To ask for info about the world's best health system please?

[haveyourselfamerry]

I am assuming that somewhere in Europe/Canada/Australasia there is a system that works better than ours.

I have spent time in US -we can rule that one out right here....

scienceblog.cancerresearchuk.org/2015/08/05/cancer-survival-in-england-is-improving-but-still-lagging-behind-similar-countries/

Cancer survival rates are getting better but we still lag behind lots of European countries. I think the problem is getting GP appointments/not getting initial diagnoses in early enough/not enough referrals from GPs (e.g. with atypical symptoms)- once in the fast track system it is quite good. We don't have as cutting edge treatment as people suppose though, there are newer laser therapy machines and other types of therapies abroad in Europe and if you are in the peripheral local hospitals the care may also be slightly worse if you have a non-standard case.

I think people are very naive to keep repeating 'the NHS is the best in the world', I can only imagine they haven't been treated anywhere else in mainland Europe like France, Germany, Czech Republic or Sweden to make these claims. If you are in these countries and you have full insurance/access some private treatment, the treatment is excellent.

Even in some of the former Eastern European countries the healthcare for the wealthier of the population is fantastic, we have had more sophisticated tests, treatment, speed of results there than in the UK and often the UK doctors (or perhaps HCA's who don't know much about these systems) are quite astonished when you bring back better results than are available on our own machines. You also don't have mixed wards, dirty hospitals in some of these etc.

I've found the Dutch system excellent. It runs on a compulsory insurance basis

Essentially, the Netherlands has a public healthcare system with a greedy middleman

The insurance industry

The Danish system works well

Healthcare is largely funded by local government

In Denmark, a percentage of income goes to local government

Keeping the source of funding local is efficient and effective

It also reduces the scope for corruption and mismanagement of funds

ooh and you get hygge in Denmark too so they say...

I've been through the urgent 2 week cancer referral route with the NHS and was diagnosed and operated on within 6 weeks of the initial referral. I can't fault the treatment I received or the follow up on the NHS. I have regular scans and appointments still and the staff are great and the appointments are spot on when they should be.

My GP is also really good and I generally don't have a problem getting an appointment as long as I ring at 8am for a same day one. I would quite happily pay up to £30 to visit my GP as I only go if I really need to. I would also happily pay more tax if it was def going to fund better care and treatments on the NHS.

Yes, it REALLY matters what you set as criteria for "best".

Highest standard of care possible for those who can afford to pay?
Greatest percentage of the population getting care?
Some weighted measure in between?

The first successful heart transport was done in South Africa in 1967 under apartheid. It's possible to have a healthcare system capable of great technical feats while being basically irrelevant to the majority of the population.

The other thing that I think is a bit hidden in these measures is that if you are a sharp elbowed or pushy person (middle class or otherwise) and are prepared to phone, chase appointments, take cancellations, refer to NICE guidelines and do your research, you always do better whatever system you are in. If you just accept there are no appointments for a month and go away with your lump, or accept they've lost the records, or accept the drs opinion without seeking a second one, you are going to do badly IMO in something like the NHS where the care is very variable and often quite dependent on being able to work the system. I have often chased appointments/treatment for my sick relative, my mum does the same and we often say we worry about people who aren't able to do that. The NHS is quite a slow and inefficient lumbering system at times and if you aren't someone who is able to go up against that, you definitely could end up with delays- I think this is again why the cancer outcomes are poorer in the UK, my grandma would never phone to find out why her 6 month check hasn't occurred, we will, she gets it, who doesn't?

I suppose one big measure is a country's overall life expectancy with functional capacity .. Ie how long you can keep living an active life

Isn't it the case that the countries with the least rich-poor divide actually have the best health & happiness outcomes generally? Not got time to look for the info to back that up though

foureyes,

I certainly recognise that phenomenon.

Would that be any different elsewhere in Europe/Australasia though?

Pausing, I see where you are going, but I'm not setting a quadratic equation, I'm trying to open up a discussion.

hmm, re taking care of yourself... that's tricky!

I don't think that's a British thing in particular...

So am I. That is part of a discussion.

Were you worried I was doing whatabouttery, or some diversion attempt?

I'm really not. We have to discuss what we mean by "best", to have any hope of achieving it.

Would that be any different elsewhere in Europe/Australasia though?

As Foureyesarebetterthantwo says, sometimes you have to be bolshy to get what you need with the NHS

It's not like that in Australia and New Zealand

Australasian healthcare is generally more efficient and advanced

However, it's not free at point of use for everyone

www.theguardian.com/australia-news/2016/nov/22/majority-of-australians-dont-think-private-health-insurance-is-value-for-money-poll-finds

no problem pausing. we're just each doing it our own way

lived in Germany, uk, Switzerland and The Netherlands in the last 15 years.
so far: NHS is the clear winner, netherlands not far behind (dental care included, but getting appointments at gp took weeks).
germany: ok, but very expensive insurance with a complucated system, endless waiting times in surgeries, doctors suggest lots of extras that insurance doesn't pay as they make money from that. lots of pressure to pay a lot extra.
Switzerland: ok, but so eyewateringly expensive that we had to decide between treatment for me or my partner as we couldn't afford both ( while paying 800 franc insurance per month for family of three!). partners condition was worse, so he got treatment, i didn't.

GP appointments at the surgery took you a long time in the NL or in the UK, yura? I've always managed to get a same-day or next-day appt in the Dutch surgery we are registered with. Even managed to get a next-day (non-urgent) appt at the hospital once!

in NL - big city, usually took weeks. Uk, usually within 1 or 2 days if urgent (UTIs).

Guess it really depends on the city and surgery in both countries - not a big difference from my perspective, for positive and negative stuff (friend in NL got denied a test for ovarian cancer from several gps a being too young for it althought it runs in family - 16 months later they finally tested her - stage 3!. sounds like the horror stories you hear from uk)

'Best' by what criteria?
Best for individuals?
Best for populations as a whole?
Cheapest??
Best value for money? (who gets to decide what is value and what isn't?)

I don't think there is a single absolutely correct answer to your questions.

I do like the Commonwealth Fund's conclusion:
Healthcare system comparison

I have lived in the US, grew up in Germany, have now live in the UK for 20+ years and work in the NHS. I think it is a great concept to have healthcare free at the point of use, and without the expense of insurance companies making a profit. However, the fact that it was devised at a time when the spiralling cost of modern healthcare could not possibly have been foreseen and that it was always a population based system, means that it does not always offer the best care for every individual. But no system does IMO.

The posters who have lauded the American health care system are, I imagine, British expats whose companies offered an attractive insurance package. It's not like that for millions of Americans. My sisters health problems have left her $30k in credit card debt. She is 32. It's a terrible terrible system and if we're not careful we'll have the same here.

In Ireland you Gp costs €50 but you will see one on the same day mostly. The Gps are absolutely excellent here.

But God help you if you have to go to hospital, especially the emergency dept....

Doctor's arrogance exists by breed not nationality maybe Yura! I've met a couple like that too. Perhaps we're just extra lucky with ours.

But I do know that in the extensive use I've made of the service, I wouldn't have had anything like the help we've had in the UK. I'm very, very grateful for it.

I hope your friend made it.

That's likely true Welsh - it is in our case. That said, we still pay a hefty contribution per month. $650 or so IIRC? That's for a family of 4. I agree with a poster above about needing an advocate in the NHS. When DF was ill he wouldn't have had half the care he was entitled to if we hadn't fought for him, argued our case, pointed out that we had rights and so on. He nearly missed out on CHC payments due to a doctor writing he'd had a stroke on his paperwork when he'd actually got a brain tumour! And that then delayed his 48 hour discharge turnaround (fast track). It was only when I sent an extremely pointed email and asked why the NHS had failed against its own targets that anything happened. Oh yeah - and then one morning I wasn't there, they forgot to do his MRI. Arrived late and got delayed for three more days. Given his condition, it was rather critical it got done asap...

"I found a lump on the Saturday, saw my GP on the Monday,"

How was this possible? Did they accept it as urgent because many people have to wait 3 weeks or more for an appointment.

In my surgery I can only make an appointment that is exactly two weeks from the day I call to ask for one. I can't have it for two weeks and two days from the day, it must be exactly two weeks away even if I would be happy to wait longer. I'm told to call at 8am, but there's never an answer. It's a nightmare, but I suppose it depends where you live.

"When you tell the GP receptionist you have a lump they usually go through Hell and high water to get you an appointment."

In my surgery the only way to communicate with a receptionist is by shouting so everyone can hear you because they have some kind of bullet proof glass separating us. Not possible to get through on the phone. Glad to hear it's taken seriously though. I thought a lot of lumps were benign so that they wouldn't be taken seriously in a younger woman.

"Spain's healthcare system is free at the point of use. I've personally (anecdotally obviously) found it excellent."

Yes. I've witnessed this (and didn't have an income over 10k euros either).

I've been told that there is a cultural expectation there that relatives will do a lot of what nurses would do here such as feeding and washing patients though so I suppose it's cheaper to run if they rely on relatives for that kind of thing.