if you take a taxi to the hospital you can claim the cost of the journey back on the NHS.

*[citation needed] [could be a load of bollocks]

[Shane 'ProgZmax' Stevens]

Which five countries would those be?  Canada?  Their healthcare system is so burdened with inefficiency, wait times, and outdated equipment that their own Supreme Court labelled it as dangerous.  Germany?  Recent predictions are that their single payer system is literally going to bankrupt their country, and as a result they've begun to experiment with markets (private practices, self-insurance methods similar to Health Savings Accounts in the US) to try and save money.  France?  They are also experimenting with markets to ease the burden and raise care standards.  UK?  In spite of the Blair administration's narrow view of NHS being the only plausible solution, markets for private practices and private insurance are starting to flourish.  I could give you a long list of references, but I'll stick with two really, really great books on the issue:

I highly recommend you read The Cure by Dr. David Gratzer before putting much stock in anything PBS has to say on the matter.  Seriously -- as in order the book right away.  Another great book on this subject: How to Cure Health Care by Milton Friedman.  


I want a book report on my desk in a week, Vince.  And don't forget I know where you live!

[Vince Twelve]

ProgZ posted before I finished typing.  I'll respond to you soon ProgZ, but I need to do something first.  Love ya! 

Original post:

This is interesting, guys, thanks.

In America, you only hear about other countries' healthcare via people like Michael Moore ("All other countries except for America are perfect!  It's all free and everybody holds hands and sings!") or people like every Republican politician or any talking head on Fox News ("All other countries except for America have terrible healthcare!  They kill babies!")

A lot of Americans can't accept that there are some things that other countries do better than us.  Yes, those countries' systems have some problems, but I would weigh "I had to wait four months to fix my knee" against "My whole family went bankrupt and we lost our house after I got cancer and the insurance company cancelled my coverage because they found out I visited a dermatologist once as a teenager" any day.

There may not be a perfect formula for healthcare, but if Americans would quit covering their ears and going "lalalalalala" whenever it's suggested that another country might do something better than us, we might be able to improve by adopting some ideas from other countries.

I'll post my story about Japanese healthcare when I get some time.  But I'd love to hear more from other countries, too.  What do you think your country could do better?

[Intense Degree]

A lot of Americans can't accept that there are some things that other countries do better than us.

That's very interesting, I must say that I have never understood America's reluctance concerning public healthcare and it is fascinating to see other countries mind sets.

In the UK pretty much everybody will complain about the NHS, long wait times etc. but realistically no-one wants to completely do away with it.

... but I would weigh "I had to wait four months to fix my knee" against "My whole family went bankrupt and we lost our house after I got cancer and the insurance company cancelled my coverage because they found out I visited a dermatologist once as a teenager" any day.

Completely agree.

[Vince Twelve]

I highly recommend you read The Cure by Dr. David Gratzer before putting much stock in anything PBS has to say on the matter.  Seriously -- as in order the book right away.  Another great book on this subject: How to Cure Health Care by Milton Friedman.  

I'll take a look at those.  Do they have cliff notes?  I'm kind of busy working to pay off all my medical bills. 

Seriously, though, the PBS show linked above is, I think, very even handed, though it was probably a little left leaning in that it pretty much started with the thesis that things in America could be done better.  If you think that things are just fine as they are, you'll probably find it biased.

The countries that you talk about have almost entirely government-run health systems.  We're starting on the other end of the spectrum with an almost entirely capitalist system (For most of people, that is, who don't qualify for Medicare, or the Veterans health coverage).  Both approaches seem to have problems.

The countries with government-run systems seem to be solving (?) their problems by mixing some capitalism into their single-payer systems.  Mixing the two together. 

Now in America, the option of completely wiping out the private companies in favor of a government-run-only system (jumping to the complete opposite of the spectrum to be like the UK or France) isn't even being considered by politicians, so would you agree that adding a government option, and moving in a tiny baby step towards the systems of those other countries, would be a positive one?

I really am trying to be even handed about the whole thing, I just can't look at our current system and think, "Now that's a system that every country should model themselves after."  Which seems to be what America wants to be in the world.  A shining beacon of democracy and capitalism, yeah?

I want a book report on my desk in a week, Vince.  And don't forget I know where you live!

Well, I also know that you won't take an airplane, so I'm betting I can get away before you get here!

[Andail]

There are plenty if things I dislike with Sweden (actually I was going to start an entire thread about it, but I think it will have to wait now) but one thing I can't really complain about is our health care.

I have been operated on once as an adult; I was..."fixed"..."downstairs" if you get me (nothing serious, it was just getting a bit troublesome and I preferred to get rid of the extra part.) I went to a doctor, got examined and referred for surgery. Some 3-4 months later they called from the hospital. I underwent the surgery - with the special robe, the anaesthetics and the whole shebang, and spent an evening on observation ward with tea and sandwiches. Everything cost me 15 euros.

To me it's very distressing that everything I just wrote would be described as socialism-communism-bureaucratic-this-and-that in USA, and Americans would knee-jerkingly dismiss it.

[Nacho]

Come on, man... explain your "downstairs" problem... don' t make me to get on my knees.

[Andail]

You know that extra part of...that thing down there...

oh heck, I was circumcised because my foreskin was acting up on me

[Matti]

Andail, I've had the exact same thing. But I was a little child and don't remember anything except that this happend.

As for the topic: I don't have the time right now, but I'll post something about the german healthcare system soon.

[Meowster]

I've experienced two healthcare systems, Irish and UK.

Ireland I don't remember a lot about other than having to pay £50 for a visit to the GP just so she could prescribe me the pill. Then I'm pretty sure I also had to pay for the pill on top of that. Fastest £50 I've ever spent, literally... I spent maybe two minutes in there talking to her.

I also remember my parents getting lots of hospital bills for things like childbirth etc... and they were quite short on money so I'm not sure how they afforded it. It was only after they separated that my mother and sisters became entitled to medical cards. Before that I had to once put off going to the GP for a week with a UTI because I couldn't afford to pay. My brother also started to experience scary blackouts and seizures that the hospital/GP could not identify the cause for, and now he's on a 9 month waiting list to see one of the only two experts in the country. Meanwhile his fits are getting worse and worse...

However, despite this I am glad that there is a cheaper public service available to people with little money, as being on a 9 month waiting list is better than being on no waiting list at all. If my mother could afford, she could go private but it just isn't an option in her case.

Irish system, not so great in my experience, but maybe it's better now.


The UK system has always been good to me. I have had two operations and both were non-urgent and the waiting lists were only about two/three months. Anything serious is treated faster of course... my boyfriend had his appendix out pretty snappy. Now that I'm unemployed I get any medication for free, which is something I'm so so grateful for as otherwise I could not have afforded any pain relief after my tonsilectomy. The Pill is also free over here (so you'd think we'd have a lower teenage pregnancy rate..)

Nobody I know has any complaints about the NHS except for maybe having spoken to a rude receptionist or or something, but otherwise the service is great and I am happy to pay my national insurance contributions. Maybe the sussex area runs things better than other areas of the country.

I had private medical insurance with a company I worked for a while back but I never availed of it and decided not to continue it after leaving the company. I could get private if I wanted but I'm very poor at the moment, and the NHS is fine for me anyway. One thing I do want is private dental though, as soon as I can afford it. The first time I visited an NHS dentist in the UK he gave me a filling I didn't need. Bad experience! The difference between private and NHS dentists seems quite significant...

I'm very grateful to the NHS over here. I wonder what the arguments against a national healthcare system in the US are? People can still get private medical insurance if they wish, it's not like everyone will be forced to use the national healthcare system. It's about pooling in and helping your fellow countrymen... I don't see a problem with that.

[LimpingFish]

Irish system, not so great in my experience, but maybe it's better now.

Oh, don't get me wrong, the concept of the Medical Card scheme and free health-care is terrific. In practice, it's less than stellar.

Lack of hospital beds, lack of specialists, mass mis-diagnosis, and the infamous HSE, scupper most of it.

Anyone who can afford to go private does, and those who don't qualify for the scheme, yet can't afford to go private, suffer the biggest screw-job of all.

[Vince Twelve]

Alright, time for me to contribute my story of different countries' health care.

I lived in Japan for four-plus years and got a bit spoiled by the cost of health care there.  It's very cheap.

In Japan, the government has decided on a very low price for every imaginable procedure.  If you have a cut that needs stitches, there's a formula based on the length of the cut, location of the cut, and number of stitches that you needed that translates into a price.  The hospitals have to follow that book exactly.  Prices are very low.  Regular trips to the doctor will cost somewhere in the neighborhood of 3 to 10 US dollars.  Medicine is similarly low priced.

The problem with this, of course, is that a lot of Hospitals find themselves under funded and doctors underpaid and they cannot raise the prices to compensate without waiting until the next time the government revises the price book and even then, prices may go down further depending on what the government decides.  The government, as I understand it, then supplements these hospitals to keep them afloat.

I may not be 100% accurate on that, but that's how I understand it.

But from a patient's perspective things are great.  Waits are pretty low.  I usually experienced a 45 minute wait on a walk-in with no appointment to see a doctor, which isn't that bad.  Obviously emergencies get you seen much faster.  The longest wait I ever had was 90 minutes to see my daughter who had the chicken pox and needed some ointment.  This fairly low wait time is more impressive considering almost every medicine is prescription-only over there, so if you need something for whatever reason, you've got to swing by a hospital or clinic, and doctors are extremely stingy with medicines.  They prefer to give you a small amount of antibiotic or whatever and then have a follow up appointment and prescribe more if necessary.  Contrast that with America where they prescribe you more than should be necessary and call it good (which can be a bad thing and a good thing).

So, doctor visits are much more frequent in Japan, and in order to keep the waiting times down, visits with doctors are very brief.  When you check in, you're usually given a thermometer and pointed at a blood-pressure machine in the waiting room so that you can get all that out of the way yourself.  Then, when it's your turn, you walk into the room with the doctor, who already knows what you're there for since you already told a nurse and doesn't ask you to repeat yourself.  He checks out what needs checking, tells you what's up, asks you if you have any questions, and sends you back to the waiting room.  A nurse in the room takes down his instructions, turns it into a prescription or whatever and hands that to you a few minutes later.  In total, you get about 5 minutes face time with the doctor, and you're out the door.  I never felt rushed or mistreated though.  The nurses also make sure you understand everything (usually takes more time with me and my Japanese ability).  The system works really well.

When it comes to surgeries, there isn't much wait at all.  I went in with an ingrown toenail, suggested surgery to prevent it from happening again, the doctor agreed and two hours later, I was tied to a table in a surgery bay, surrounded by two surgeons and several nurses, hooked up to a heart monitor, and getting nervous about whether or not the doctor misunderstood my Japanese and was about to take the whole foot.  Full story here.  It was extremely cheap considering all the things that went in to it.

I also had a septoplasty to repair my deviated septum.  I'm not sure if there was a waiting line or not because I scheduled it several months in advance and didn't have any trouble reserving the days that I wanted (which fit into my work schedule best).  I spent five days in the hospital afterwards.  In America, I would have been kicked out to watch after myself after a day.  Hospital food in Japan is awesome.

And as for child birth.  Wow, it's like night and day when compared to America.  First of all, the wife and baby stay in the hospital after birth for a week standard.  You can request to leave earlier if the baby is healthy, but they recommend and welcome you to stay the whole time.  My daughter had to stay an extra week because of some mild jaundice and some eye infection she developed.  100% of the cost was covered by the government.  Also every time she visited a doctor in her first three years, we could keep records and get the money refunded by the government. 

Total cost from conception to three years of age: $0.

In America, just recently I had a son.  He stayed a day in the hospital and then came home the next.  He had much worse jaundice than my daughter had and had to be hooked up to this cool UV glowing vest.



Even after my insurance, I was paying $150 per day for two days for the rental of the vest plus $150 per day for the nurse to come and check him.  Cheaper than staying in the hospital, to be sure, but still...

Total cost from conception to three months of age: $4000 (or thereabouts)

I feel fairly confident that if we have another kid, it's going to be in Japan.

[Meowster]

Irish system, not so great in my experience, but maybe it's better now.

Oh, don't get me wrong, the concept of the Medical Card scheme and free health-care is terrific. In practice, it's less than stellar.

Lack of hospital beds, lack of specialists, mass mis-diagnosis, and the infamous HSE, scupper most of it.

Anyone who can afford to go private does, and those who don't qualify for the scheme, yet can't afford to go private, suffer the biggest screw-job of all.

Like my parents :-/

What are they doing with it now that the entire country has collapsed in on itself? I remember just before I left, my mum was saying something about how only a certain amount of medical cards were allowed to be issued that year or something... which I thought was ridiculous, to only allow a certain amount whether or not more people qualified... but I am not sure if that is true, my memory might be skewed, do you remember anything like that?

I also read somewhere that they might bring back university fees in Ireland now that everything there has blown up in the recession.

Vince, that story about Japan's system sounds amazing. Completely different from over here, and seems to work which is cool.