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 ?

I'm in The Netherlands. I pay €5000/year insurance for two adults, on a discounted (via work) top care package. The excess is €385, the lowest level - actually this year it's more.

I can choose which hospital I want to use (not only ones the insurance company says) and I get fully reimbursed on most things, if I have to pay out of pocket in the first place. I pay about €417 per month. That includes physio and basic dentistry (checkups). Lenses are covered to €150 per two years. My actual lenses cost about €800 per two years due to a complex prescription...

Children are free.

Mental healthcare provision is better than the U.K. There are waiting lists, but not that bad. There are two levels of treatment. Level 1, which is your 12 sessions of CBT. Depending on your level of coverage, that is not fully covered. If you need more serious/long term care, that's Level 2 and is fully covered.

Contraception is not covered.

Most dental work is not covered.

There is an out of hours GP and that costs about €80. If you go for something that's not a minor emergency then you pay out of pocket.

It is a legal requirement to have Dutch health insurance. There are many cheaper policies - I think the cheapest is €100/month for students and/or higher excess. You cannot choose your providers freely with those policies - which means waiting times can be longer - and they don't include things like physio.

What people are not factoring in with insurance companies is collection of your health data. The insurance companies here collect information on your mental health treatment, for example. It's not anonymised. There are psychiatrists and psychologists fighting this, because it breaks patient confidentiality. At the moment they cannot use it he info to discriminate against you (as long as you can afford a policy, you're entitled to it), but I cannot see any other reason why they'd want it long term.

Also, the health insurance companies are involved in salary payment of medical staff.

And health insurance companies are involved/influence the government's decisions. During covid health insurance companies were complaining that they couldn't afford to pay out all the covid costs, for example. The government had to involve them at least partially, in discussions.

So while individual payment is an issue, there are much bigger issues involved when profit gets involved.

I’m in an optional mixed system which works well. We have private insurance. It’s flat rate for tiers here. It’s not the type of insurance that goes on risk, so if everyone in your family needed heart surgery around 30 it doesn’t matter, you pay the same as others whose families have no heart problems for the same chosen tier.

It does mean getting surgery faster as you will generally have it in a private hospital, and many now are equiped for complex surgeries. However, we still have a large wait time to see many specialists privately depending on specialty. Still shorter than waiting in the public system though. I will be waiting 7mths for one of my initial appointments and that’s with strings pulled to get an ‘early’ appointment. Just not enough specialists in many areas. If surgery is needed it would then be a quick route though unlike then being put on the public waiting list.

A&E services are mainly public though so generally used irrespective of whether you have private cover. Certain tertiary services are only offered publicly as well so you can’t jump the queue by having private insurance.

You can choose to see a GP privately and pay, or publicly with no payment. Funnily, it’s often a lot quicker to go publicly. We can always see someone same day publicly (will be whoever is on at that medical centre at the time so you don’t necessarily always see same person) but there is a 2/3 week wait to see many GP’s privately.

We generally pay a set price for medicine irrespective of what the medicine is and I think it’s a pretty fair price but if you are unemployed/on sickness benefit/earn below a certain amount then you pay roughly a third of that set price.

I always laugh when people make out it’s either got to be a system such as the current NHS or the US system. So many countries have different permutations that work well that could be considered but nope, seemingly only the ones at either end of the spectrum, NHS or US🤦‍♀️.

I get insurance through work so pay nothing but a 15% co-pay when visiting a doctor (a little more like 20% for dental/maternity). Medication is typically free but some things they deem ‘unnecessary’ won’t be covered.

The worst thing is having to fight insurers when they won’t cover something. This system rewards the pushy …

But it’s great and works well with a more bare bones public option for those of limited means. (This isn’t the US btw but functions similarly)

I do think a co-pay is essential so people don’t just book unnecessary appointments and waste everyone’s time. Also, letting the insurers decide whether something is necessary or not is annoying, but does cut out the admin from the hospital side.

In the US, the huge admin (with similarly huge paychecks) in hospitals is a problem and will need to be culled somehow.

@PlaitBilledDuckyPuss which people ? Every fecking thread about the NHS there are posters banging on about the NHS ‘needing an overhaul’ and wanting a ‘European health insurance style arrangement’. Gathering up speed at the moment it makes you think there’s a bit of nudging going on. I don’t necessarily think the idea is a good one by the way !

I work in the NHS. I stupidly read most of the threads on MN about it Many posters moan about it and bang on about the ‘German or French system’ etc without knowing anything about them. I actually thought that a thread describing how complicated and potentially costly they were would illustrate how lucky we were in the UK.

The issue with insurance is that if you are very ill, or old, it is very expensive. Socialised medicine is better because everyone shares the risk

Everyone paying into the same bucket is fine to me as long as the user can decide where/how they use it to introduce competition in the medical sector (and is something they can do on top of insurance schemes).

I think Singapore’s system is quite good tbh

I completely agree.

Also NHS and agree the system is broken. I think people only see the good of somewhere else's system and the press defiantly hang the NHS dirty laundry out to dry. As a working adult I can see the benefits of some top up system and as a scientist I can also see the benefits of the NHS funding revolutionary treatments that insurance wouldn't cover.

I'm currently awake due to a minor chronic condition, simple prescription would sort it out but as I haven't been for my review (#COViD #NHSSHIFTS etc) it's now been taken off repeat. Once they open I need to battle for a GP appointment then try and get leave at work. Would I pay £25/50/100 to go online and book an appointment at my leisure yes without a doubt. Would that be fair to X who can't afford it, according to the NHS principles no.

Yes this is what I assumed you were referring to

USA here. My employer covers my monthly insurance premium in full. I add my husband at $400 a month. I often see people on MN saying “but I don’t have a spare 400 a month”. Well you would if you had our taxation structure. What many people forget is that those of us in countries with private healthcare pay a lot less tax (both in terms of income tax but also sales tax/VAT) than the UK. My state has no income tax and out VAT is less than half that of the UK. Our energy bills are also much lower but I digress. It’s impossible to compare the cost of the US system when you don’t look at the whole picture. Our wages are higher, our taxes are lower.

My employer also puts $1000 a year into my HSA (health savings account - a savings account you have for medical costs). I add $300 a month to it also. The $300 a month is not compulsory. I’m a high earner and can easily afford that but it’s possible to not pay anything in at all.

Our maximum out of pocket costs each year are $3000. That means no matter how much medical care I need I will not pay more than $3000 a year. With the $1000 that my employer pays I actually will only spend $2000 a year, maximum. Preventive care is concerned at no cost (mammograms, smears, wellness checks, cancer screening) as well as things like flu shots, shingles vaccines, etc.

Having been ill in both the UK and the US, I know which system I prefer: the US system. No waits. Private rooms. Much higher survival rates. No strikrs. A wider range of treatments. More choice in who treats you and where. My husband had his knees replaced. From the appointment with the doctor where it was decided that the only option was a total knee replacement (other things hadn’t worked) to him being “under the knife” was less than 6 weeks. And most of that time was spent having measurements taken and various pre-op scans and blood tests. It couldn’t have gone much quicker.

There are government assistance programs for those unable to afford insurance.

Contrary to MN and daily mail belief, you are not asked for payment here before the ambulance will even take you to the hospital. Everyone who needs emergency treatment will be treated, even if they cannot afford to pay. That’s the law. The payment part comes much later. I went to see the doctor back in September and had some blood tests. The bill arrived last week, some 3.5 months after the event.

I don’t want an overhaul tbh

Nor the US system, others might be good but changing over is costly and there are better and easier ways

I live in France now. The state pays a reasonable percentage of our medical costs and then the vast majority of people have top-up insurance, often though employers. We don’t have one available through work and have a relatively expensive policy. For a family of 5 it’s 190€ per month. I think my part is 55€. When I say relatively expensive, that’s for the level of coverage we have. For example, it’s not a 100% top up for optical and orthodontics, it gives us 175% of what the state reimburses. Realistically, for DS2s orthodontics we have to pay about a third.

To see a GP is 7.50, and that’s reimbursed by our insurance. As is all medication and any other payments.

I’ve recently had pneumonia, I was seen by the gp every 2 days, got an X-ray at a private clinic the same day, which cost me 9€, but was reimbursed, walked in and out with the X-ray in 7 minutes, and had the radiologist report 20 mins later. Had a CT scan with a one week wait, same deal, paid 11€ up front, left with the CD and had the report 2 hours later. I’ve just been referred to specialists, it will all be covered by the state and our policy.

If we travel to the UK and someone needs medical care we have to pay upfront, but are then reimbursed in the same way when we get back.

We don’t overuse it, but all sick days here require a doctor’s note, there’s no self-certification, so with 3DCs we have seen the GP here more than we did in UK. And GPs do the vaccinations etc, not nurses.

We can see specialists more easily. I have bad allergies, mentioned it to the GP and now see an allergist twice a year. Smear tests etc done directly by a gynaecologist. There’s much less gate keeping.

So it costs us more than the NHS, but there’s less waiting. A&E is having problems here too though, with the flu and bronchitis epidemics this year.

Oh and as for introducing a Co pay system, like £20 to see a GP. Yes, that's worked brilliantly for dentistry.

@SlicerAndEcho

Re France and

To see a GP is 7.50, and that’s reimbursed by our insurance. As is all medication and any other payments.

That's confused me TBH ..I thought the going rate for the general public for a consultation was now 25 euro, with some minor variations?

www.ameli.fr/medecin/exercice-liberal/facturation-remuneration/consultations-actes/tarifs/tarifs-generalistes/tarifs-metropole

As you probably know the generalistes are pushing for the tarif to go up to 50 euro, and a strike related to that issue is another factor in the current problems some Urgencies (A&E) are experiencing.

We did pay more for it. The govt put an extra levy on.

Then Truss came in, scrapped that, trashed our economy further and here we are.

Higher earners should pay a bit more. Tax loopholes should be closed to ensure fairness.

@blondieminx it's not just about money tho. One of the biggest problems is the aging population with its increased demands and bed blocking. We are asking our kids to fund a growing burden that isn't going to slow down unless we introduce radical ideas like forced discharges and ceilings of care.

It’s 25 euro before the state covers their share of the cost. Which then leaves 7,5€ to be payed. Many GPS, like ours, offer to let you pay the « third party cost » which is what’s left, and is then covered by your insurance. Depending on your insurance company and your doctor, you sometimes don’t even need to advance this. My neighbours don’t. If we see a different GP, like an
out of hours, then we pay the full out of hours fee before getting the two refunds, state and insurance. No one actually pays 25€ to see a dr, not permanently. The state refunds at least 17,50 of it. Third party cost for children 6 and under is 9€ as their GP fee is 30€. No one will be 50€ out of pocket to see a GP.

“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!”

I agree. I pay 20% on anything over approx £12k. I’m lower earning. I pay NI which is about 3%. My employers pay about 10% NI. I pay pension of 12%. My employers pay 12%. I pay council tax £2500 year. I pay £15 month dentist. I pay £10 month prescriptions. I think that is a lot less than France, Germany etc. I get free NHS, elderly care (as long as I don’t own anything).

Also, road tax, VAT,

It’s 25 euro before the state covers their share of the cost. Which then leaves 7,5€ to be payed. Many GPS, like ours, offer to let you pay the « third party cost » which is what’s left, and is then covered by your insurance.

Ok this is a bit tangential to the main thread but I'm still confused TBH,

We're very long term resident in France, long term in the system, Cart Vitale etc though not working for a French employer.

We've always paid the going rate tariff as per Ameli, which was 25 euro last time...., paid by cash, card or cheque at the end of the RDV...that amount we then claimed back from insurer.

Anyhow the main point is unlike the UK you do indeed pay something on the day and insurance is available to cover it.

That’s surprising. You should ask your doctor.

www.service-public.fr/particuliers/vosdroits/F167

Our doctor offered it as an option.

Ah OK..

Doubtless they are... but when they have to pay their normal taxes plus £1k per year pp on top, they wont be.

Bottom line is though that any new method of funding the NHS wont address long term under funding, staff shortages and retention.

These exist in the private health sector too, they don't have a enough resources to take up any slack, waits in PH are getting longer too...... the difference is they can up premiums and attract staff from the NHS.

The descriptions of how well the US system works is demonstrative of what is WRONG with it. Yes, if you are a high earner, have savings and a generous employer you get a great service. Not so good if you are elderly, poor or have chronic conditions for example.

It is a much more civilised system to all pay in to a single pot (NI) depending on our income and use that pot according to need, regardless of your ability to contribute (i.e. NHS).