Anyone have experience of health care systems in other European countries that works better than NHS(198 Posts)
For decades we've been told the NHS is in crisis/at breaking point etc
I often read on MN about how wonderful health care is in Germany, France, Scandinavia. So what are they doing differently/more efficiently and could we adopt it?
They seem to be much stricter on who can access their healthcare - follow people up.
We had to use hosptial in France - we had massive interview asking for address etc and we got a bill when we got home.
In Germany it seems more efficient no surprise there. Very quick to pin point health issues and act on them.
A close family member has just spent a week in hospital in France, he said the care there was amazing. DRs are quite happy to do jobs that would usually fall to a nurse which in turn speeds a process up.
France works extremely well if you have both Sécurité Sociale and Mutuelle insurance. They've been bloody amazing with my husband's open-heart surgery and follow-up care and more recently with my rare auto-immune disease.
If you don't have both types of insurance, it would be inaccessible to most.
I'm in Switzerland. Here there is obligatory health insurance and for our family of 2 adults and 1 child it is 1200 per month.
As you can imagine, the hospitals are absolutely spotlessly clean and very efficiently run. So far (touch wood) my husband has been fine, I've been to A&E once as I broke a rib and was seen in 15 mins and was home within an hour. I have taken my daughter to A&E multiple times with various childhood ailments and again the maximum we spent waiting was 45 mins. She was admitted for dehydration following severe gastro and we received a high standard of care.
So it "works better" than the NHS but it's really bloody expensive.
I'm in Italy and it's patchy. The actual treatment is very good - and they have very good survival rates for cancer treatments and other serious illnesses. The bedside manner and facilities are pretty bad often though - although that again really depends on where you are. We also pay for quite a bit out of pocket - we pay for a lot that would be free on the NHS.
Yes, Germany. DH needed emergency care in middle of the night and his hotel called an ambulance which arrived almost immediately. He had blood tests and scans (all in the middle of the night remember) and the results were ready for the consultant when DH was back in his bed. Diagnosis and meds before morning. There are probably many explanations but one might be that because he'd forgotten to take his EHIC card with him they wanted his passport and address details before he left. I was a little too slow sending them the card details obviously as less than a week after he was discharged they chased us through debt collectors. All was sorted once they had the EHIC but point being they were not going to waive that money.
I have personal experience of the French and German systems and I studied comparative health law as part of my postgrad in Germany. IMO both systems work vastly better than the NHS from the patients' point of view.
The key difference in other European systems is that the government does not actually try to deliver the healthcare itself. Private providers can open polyclinics and hospitals, leading to competition - giving massively improved service because they actually WANT to treat you. The money follows the patient.
Everyone is insured but the insurance industry is heavily regulated so there can be no exclusions for pre-existing conditions. Government will pay the premia of the lowest paid so that nobody need be uninsured. Iirc there is a sliding scale of contributions depending on earnings and (in Germany at least) you can opt out of the system entirely and self-fund.
I really hope that we change to this type of mutuelle system. The NHS is too big and clunky - additional taxes put in are not always spent efficiently because of poor management and even giving all staff a 1% rise eats tons of cash with no added efficiency or productivity. The patient has choice over where to go so bad clinics fails and close.
It's a shame we are not having an intelligent debate about the alternatives instead of pretending the NHS can go on as it is - it simply was not designed with current costs or demandin mind. Better to make a positive choice for social insurance rather than sleepwalk towards a US system.
You get what you pay for, really.
Insurance in Switzerland is eye wateringly expensive, but the care you get is exceptional.
My autoimmune disease was repeatedly diagnosed as scabies in the NHS, I am convinced I would have been diagnosed quicker and spared a lot of pain under a different system.
Even in these countries that have semi private healthcare, their governments still spend more narional GDP on their health service. Our health service is starved of funds.
If we needed to replace the NHS I would prefer the German system were insurance companies cannot exclude conditions and we're the government pays for the insurance for the lowest paid workers and for children I do not want a usa system were they let people die of easily treatable things because they cannot afford the treatment
I have experience of France and The Netherlands.
Both have top-up insurances on top of the basic level. If you've got those, you've got good coverage. If you've got those you've often also got good paying jobs.
But. France has a MASSIVE shortage of GPs in the countryside. It's nearly impossible to get appointments in some places. Cities are different - although finding a GP who accepts only basic healthcare in Paris is also very tricky.
In The Netherlands these health insurance companies have more and more influence. I've spoken to physiotherapists and psychologists who have told me that insurance companies can (and have) demanded to see their medical notes. There are psychologists now who are moving into private practice because they refuse to deal with insurance companies (so individuals pay bills and get reimbursed by top-up insurance companies, or just pay privately).
The Netherlands doesn't have good cancer outcomes in comparison to France. But, that's because the system looks at general group traits rather than dealing with the individual in each occasion as they do in France. It's also more reactive here (only responding when there's a clear problem) than proactive like in France, Switzerland, Belgium and Germany (that I know of) where you're more likely to get tests to rule things out, than tests to show what you've already got.
The NHS is chronically underfunded. Funded properly and managed by medical staff it would be out of this world.
In France we get to see a GP on the same day or next. We have the same GP, not one in a huge surgery. An appointment costs 1 euro and the appt takes as long as it takes. No 10 minute slots. It does have to be paid for through taxation but it works.
I spent a week in hospital in France and the care was super. A friend had the same issue in the UK and was in hospital for 2 days and then sent home. Her recovery time was significantly longer than mine once out.
I also lived in Belgium which has the mutuelle system. If you want a Dr, you go to the Dr and then claimed it back. When I was there it was something like E30 per visit. If you needed treatment you could sort it yourself if you wanted and pay more if you wanted. But even if you wanted to go minimum route the treatment was much faster!
In Sweden we pay for appointments 10-30 pounds depending who it is with. Once you have paid the limit for the year 150ish I think) you don't pay any more. Our dr also does free phone consults and direct referals without seeing him to physio, asd assessment, gyne, counsellor etc
Nb maternity is free.
Im in Denmark. Ive had mixed experiences. You get a lot more for free in the uk. The danes seem to think theirs is the only country in the world where you can see a dr for free which is a bit annoying. Theres a regional max waiting time of 31 days for child psychiatry which is great. Then they have to be diagnosed within 31 days or have a plan for investigation. However having said that getting them to accept a referral is a nightmare. They told me they wanted a referral from the gp then rejected 4 of them. In the meantime the speech therapist, educational psychologist and play therapist also referred him which is what got us in the door eventually.
But all in all its pretty good. Much like the uk.
I'm getting the impression that most of these wonderful sounding systems are for the lucky ones in stable, "proper", jobs who live in metropolitan areas?
TBH, although DP and I fall into that category, that group of people will usually be fine. I am more interested in how the system works for those on the bones of their arse - lost job, live in shittiest of shit areas, maybe have learning difficulties/not fluent in language that make jumping through bureaucratic hoops difficult?
Generally they spend more per head. We spend a tiny amount per patient compared to Scandinavia, France and Germany. Weirdly the governments we've had seen to view the NHS as a business instead of a service
France - great system if you have insurance and are in the system. GP appointments easy to get (suppose it depends where you live), great at sharing information (you take your x-rays, letters, test results etc home with you), no waiting for results weeks later - you wait an hour after MRIs, scans etc and are told then and there by specialist so you can ask questions. DH and DD both diagnosed and treated very quickly - can't thank them enough. Insurance is around 150 euros per month for a family - costs of treatment, prescriptions, appointments are paid back quickly.
Yeah my worry here with the pay appointment claim back would be how that would disadvantage some families who couldn't shell that out without consequences.
I can also see the backlash from some folks who book appointments and then don't turn up!
Not Europe but israel.
Similar set up to some of the others.
Four public insurance companies which offer the govt determined minimum basket. You either pay as a capped % of wages (if employed) or make compulsory contributions with national insurance (if self employed or not working). If on benefits, child, pensioner etc then you're covered for free. The insurance companies are reimbursed with the formula taking into account age and area. They can't turn someone down and no conditions for govt basket.
The. they can sell you too up insurance for extra cover, private care, alternative treatments etc. they can compete on that and charge what they want (not on an individual basis) and can impose minimum wait times before you can access.
I think it's a pretty good system. There's controlled competition. It's a bit unegalitarian with the top up but everyone has the basics. Also chronically underfunded under the current right wing govt...
Spain, the national healthcare is amazing.
But you have to qualify. Much better than the UK
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