NHS vs Elsewhere

I've taken my child to a & e here and in the US. As it was breathing related he was seen immediately at both places. Wait after was about the same. The main difference was the $1200 bill with the US one (mostly paid by insurance, but I had to pay £250), and that they prescribed steroids ($120) and an epi pen ($500).
My father had a stroke in Spain. The hospital was all new and shiny but they basically told my mother to get his kids over and there was minimal nursing - the family are expected to do alot of the actual physical care. We flew him on a medical plane home as soon as he was stable and the care he received at the hospital here was leaps and bounds better. Unfortunately he had another and didn't recover, but the hospital was amazing.
My son was in a motorcycle accident recently and he's had eight X-rays and will have his fifth hospital appointment tomorrow. Yes it's a two hour visit each time for 15minute actual face to face time but it hasn't cost us anything.
The main difference in the US system, other than cost, is access to specialists without the long waiting periods (of weeks or months). But you pay for it dearly. Here I'd rather the NHS and the option for paid for quicker medical care (yes I know that means many people couldn't access it, but they would not be getting even the basic care without paying out for insurance in the US). You can do that now anyway - I paid for a private MRI for my daughter as the wait was three months.
Plus the drugs. I have type 1 diabetes and even with insurance would be paying hundreds a month in the US.

@Justdontask I do like the idea of an annual check up. I have a health condition which was picked up by chance, during tests for something else

I have an annual smear and mammogram. I've had annual mammograms since I was 29 because my mum had breast cancer. This is in France.

Do you view translators as a good use of health funds? I moved here in my 20s. I've never expected anyone to speak English.

When I have encountered the system with non French speakers, as their unofficial translator, I've been surprised by HCW high level of English.

I have experience of NHS in the UK and of Kaiser and blue cross in the US. I'd far rather the NHS.
US:
Insurance part covered by husband's work, but we had to top up 2 grand a month for me & kids (this was around 2010). We had HMO insurance which has minimal copays etc so going to hospital had a copay of 100 dollers a night. I had my DS there so was in hospital two nights for that. I also broke my leg. Some places took our insurance some didn't. We had to go to 5 different places to get treatment. One place could take the cast off, which they did, but not supply the walker boot, even though they had them. They then taped the cast back on and I had to get a taxi to a different place. The admin and dealing with the bills was such a pita that there was a whole industry set up to help people with it.
They were keen for you to have lots of tests so you got more tests. For example DS hitting all his milestones as a baby, but had a big head - they wanted him to have an MRI to check for hydrocephaly without first checking that me and his dad both have a big head too. Getting contraception with Kaiser was dependent on you having a smear & internal exam. The streets (in SF) were full of uninsured people with chronic mental health problems.

I've lived in Austria and experienced healthcare there and it was excellent. Easy to access, state of the art, free at the point of need, fast and efficient. It is paid for by an insurance system with a small number of providers heavily subsidised and regulated by the government, so I saw a health insurance fund deduction itemised on my payslip each month, but it was a pretty small amount. Those on very low incomes had this funded by the state.

Overall most (all?) Western European countries spend more on healthcare than the UK, and I don't argue with the notion that we need to spend more on healthcare. However, for many many reasons, I don't believe that ploughing more money into the current NHS is the answer, so I would never vote for that.

I went to see family in EU this winter. It was frankly embarassing to explain to people why it's so hard to find a dentist or get to A&E in the UK. It was painfully obvious this will happen after Covid - it was not a sustainable system before and the cracks were huge, but the 'our NHS' rhetoric was too loud.

We need a co-paying system for routine appointments.

Penny wise and pound foolish is the mantra of the NHS. I have never understood why preventative checks aren't more of a thing. And I mean preventative at all ages, not just at some pre-determined age based on statistics.

I came from the US system where you go to the gyn once a year for your annual checks. My employers all had employee clinics several times a year for things like basic health screenings (similar to the Spanish example above), flu shots, etc - all done in a private screened off area somewhere. Part of it was to improve insurance costs, but part was to also make sure anything potentially serious was dealt with when it was cheaper! The insurance and profit motive pushes a competitive market which is lacking here. If you don't like a doctor or cant be seen in a timely manner, you just switch. Its not a big deal and it has nothing to do with where you live.

UK its been awful - I once spent 8 weeks in a lot of pain waiting on an MRI scan for a herniated disk and I now have a serious illness for the rest of my life because I couldnt access GP care in time and the whole one symptom = one appointment delayed diagnosis for half a year. US system would have picked up the issue FAR sooner. The initial treatments were absolutely frightening in terms of lack of proper cleanliness, poor nursing care, and hell, one hospital had rainwater pouring through the ceiling. I got into private care and its closer to what I would expect in a first world nation, but even there things are starting to fall through the cracks. The doctors and drug access are very similar but I cannot access, in a timely manner, supportive services such as PT and specialist massage, so I go private for that as well.

But it goes beyond the NHS into things like access to fresh vegetables and easy access to (clean) fitness places like swimming pools. This country is storing up a whole load of trouble for down the road and will require a completely rebuilt NHS to deal with those demands, not just some more bureaucratic processes thrown on top of existing ones.

Similarly it's encouraged that every woman has a gynaecological check up yearly which includes a yearly smear test and physical breast check

Women's pretventative healthcare is basically non existent. Tbh it seems lots of preventative healthcare is. Annual checks with gp? Nah, you crazy? Free basic dentistry? Same.

But a smear that tests for HPV every 3-5 years is the absolute standard now in the developed world- the UK, US, Australia, Canada, NZ, the EU etc all have this recommendation

Eu developed country test is done annually with your preventative check up

Similarly it's encouraged that every woman has a gynaecological check up yearly which includes a yearly smear test and physical breast check.

You hear a lot about annual smears in other countries as if this is such a great thing, but I struggle to believe that this is actually true, or else there are a lot of doctors who aren't following guidelines. There's a concurrent thread about US healthcare also claiming a lot of annual smears! But a smear that tests for HPV every 3-5 years is the absolute standard now in the developed world- the UK, US, Australia, Canada, NZ, the EU etc all have this recommendation (unless you need closer follow up for previous abnormal smears).

I take everything people say about their healthcare experiences with a grain of salt.

I live in Spain and the healthcare here is excellent. I have access to free state-provided healthcare and I pay a tiny amount each month through work for private insurance (which I have rarely used). This dual cover seems quite normal here. I think the biggest difference is that there is a much better approach to diagnosis and early detection, which obviously has a knock-on impact on the pressures on primary and emergency care.

For instance, it's a legal requirement for employers to provide access to a free yearly health check for their employees. I've never had one in decades in the UK but it's very comprehensive with blood and urine checks (checking cholesterol, most major vitamin and mineral counts, white and red blood cell count and probably other things I'm forgetting), physical checks for things like the curvature of the spine, blood pressure, listening to your chest, etc etc. If anything has come back as a possible cause for concern it's picked up in the review you have of your results and they advise if you can just make changes to your diet/lifestyle or if you need referrals.

Similarly it's encouraged that every woman has a gynaecological check up yearly which includes a yearly smear test and physical breast check. In the first one I had in Spain they picked up that it was highly likely I had endometriosis after discussing my period pain and then them doing an internal ultrasound then and there. This was followed up with more diagnosis to confirm it. This after about 12 years of being fobbed off by British GPs that it was just normal for some women to experience painful periods (I do realise endometriosis is very under diagnosed but the difference was very striking to me). I saw comments in another thread about why you would possibly need a yearly check up like this, but I think it's a great idea, serious problems could be detected a lot sooner.

Every time my partner or I have needed to see a doctor when feeling unwell I've been seen within an hour (usually 30 minutes) of arriving at the primary care centre and requesting an appointment, usually rather apologetically that the wait would be so long! Doctors have on a couple of occasions told me off for leaving it so long before going (I think here this comes from that British thing that you shouldn't see a GP unless on deaths door as you're wasting resources!). Prescriptions are very cheap for things like antibiotics. It's often recommended to turn up at the GP for an additional test/appointment after completing the course of antibiotics to check it has cleared everything up.

i think a big problem in the UK is that any suggestion that things could be managed better or differently is viewed as criticism of those who work for it, I think the next government needs to take a much more pragmatic approach to the struggles.

Here in Northern Italy I have a Gp that I can see on the day I ring, and all kids are registered with a paediatrician till they turn 14. There is no charge for this.

Had a gynae issue on holiday (aug). Consultant in hospital (nhs) said it needed urgent surgery to resolve. Waited for referral, heard nothing. Back home it recurred and went back to hospital. Again after repeat internals etc consultant agreed it needed urgent surgery. (Sept). March I get a letter for a gynae appointments. No reference to what it is for (I have more than one condition needing investigation). Go to clinic, assume it is info for pre op and told to get into a gown, no idea why. Consultant tells me it is for a gysteroscopy but then asks me what she is supposed to be investigating (!). Following hysteroscopy (which was a bit shocking considering I wasn't pre warned that was what the appointment was for) she concurs with the 2 previous consultants (and a specialist nurse from a separate occasion) that I need urgent surgery. Apparently despite repeat chasing and referrals, I was not on waiting list. No idea how long the wait for surgery will be.
Moved to Israel in the summer booked in with gynae seen the following week, who immediately sorted the problem.

Meanwhile, one of my children ended up with hearing aids on the NHS, due to hearing loss from glue ear, as despite audiology noting his hearing impairment was bad, ENT kept pushing the grommets surgery down the line. Also snored very badly. Waited several years. Since moving to Israel, he saw Consultant and had the surgery all within the space of one month. Contacted about my younger child with similar concerns, and whole process done within approx one month also (initial appointment, hearing tests and surgery).

I am a huge fan of the NHS, but the staff are increasingly in an impossible position and the system is collapsing. Understaffed, overworked, leading to endless waiting times. I never realised how used to we had become to putting up with poor service we had become.

For emergencies, the NHS can be incredible, but as soon as a condition is chronic, the endless waiting times do so much damage.

@Wallywobbles

Healthcare in France is pretty good. I had no specialist appointments canceled during covid.

Same here, only delay I suffered was a short delay to an op due to the local covid rate temporarily spiking, so elective procedures were postponed for about a month. System is definitely coming under more stress, we've had some protests by healthcare staff locally, then again we always have (it's France) but it's generally done in a way that doesn't effect patient care.

As a slight side on the subjects that of language, use of French and the system being French staff working in healthcare, civil service etc do tend to expect patients/clients to be able to communicate at a basic level in French.

I know in our local regional hospital you will find some docs and some nursing staff with a smattering of English and maybe Spanish but funnily enough they tend to try and stick to speaking French especially when things like rounds are being done and they have colleagues in the room. They certainly don't have interpreters for a multitude of languages "on tap".

I got badly burnt in Italy late evening about 20 years ago. Treatment was superb. I was seen in emergency department within 10 minutes and followed up with a demertology appointment at 10am the next day.. all c9ndicted very professionally in perfect English.

I think it was about £15

the doctors refer you for unnecessary tests imo as they get paid to do so-

No they don’t, there’s no financial link between private lab and X-ray providers and GPs. It’s true that they are easy to access - I can order investigations with everything back very quickly but that’s because the labs and radiology groups are in competition with each other, not because they are paying the GPs or specialists.

The issue is whether some tests are “unnecessary”. That’s hard to know, isn’t it? My teen daughter is a bit fatigued and dizzy at times, she had bloods showing normal iron, Vit D, thyroid etc. They weren’t necessary in that they were normal but equally it’s reassuring that they are normal.

In France the system is you pay at point of service. You are reimbursed by the state up to a point. The other part is reimbursed by your obligatory private top up health insurance. This private insurance is paid 50/50 by you and the company you work for. This is also true of prescriptions. But they are covered without you having to pay up front.

The state cover 100% (CMU) you have a particular set of circumstances eg cancer. Being unemployed means you'd need to pay for the top insurance yourself or be on your partners policy.

Healthcare in France is pretty good. I had no specialist appointments canceled during covid. When I moved here in 1995 it was noticeably faster. A mammogram used to be same day. Now it's probably next week.

One thing that does surprise me is contraception is not covered.

There are fewer GPs then there were. Rural practices are closing. Dentists are very difficult to get. Our GP is 45 mins away where the kids go to school. We do almost all appointments by video. We'd usually wait about a week for an appointment.

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Have had a couple of (expensive!) experiences abroad, but I have to big up the NHS here - yesterday (Sunday) managed to get an out-of-hours GP appointment for my poorly daughter within a couple of hours of calling 111, then picked up her prescription from a helpful chemist, one of many open on a Sunday. I was reflecting on how easy and prompt it always seems to be (round here anyway) where young children are involved, and always feel so grateful for our NHS. And all for free of course!

I live in Spain and use the state heath care. I see a gp the same day, have never waited more than half an hour at a&E treatment is of a very high standard. It's slicker and more efficient with excellent aftercare. My 4 prescription yesterday cost me a total of €1.20

Have lived in UK and USA, would probably prefer neither!

That said, am surprised someone said NHS postnatal was better as my experience was very opposite. It wasn't simply being in a ward vs. a semi private (2 people) or private room. the staffing levels were appalling for my first and there was no way the midwives could provide good care. I was unable to move properly as I was on a magnesium sulphate drip for pre-eclampsia (plus the anaesthesia was wearing off, still had a catheter, etc) and could not get any sort of help. In both US hospitals the nurses came round to check on me, and the nurses/CNAs made sure I was comfortable and had eaten. And there was a baby nursery at night (optional) plus with #3 since it was a private room DH could have stayed overnight.

In theory community midwifery, which isn't a thing in the USA, would have been wonderful except naturally I managed to get a rather mediocre one and wound up having to go back to hospital to have the consultant deal with a problem.

I wish I'd given birth in the EU country I can access health-care in. I could have ticked-off an epidural on a sheet and actually received it.

Took my child with severe eczema there. He had a subsidised blood test in a private clinic (can get tested for anything YOU want). We saw a GP and a pediatric dermatologist within a week. Got an appointment with an immunologist in the coming fortnight but we never made it, no need- my son was already nearly healthy and had a clear skin by the time we returned to UK.
Our NHS pediatric consultant was in awe and wanted to know what on earth happened to DS abroad.

I'm considering a basic private health-insurance for tests, specialist consultations and check-ups.
NHS is only of use in life or limb situations... Unless you get stuck in A&E. If one makes it past A&E, surgeons seem quite able.

The previous poster who said " The NHS system is the best in the world" . I strongly suspect that you haven't lived overseas and experienced something other than the NHS. I have lived in the UK and now live overseas. I worked in the NHS for 15 years . I have had a baby in the UK and also one overseas feel like I can comment with authority. The NHS is still great in an acute health crisis but the lack of funding means that chronic health is neglected and serious diagnosis is delayed because of lack of access to GP's and long waiting lists. The NHS tries its best but it's crumbling before our eyes.

Living in the US, the delivery and access to healthcare is better than the NHS but you pay for it.

The Uk needs to wake up and realize we can’t afford to keep things going as they are. The NHS isn’t properly funded but it is also abused by a lot of people. I don’t think it would be the worst thing to have everyone pay something ‘out of pocket’. If everyone deemed ‘healthy’ was given £200 at the start of the year and charged £10 for each appointment and script, I think we would see a sudden mindset change. People would only book appointments needed and would show up. If they ignored an appointment, charge them £50.

The other idiocy of the UK NHS is because DH and I are over 60 all our prescriptions are free despite the fact that we both continue to work full-time. Further because I have had an underactive thyroid for more than 30 years, I have received every single prescription free. I only ever needed the levothyroxine to be free. The system is an ass.

i lived in the Middle East and it was easy (for me) to access healthcare. But they had very different descriptions of diagnoses and very different treatments too.