NHS vs Elsewhere

I’ve been treated in the UK and US and frankly there was no comparison, the US hospitals and care are phenomenal. All private rooms, entire teams of top-notch specialists (and you actually see each one daily), and I’ve hardly paid a thing for it with my insurance. The speed that everything moves here is also amazing. It’s a lot easier to get the latest treatments/prescriptions which makes sense as they develop so many of them. I also like how much control they give you. Like they’ll say “Your treatment options are A, B, C, and D” and lay out how each works and the pros and cons, then offer which one(s) they recommend, then ask you “Which treatment option would you like to try first?” I was stunned the first time I was asked this, I’d never been given an option for anything on the NHS. They just told me what we were going to do.

That said, one summer when I was here visiting when I was 19 I stupidly broke my arm and also stupidly had not gotten my insurance set because I was a procrastinating teen. I was terrified that it was going to cost a fortune or that they wouldn’t treat me. They fixed me up and when I told a nurse that I was worried about the cost/lack of insurance she told me to get my bill and then take it to the hospital finance department and tell them what had happened.

So a week or so later I did, and they asked me questions about where I lived and if I worked. I’m a dual citizen and was a student so they had me fill out some paperwork and then said “Alright, you’re set! Obviously you can’t pay this bill so it will be waived. You’ll get a letter saying that and a statement with a $0 balance in a week or so.” I asked her how that worked and she said that the government reimburses the hospital for people that can’t pay if they are uninsured or make less than whatever amount. Apparently a lot of people just don’t bother to take advantage in spite of the fact that they tell everyone “if you can’t pay your bill bring it in to our financial office and we’ll help you.” I sure as heck took advantage! I didn’t tell my parents what I’d done regarding failing to get my insurance together for years and years. They wouldn’t have let me spend summers in California anymore if I had! 😂

Ive always had excellent treatment on the NHS- Childbirth plus repairs, eye problems (seen in one day by professor!) GP for depression etc - but a while ago - and I did have private insurance as back up (only ever used for non emergency)
I'm in Australia now and generally the equivalent to NHS is supposedly good- easy to see GP etc, DS has excellent care for appendicitis - you get referred to specialists easier but there are a lot of additional costs that medicare don't cover (eg a GO visit -part of it will be covered part not - I think if you can't afford you have to hunt for the cheaper GPs- like hunting for an NHS dentist)- the doctors refer you for unnecessary tests imo as they get paid to do so- you are left unsure what you actually need.
You end up needing private health insurance to cover all the costs

@MMMMMaria firstly I don't recall a brilliant NHS between 2000 and 2010. Grommets weren't available for my DC, 28 day prescribing was introduced and I recall waits of up to 14 days for a hold to be reviewed by an orthopaedic surgeon after a break had been patched up in A&E. Secondly if the NHS was so fab at that time, why were GP's, hospital drs and nurses all complaining so much? That's a very serious question and I suspect the NHS is in the mess it's in now because too many boys and girls in the NHS cried wolf. That is why I now have very little sympathy.

On a practical note as a family we pay taxes in the order of £100k. It used to be far more. In addition I pay £240 pcm for private healthcare. In the last 8 years, this is what the NHS has not covered:

DD - MH support for depression and anxiety manifesting as cutting and overdosing. CAMHS refused to accept her. Private healthcare paid about £15k for psychiatric support and day therapy. I paid about £7000 for therapy and diagnosis of ADHD which was the underlying cause. NHS support - a big fat zero. My GP told me to find a therapist off the Internet. About £22k over two years. Happily dd recovered. She would not have dine so had we been reliant on the NHS.

Me: failure to diagnose a fractured vertebrae in A&E. Radiography report contained an error. GP didn't look back at notes. I didn't have the radiology report. GP refused: physio, and any other investigations on the basis that pain was muscular. Private referral to a spine consultant, MRI, XRays, 3 consultations. About £2k to confirm what I knew had happened in the first place.

Above due to already diagnosed osteoporosis for which I had already had 5 infusions of zolendronate. The best intervention now is teriparatide. Ah but I'm not quite old enough to meet the bar for the nice guidelines so I have to self fund the medication £2500 for two years.

The last dental crown (root) was about £1000. Two fillings and Xray and check up last year £650. 6 monthly check ups are £80, hygienist is £60 four times a year. I have no beef with dentistry - it is efficient, polite and well run.

Even with private insurance - A&E is not covered, GP referrals (which can take weeks) are required. Notwithstanding all the lengthy waits when one turns up on time to NHS facilities, the surly attitudes, the lack of communication generally and the impression given that we shoukd be grateful for an unpolished turd because it's free. No human should be grateful for suboptimal standards because they are free at the point of delivery. The NHS is funded by the people for the people but seems to exist for its own internal system.of excuses and bureaucracy.

The system is spectacularly inadequate, disingenuous and ungraciously delivered. The NHS hails equality and inclusion with its EDI Directors and rainbow crossings yet it serves women very badly minimising women's illnesses and women's pain.

It has to change.

I apologise for the essay.

I had experience with emergency health care in Portugal and it was on a par with uk.

Also in Greece which was so underfunded it made ours look rich. They were also very skilled clinicians.

Those are the only two other counties I can comment accurately on.

Lived in and used healthcare in us, uk, Switzerland and china. Uk by FAR the worst for healthcare. In the other 3 countries I never had issues accessing healthcare, and any diagnostics were often available same day, but never more than a 2 week wait MAX. Quality of care also far better - more likely to deal with a fully qualified doctor and said doctor more likely to have time to actually engage. In the UK, after a devastating diagnosis I was hospitalised for 2 weeks without ever seeing anyone more senior than a junior doctor (and only twice in those 2 weeks), and only saw a specialist 3+ months after diagnosis; diagnostics took 6 months vs full process taking days/weeks in other countries. Yes, the other countries required insurance and some direct payment for healthcare , but overall taxes were lower vs UK so financially no real difference.

it is a major source of anxiety for me - My greatest fear is me or my kids getting really sick in the UK, worrying about whether we would receive adequate care. I have a chronic condition with potentially life threatening complications if not well controlled, have reached out repeatedly over past 6 months to gp about signs that medication isn’t sufficient, but it is impossible to get time with a doctor.

Worked in the NHS for years, had investigations and surgery several times though the NHS. Had investigations and surgery in France. There is no comparison. France's healthcare system is infinitely better.

www.bigissue.com/news/how-much-does-the-nhs-cost-the-uk/

Not sure if the above link works for others, but it illustrates that the U.K. doesn’t really underspend compared to others. The US system sounds much more inefficient to me.
Having lived in lots of different European countries and Asia, I think care in the NHS is good once you get to see the right doctor. It is the getting there and communication that is seriously lacking compared to other high income countries. Accessing health care should be easy and straight forward and not a struggle. That makes for a healthier and happier population.

@Allthegoodnamesarechosen to be fair to the French, this clip is the reality if there doesn’t happen to be an Urdu/Cantonese/Spanish speaker on shift at the precise time you need them.

We do have cordless phones (never use your own mobile for languageline! It is a premium-rate number, guess how I know this), but that aside that clip is less black comedy and more gritty documentary.

Small Greek island with a clinic that ran Monday - Saturday.

I went to the pharmacy who explained it was a medical emergency. The dr was called and opened the clinic for me within 5 minutes.

The dr explained that I needed a gynae assessment and had consulted with the hospital on a larger island - they were happy to have me.

I explained I was returning to the UK the following day so she gave me 5 days of antibiotics there and then.

Came home, called out of hours at 7pm and had a call back at 3am (which I cancelled in my sleepiness). Cue having to start the whole process again. The process was frustrating and pointless.

Thankfully the Greek dr was aware of how it is almost impossible to get treatment in the UK. Our A&E regularly has 9+ hours of waiting.

On my to-do list is arranging private healthcare for me and DC.

The main thing I noticed in France was how resolutely French it was! There a quite a lot of lovely extra services (like hand massages during chemotherapy) but everything is run totally for French speakers and for a French ‘ way of life’.

I was talking to a HCP about maternity services in England, and I told her that there are hospitals in big cities in England where 96 languages are spoken In The maternity ward. Everything we received through our local very rural GP in England comes in at least eight languages, and several different writing systems. She couldn’t believe it. I asked her what happened if a patient didn’t speak French. She just gave a very Gallic shrug.

Swiss system - experienced it as a tourist. DH needed emergency surgery. Care was great, food was great, clearly significantly more money/beds/staff than we have in the NHS. Was free for us as travel insurance covered it. NHS did provide excellent surgical aftercare and physio when we came back to the UK.

Canada - have used the system there both as patient and physician. Massive waiting lists for secondary care (18 months or more) as GPs do far less chronic disease management and specialists work at a much lower intensity (I see 15 patients in a clinic in the NHS, average was 6-8 in Toronto as appointments were twice as long and there is no overbooking).

Very hard to actually get a GP as well, which meant that people who were less health-literate/engaged tended to present very late - these people tend to be on their GP’s radar in the Uk, if only to get access to other services.

Actual care once you were in the system was very similar to UK, both in terms of the physical environment, standard of treatment, and bedside manner.

Provincial healthcare is free to residents (paid by taxation) but doesn’t cover dental, drugs, physio, equipment like wheelchairs etc. So some of my patients were spending $200 per month on drugs, and lots more just weren’t taking them (many renal patients are on 10-15 medications to keep them alive). DH paid $80 for a week-long course of amoxicillin, would be £9 here.

Overall I think the average person gets a slightly better deal from the NHS, but not by a massive margin, and HCP working conditions were significantly better in Canada.

I think this quite hit the nail on the head

This is so interesting

The NHS is not free. It costs about £4000
per year per person. It is just that the higher rate tax payers in U.K. pay more for it and others don’t pay. So many people get it for free but many pay far more indirectly for it than they would if living in Eg Switzerland and paying 500 pounds a month.
Many of the higher rate tax payers now also have private health care in U.K. too. And many of those same people are powerful and wouldn’t mind privatisation (because it would be better and cheaper for them personally) and some would even benefit directly.
However, given the low wage economy the U.K. currently still is I really cannot see how poor people could also afford private health care. Ill poor people is very inefficient and leads to further problems in society which eventually means even the rich have a lower standard of living.
Yes, Swiss health care is better, but until people in U.K. get a high basic wage like in Switzerland, forget it.

I ended up in French A&E in December. This was on holiday. 14 hour wait to be seen. I had cracked my head open and needed stitches. Was put on a bed though and “padded” before being told the wait. They were lovely and hospital seemed as nice as could be.

It was almost reassuring that it’s not only us with nightmare waits when you’re not in a life threatening situation but still need assistance.

I’ve been in hospital in Hong Kong (government), Singapore (private), Jordan (private), Indonesia (private), Switzerland (local insurance funded) and the UK ( NHS and Private). Would always choose to go NHS… depending on the Trust.. over and above anything private here or abroad.

I’ve had care in the American system. We have decent health insurance but have still had to pay out thousands for non-covered expenses. Some care has been exemplary and some pretty shoddy. Post-natal care, for example, was a bit of a nightmare.

But there aren’t long waits to be seen. And all the doctors I’ve had have seemed engaged and attentive. (Whereas NHS GPs have often seemed to be rushing and I’ve felt fobbed off on several occasions).

I do find the US system bureaucratic. I spent 4 months going back and forth between by doctor, hospital imaging and a specialist before I getting a course of physio approved for my shoulder, then had to do it all again because I changed insurance company and the second one didn’t trust the first one’s assessment. And then after it was approved the insurance company sent me a questionnaire I had to fill out giving details of how I got injured so they could decide whether or not to sue the owner of the stairs I fell down. I’ve also had to phone up a lot getting payments sorted out and chasing medical records and the like.

The French health care workers are widely on strike, though. Not looking very happy in France.

In our family we have a load of dental issues going on.

We are paying privately.
We still have to wait MONTHS. MONTHS to get a filling, temporary crown or an initial assessment by an orthodontist.
My American relatives can't understand these many month waits for simple dental/orthodontic care.
Neither can I , actually.
if the system is so broken that even private patients can't get timely care. It is super super messed up.

My dad is with Blue Cross, albeit still Medicare. He has a chronic neck problem. Saw doc about it ~2 weeks ago. He's since had one scan (CT?) and in next 14 days he will get MRI, some xrays, and then consultation and clinical plan about what is causing his terrible neck pain.

Meanwhile I wait 3 months to get a small filling, when I'm paying for it privately.

Btw health insurance in the Netherlands is basically a tax because it's illegal not to have it. The hospitals are all "public" (it's not like BUPA/Spire who have their own parallel system).

I've also lived in France and while I believe their healthcare is really good, I've found their bedside manner isn't. There's no privacy or dignity - I had to stand top naked for an X-ray with multiple people - men and women - coming in and out of the cabin to chat. It was horrific. I couldn't move and was crying. When the lady came to move my position she asked why I was crying and I told her and she said "Oh it's just like being at the beach!".

Had another doctor offer apologies to me when giving the positive result of my official pregnancy test, then proceed to tell me how much children ruin your life (he had none). He wasn't joking either. I changed dr and found a lovely one, but it was quite unbelievable. Also come across the stereotypical tipsy rural GP. I've had good ones, but it was hit an miss - and the misses were really bad!

PPS. Properly funded and properly managed!

PS I agree with PPs saying that a properly funded NHS would be viable, and even excellent. I am not convinced the electorate is willing to pay for that, however.

The NHS recently provided lifesaving surgery for DH. Excellent standard, as was the care on the CCU where he stayed for three extra days because of bedblocking. But nursing care in the ward was substandard in several ways - I am able to assess this. I am not really criticising the nurses, as they were short staffed and doing their best. But DH developed massive sepsis and ended up spending an extra week in hospital, requiring intensive nursing care. Those shortcuts were at best penny wise and pound foolish.

I really find it difficult to imagine that standard of nursing care either at the hospitals our joint American HMOs were affiliated to or in the EU countries I know well.

Also our health outcomes are poor on many measures compared to similar European countries, and even poorer ones. American outcomes really depend on whether you have access to decent care. That’s morally reprehensible, but those who do have access also have better outcomes. It’s the American without health access who bring their stats down.

I live in The Netherlands. I find the healthcare here better then the U.K..for now. Thing is though that I pay €213/month for my health insurance package plus an excess of €385 and pay for things like contraception as well as some prescription medicines. Kids are free.

This gives me "free" treatment in any hospital of my choosing, physiotherapy, basic dental care (checkups and hygienist), 80% reimbursement on mental healthcare (if you need more long term mental healthcare it's 100% free). I can't remember what else.

I also pay 49% income tax.

I don't know whether fellow Brits really understand the amount of investment that's actually required and how much it's going to cost. I pay a minimum of €2941 annually for my (good level) healthcare. I think the cheapest policy this year is around €185 with the same excess, and if you increase the excess to about €750 you can pay about €100 per month.

The NHS is a brilliant system. It needs revising and updating but the idea is sound. The biggest problem, however, is that people expect it to be "free". Nobody will vote to pay higher taxes/NI contribution to fund it, or to pay between £1000-£3000 annually to access it, never mind both!

I think the WHO and other organisations actually have comparisons of different healthcare systems based on data rather than anecdote. Also, if you look at how the NHS was doing 10/20 years ago compared to other systems, and how it's doing now.

I have lived in a number of different countries

When young, and nowt much wrong, then the convenience that comes from private (insurance) systems is great.

But if you have something seriously (and potentially expensive on an ongoing basis) wrong, then hell I'm grateful for NHS. Because making those decisions without reference to cost is invaluable