People are apparently clamouring for a health system funded by insurance so...

[Hanschenklein]

Those MNetters in countries outside the UK how much do you pay a month for your health care ? Is your country's system completely financed by this insurance alone or does your government contribute too ?
People call the NHS a financial black hole. They resent the fact that ever increasing amounts of money are apparently being ploughed into the service to see no real improvement. They seem happy to pay via an insurance style system instead.
So how much do you and your family pay ? How do you contribute towards your pension in the absence of national insurance payments ? If you pay a fee to see a GP does that put you off going ? Do you struggle to pay this insurance if not well paid ?
Most importantly is your health service sufficiently staffed, safe and prompt ? Are HCPs in your country valued, well paid and happy in their jobs ?

Are they clamouring? In the UK? Have you got a survey to show how many?

Define 'people' in this context, please, OP. Which people?

This government, or any UK government better not dare even think about it.

Cunts.

It’s mandatory in the country I live in for employers to pay. I co-pay for doctors appointments of £10 (this is 10% of the cost, but I think £10
is a cap anyway). I can go to any surgery in the city and be seen on the same day. Medicine is covered too. There is provision in government hospitals for people who don’t have insurance.

Expat Brit here, now an American citizen since 2008 and living in the USA. I am past the age for Medicare so I benefit from that policy.

I pay a basic $93.20 a month for basic Medicare, which pays 80% of any covered bill. I also pay an additional $366.40 a month for a "Medigap" policy that covers the remaining 20% of any covered bill - they don't cover anything that Medicare doesn't cover, so if (for example) I wanted to have a non-malignant mole removed, I'd have to pay separately for that. My husband pays the same as me for his basic Medicare, but has a Medicare "Advantage" policy that is pretty inexpensive and covers most other stuff but limits where you can go to get your healthcare. We also pay $128 a month between us for a dental insurance, which covers 60% of any procedure. I could pay separately for an insurance policy that covers opticians, but I choose not to.

Before we get to the argument about the NHS being funded by taxes/NI, we also paid into Social Security before we started drawing our Social Security pensions, but unlike NI that has no health care component unless you are very hard up and need Medicaid, and what you get from that depends very much on which state you live in. Some states chose to expand Medicaid when the Affordable Healthcare Act came in under Obama, but some did not.

I'm in another country yes, and my medical insurance is one of my higher bills monthly. Yes we only use it when really necessary.

I'm not sure if you are asking for more details or if you are implying this is the way UK may be headed.

I was an expat in Europe and it cost me around £90 per month. The system was much more efficient, you could even choose your doctor and hospital based on online reviews, etc - like you would a private doctor here. The only thing I would say negatively is that the ambulance service was more like a taxi service with semi medically trained staff. They aren't equipped like ours in the UK and the staff aren't trained to the same level. I would take their system over the NHS ay day. Also you had to keep your own paperwork and take it with you to appointments as there isn't a central system.
I was on benefits at one point and my medical insurance was paid for by the government during that period. I don't understand the obsession with keeping the NHS. The system needs updating. Too many people are abusing it and I'm not just talking about patients.

There are a lot of different systems - obviously nobody in their right mind wants the US system.

We're in Germany and we each pay 15.5% of our income - deducted from salary the same way our compulsory unemployment insurance, care insurance, pension insurance and income tax and solidarity tax (all separate payments) are.

Obviously this is a massively different € amount from person to person.

It's theoretically impossible not to be insured (and certainly illegal). Children are covered by their parents for free (in some circumstances if they're in full time education and not earning up to age 27). "Dependent" spouses (earning under 500€ per month or so) are covered for no extra charge on the "main earner's" state policy. Unemployed people and people in receipt of state pensions without a working spouse (including anyone medically retired) are covered by state payments.

The main problem is that people earning over a certain amount are allowed to opt out of the state insurance options (there are multiple state options) and be privately insured. The "I'm alright Jack" high earners do this because it's actually cheaper for them when young and healthy and they get some preferential treatment (there are doctors in cities who only take private insurance, though it's not really a phenomenon outside big urban areas, and some policies cover things like IVF more easily, and most give private hospital rooms and other luxuries accommodation wise).

Then they get old and less healthy and perhaps their earnings reduce or other outgoings are high and can't afford the suddenly higher premiums and want back into the state system which they opted out of because they didn't want to "pay for everyone else" with high premiums when they were young and healthy - and they aren't allowed back in.

On the less karmic side self employed people have to be privately insured, which is just stupid especially as there are plenty of low earning self employed people - cleaners for example (which is why you can't get an above board, doing everything legally and happy to provide bills/ receipts cleaner for less than 20€ per hour minimum...)

Also the private insurance is a real problem in some cases when children with serious chronic illness are on a parent's private insurance or have their own private policy and become adults as there are situations where it's near impossible to get them onto their own state insurance policy and their own private policy is unaffordable.

So it's a good system but IMO the private insurance shouldn't exist - everyone should have to pay their 15.5% (ish, there are some differences between state options but they're broadly similar) state insurance.

I am living in a country with a split of public and private.
So you must have a basic policy., choosing your own risk begining at €380 ish, which if higher can decrease monthly payments. Then add on extras such as dental, extra physio.
This €300 fot 2 adults. Kids are covered by the goverment for medical and dental until 18 but not optical or orthodontics.
The public system has been good to us but we are not heavy users.
I would rather pay my health insurance to the government.

The companies raise the own risk each year. This year we changed providers to save money but we all so noticed the polices were very paired back.

For things like orthodonty and glasses you need to really work out if it is worth being insured for or beter value to pay yourself.

It is a pain here because you can only change providers once a year. So you have to be prepared on that date.

Brit in Switzerland here:
The Swiss healthcare system is based on a federalist structure, which means that the federal government, cantons and local municipalities assume different tasks in the healthcare system. For example, the government specifies the rate of deductibles and accepts or rejects changes to premiums, while the cantons specify which benefits are provided by which hospitals. They also set the wages and working hours of hospital doctors and nurses. In addition, the state and private sector have to work together. Private health insurance companies provide both basic and supplementary insurance, but they must strictly observe the regulatory requirements of the Federal Office of Public Health (FOPH/BAG) and the Financial Market Supervisory Authority (FINMA). In accordance with the Swiss Federal Health Insurance Act (KVG/HIA), basic insurance is compulsory for anyone who lives in Switzerland. To supplement the benefits available under basic insurance, you can take out supplementary insurance plans that cover, for example, dental treatment or single-room accommodation during hospitalisation.

You can shop around for health insurance from a number of providers - basically everyone uses the same hospitals/Doctors. There is a go compare for insurance and you can change provider every year.
A lot of people have their health insurance paid by their employer - it’s a typical benefit. This means DH has private - more choice of doctors/private hospital room, glasses prescription paid every couple of year, money towards gym membership. Whereas at a SAHM we decided I would have basic - it’s cheaper. So none of the above benefits but I still wait as long as DH for treatment but I can’t choose my surgeon if I have an operation- he can. There is also semi private. However I could pay for a private room if I had an operation if i wanted too.
Some things are standard eg certain numbers of hours of entitlement to psychological help - but there is a shortage of places after Covid.

You also choose how much to pay monthly as opposed to how much franchise you pay - so lower monthly payment and higher franchise and visa versa. So it’s a bit of a gamble - how much medical care will I need this year kind of question.
But to put in context when my son was mentally unwell he has a psychologist and psychiatrist working with him within a couple of days. And I was struggling so had help for myself within 2 weeks - weekly therapy.
DH has a mental health breakdown and I called the out of hours doctor and they were with us within 1 hour and 2 days later he had weekly sessions with a psychologist who could also prescribe medication.

Ore Covid a wait would be a week or month maximum- for most things eg specialist, mri. If your doctor thought it was urgent eg I had a stomach pain and that afternoon I had an mri. Now it’s a bit longer. DC had to wait three months to see an allergy specialist. I waited a month to see a urologist- however I was then treated on the spot and provided with medication.
It’s always well staffed. There have been issues recently with the pay rates of care staff.
Here they have a strong apprenticeship scheme so many of the nurses and care staff are young and motivated and have a career progression.
It certainly isn’t perfect. It isn’t cheap. Currently there is a shortage of pediatricians and psychologists. On the flip side all children have a pediatrician- not a GP. Even at A&E you must take your child the the specialist child’s A&E not the adult one.
And all women have a gynecologist as standard and yearly controls are included in all insurance plans as standard. But it works.

BritinMe do you have the option of just doing pay as you go, so to speak?

I’m in Switzerland. We pay about £800/ month for our insurance- this is on the Hausarztmodell (GP model) - the more reasonable option (you can pay extra and go straight to a consultant. We pay about £80 per GP visit on top of that with a capped co-pay system.

The lack of standardised care does mean the treatment you receive depends on your GP. Some give out antibiotics like sweeties, others are more sensible. They also always give you medication. There’s a sense you need to get your money’s worth from the appointment, so people are less likely to be told to monitor it and come back, or to have a hot bath. You go for tests / ultrasounds etc much more easily.

Oh I didn't cover all the points.

No fee to see a GP (there used to be until a few years ago a fee of 10€ per quarter payable only if you actually went but apparently the revenue didn't cover the administration costs. It was complicated by the fact that we can self refer to specialists (nobody goes to a GP about gynecological issues, everyone goes straight to a gynecologist) and the 10€ was payable for each separate doctor if you self referred but not if you had a referral - obviously this drove up administration costs and wasted some GP visits done for an obvious referral).

The media is just as full of stories about the health system being in crisis as in the UK - there is a recruitment and retention crisis across the board here too.

However if we want to see a GP we always get an appointment on the day and this is standard - people complain about waiting times but they mean in the waiting room, not being unable to get an appointment.

You can't not pay into your state pension, you can't not pay your health insurance, you can't not pay your unemployment insurance, you can't not pay your care insurance - all of them are compulsory deductions like NI in the UK - they're just a lot more as a % than NI is!

People in the UK kid themselves that they pay a lot of tax, but in comparison to other countries with a comparable social and health safety net UK compulsory deductions are low!

Can you just see a private doc if you don't want your employer to know?

Clamouring?? I dont think so

No one wants a US system, but it also wouldnt be unreasonable to charge say £10 for a GP appt provided you could actually SEE a GP! A small fee for an ambulance of say £50 for non cat 1 emergencies etc.

Mostly I want the NHS to actually claim back the money from people who use it but arent entitled to do so. Tourists and those who dont pay NI for example.

I dont believe the answer to fixing the NHS is throwing more money at staff. Whilst I sympathize about the pay and cost of living issue, that isn't unique to NHS staff. I'm not getting an inflation rate rise either, never have done. DH is police and they're not paid well either and arent allowed to strike. He has PCs using food banks like nurses. We are all feeling the pinch.

If you keep telling people how crap it is to work for the NHS, well, no amount of money will convince people to work for the NHS as they're told it's a crap job to work in and they dont want the stress irrelevant of the pay when other jobs elsewhere will pay the same and the cycle of being understaffed will continue!

"Mostly I want the NHS to actually claim back the money from people who use it but arent entitled to do so. Tourists and those who dont pay NI for example."

You think if someone earns so little that they don't have to pay mandatory NI contributions, they should have to pay to access basic healthcare? Or, in practice, suffer and get sicker, because they might not have the money?

Oh yes dentistry is covered too, but not everything (check ups and basic cleaning by the hygienist is covered twice per year but after that it depends - there are a lot of potential charges and it's common to have supplementary dental plans, often as an employment perk). Orthodontic care for children works on the same scale as the UK where it's free if the issue actually prevents biting/ chewing/ impedes speech or causes serious social issues but in most cases parents end up paying part of the cost.

I don't know anyone who can't find a dentist who accepts state insurance, and if you change dentist you usually only have to wait about four weeks for a first check up.

USA. I have absolutely gold plated health insurance through my work and pay $118 out of each pay period, which is roughly $236 a month for my whole family. I also put $240 a month into a special health savings account (HSA). These come out of my salary pre-tax, so it lowers my overall tax bill.

I'm pregnant right now and don't have a co-pay for any prenatal appointments - they're 100% covered by insurance, except for things like genetic testing. I go to a fancy(ish) concierge GP who charge $200 a year for membership. Each appointment is a $30 co-pay, but if I went with just a regular doctor it would be much less - I like the access to telemedicine, an online chat and an app for booking appointments, messaging my doctor and renewing prescriptions.

DH's insurance covers our vision and dental - I can't remember how much it is, but I think about $100 for the whole family. He also pays into an HSA and his company tops it up with a match.

Here is the Wikipedia page on German health insurance:
https://en.m.wikipedia.org/wiki/Healthcare_in_Germany

You pay 7.3% of your salary for health insurance and then so does your employer. If you are unemployed the state pays. This covers your dependents too.

You can always get on the day appointments with your GP and I’ve never waited long to see a specialist. Maternity services in my area are excellent. Mental health services have been very busy since the pandemic but I don’t think it’s as bad as the U.K.

You do need to remember to take your insurance card to appointments, but there are no fees to put you off getting medical treatment.

The key is that although it’s insurance based, because government and employers also contribute, the rates charged by medical services are subject to negotiation. It is in the government’s interest to keep the rates lower.

I pay 45 euros a month. This covers me for dental stuff and glasses, although if I wanted very expensive or cosmetic dentistry, and glasses, I would pay above that. It covers me totally for the doctor, specialists, hospital stays, and all main medecines (so not vitamins for example). It also means I get my flu jab paid for, although I'm not entitled to one (If I was entitled I wouldn't claim it off the insurance). It's not really insurance, it's like a building society is not really a bank. So they don't make a profit off me. If I was unemployed, I would have this paid for me. I pay when I see a doctor and it goes right back into my bank account so I pay the doctor, the social security and the insurance pay me back.

There are problems with health care, especially in rural areas where there are not enough doctors.

I pay into the social security system through my wages too. I could decide not to pay the 45 euros a month and take a chance. It is totally up to me. If I got anything very serious, it would be 100% covered.

I really don't understand the question about pensions though @Hanschenklein

@EmmaEmerald I'm in the US, and you would need an actual money tree growing in your backyard to pay as you go. As an example of how much healthcare costs, one of my DCs had a bill for a 15 minute telehealth appointment for $220 last year.

There are Health Savings Accounts which pay for medical bills, but people relying on them are basically taking a huge gamble that they won't be diagnosed with cancer or an aneurysm, etc.

The ACA opened up the health marketplace to self employed and/ or uninsured individuals, who can opt for their level of comfort when it comes to deductibles, levels of overage for various elements of healthcare like women's health, behavioral health, etc. Premiums can be paid 100% by the covered individual or subsidised for low income individuals.

People whose income falls below a certain threshold can apply for Medicaid, whose coverage and T&C vary from state to state. In general, it's better to be poor in a blue state.

The cost of a visit to the emergency room or the doctor is definitely a factor in decisions to make an appointment or go to see about some acute condition.

Exactly.

we do pay for our healthcare here, via tax & NI!

No, I mean people who are visiting this country for tourism, temp work visits etc who dont pay NI should pay for their care

Low income households are on benefits and so get the NI credits that way.

Nice try at baiting though 😄😉

There are also some medical practices where you pay an annual retainer to the primary care doctor and get whatever office visits or even home visits you need. Some obstetricians do this too.

However, all other costs are out of pocket - lab charges, any hospital charges, anesthesiology, newborn care, etc.

Basically, people pay to have a GP available whenever they need one, and don't have to wait a week or more to see a doctor for strep, for example.

The NHS definitely needs an overhaul. But if we move over to a private insurance based system and as the NHS is the biggest government outlay, then would taxes be reduced accordingly? My guess is nope!