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....

"That this is so common that patients don't receive proper care if their relatives aren't there? No, that is bollocks. If you are in hospital with no relatives to visit your care is exactly the same. "

I didn't say that, did I? I presumed that patients without relatives would be looked after by nurses, not just left to rot.

"there's a secret to how to use it properly; you need to keep phoning up and pushing doctors for appointments"

They can just say no. There's also no right to a second opinion in primary care. You can ask for one, but you're not entitled.
In any case, there have been days when I've phoned my surgery 50 times and no answer.

You said "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."
I am telling you that although the relatives may want to sit there and provide company for the patient and even help them with eating their food, the healthcare system is in NO WAY "relying" on that, or relying on relatives to wash patients, absolutely not.

If the relatives do that, then it's obviously less work for nurses and assistants isn't it? If a nurse doesn't have to feed some of her patients, she has more time for other tasks so the relatives are a human resource used by that system.

PausingFlatly (from down thread)

Yes, apologies re: three options, I didn't express myself very well there

Rushing at the moment (hwk supervision/supper prep) so excuse brief responses but

Under current arrangements

Meaning where there is limited funding and savings in other sectors are adversely impacting the ability of NHS to carry out its core functions

Thus for example …..Why give the NHS more money to deal with old age care when this should be funded through local authorities….

And in answer to the rest of your post ...briefly ...

Background to the issue on NHS is that there is a shortfall in funds for all govt activities.

Where contributions are made - this gives sense of ownership/autonomy/responsibility to the end-user…. Stops reckless use of service AND can be set at effectively a non commercial rate ….

None of this is achieved through general taxation.

It is better that users of the service see the costs for themselves …. Show the cost of the service and then the contribution to be made

Most importantly, t is quite possible to set this up in a way that allows those with chronic illnesses or those on the poverty line to receive free treatment or virtually free treatment, depending on circs

Gwen I had access to a gynea because I paid for one, pretty sure you can pay for a private gynea in the U.K. as well.

The NHS is incredible. Every interaction my family has ever had with them over the country has been wonderful. Remember you only hear the negative stories. Free healthcare at the point of use is such a privilege and we are so lucky.

" pretty sure you can pay for a private gynea in the U.K. as well."

I can't really afford and don't use private care. It's not really the ethical thing to do in this country.
I would never say never of course.
In most countries gynaecology services are available in the subsidised sector.

"Remember you only hear the negative stories."

Not true at all. We hear the positives as well, at least I read them in the papers I use. But there's no getting away from the disadvantages either.

"Where contributions are made - this gives sense of ownership/autonomy/responsibility to the end-user…. Stops reckless use of service "

I disagree with that. The use of services that we would consider reckless here are routine in many other countries e.g. going to the doctor when there's nothing major wrong or just to ask for a checkup and people are MORE likely to do that when they're paying and doctors more likely to allow it if they get paid per consultation.

I remember a friend worrying and feeling guilty that she had called a doctor out for a home visit, but of course the doctor was being paid for it, they weren't likely to resent it or get rid of the option altogether as they do here.

My mum received amazng treatment on the NHS. Went to GP with lump n Thursday afternoon, appointment at breast clnic on phone message by the time we drove home. Seen the following Monday and diagnosed. Mastectomy 10 days later. Follow up lab results within a week and tamoxifen for 5 years. She was fine and very lucky.

Gwen I think you forgot your previous posts in reply to mine. You suggested I was lucky to at least have access to a gynea as they are not directly available on the NHS, to which I replied that mine was private anyway. That doesn't make me lucky to have access to a gynea in France when you can't see one in the U.K., it makes me lucky to be able to afford to pay for one in either country. My original point, I.e. that even when I accessed the gynea I could not convince her to allow me to have a fairly basic test, stands and is indicative of the problems of the French health care system.

Another vote for Belgium here. You pay a contribution through your social security, then about €30 a quarter for a "mutuelle" (non-profit insurance company). This covers you for around 85% of costs of seeing a doctor, etc. The problem is that doctors can choose to charge higher than the agreed government rates if they want. It's a problem in Brussels, where you might pay €40 to see a GP and then only get €22 reimbursed by your "mutuelle". But, outside the capital (like where I live), I pay €30 to see a GP, so only end up €8 out of pocket, my young kids get to see a paediatrician, for which the non-reimburseable cost is about the same, visiting the dentist costs nothing for the kids as it's all reimbursed, and about €5 for me, as our dentist charges agreed rates, and if we have blood test or analyses done it usually costs around €6 (the non-reimbursable part). I've had 3 CS (1 EMCS) and 1 normal birth here and the hospital care was amazing. My 5 day stays in hospital each time cost me nothing, because my husband has hospitalisation insurance paid by his employer for the whole family (often included by many employers, otherwise costs about €150 a year for a family). My son's 6 week neonatal stay was also 100% covered by this same insurance.

I really couldn't fault the system here. You pay a small amount to see a doctor or a specialist, but the waiting times are usually low, you choose who you want to see (so you can switch to another specialist if you want), and turnaround times for blood tests etc are really quick. Compare that to my sister living in the UK who had to wait 2 weeks for blood test results that I can get in 24 hours.....

"The problem is that doctors can choose to charge higher than the agreed government rates if they want. It's a problem in Brussels, where you might pay €40 to see a GP and then only get €22 reimbursed by your "mutuelle". "

It's not a problem in Brussels as you can choose your GP so if you don't like the prices of one GP you just go to another. There are lots of them and they often work alone and answer their own phones rather than in big surgeries.

"Gwen I think you forgot your previous posts in reply to mine. You suggested I was lucky to at least have access to a gynea as they are not directly available on the NHS, to which I replied that mine was private anyway. That doesn't make me lucky to have access to a gynea in France when you can't see one in the U.K., it makes me lucky to be able to afford to pay for one in either country. "

My point was that access to gynaecologists and paediatricians is available in the subsidised/affordable sector in most countries. For example in Belgium, you could go private, but you wouldn't have to and women can go straight to their gynaecologist whenever they want to. It's still paid for, but not entirely private.

My mum was diagnosed with cancer back in October they literally gave her 3 months to live if she didn't have treatment straight away
She spent 9 weeks in hospital as she was extremely dehydrated and was suffering initially from delirium.
Today she has her 5 th round of chemo and last one in 3 weeks time she also spent 2 weeks in a nursing home which was all payed for by the Social services
I have no idea what the cost was but at she was in a HDU so a nurse 24/7 so maybe around £12000- £15000 for 9 weeks plus the chemo MRI scans and on going cost & treatment and two weeks in a nursing home before we took her home on Christmas Eve
Doctors are very pleased with her progress at present. She is 81 and doing well .

We as a family found the care to be excellent as long as one of us ( me normally) was prepared to follow up stuff with the staff and doctors & social workers who were all fantastic .Wr got to know the nurses well and we are so grateful for them .
I took them up several huge boxes of donuts & bottles of wine on Christmas Day to say thank you to them as they were totally amazingwith my mums care .

On the otherhand my son who is very overweight is considering a gastric Sleeve privately .
My son is paying privately to have a full health check MOT privately
The cost is £190 for test inc diabetes heart check and the consultation is 1.15 min

I told my son that he shouldn't expect to ask his doctor to do this type of intensive health check for himself especially as my son has very recently given up smoking & his excess weight is purely down to eating shit food. He is however changing what he eats slowly and us given up smoking .

but once the surgury is done my son will give his medical records to his doctor for aftercare with the local biaatric team

Gwen that is because the U.K. adopted a gate keeper role for GPS, so GPs are the first port of call and redirect to other services as appropriate. Appropriately funded this seems to work at least as well as patients having direct access to specialists. When funds are low both systems break down. Comparing an underfunded gatekeeper system with a well funded direct access system will give the impression that the latter is superior, but it is not the system at fault, it is the funding.

Gatekeeper systems can be quite problematic where the gatekeepers (GPs) are poorly trained in certain areas. For example, UK GPs tend to have very inadequate knowledge of dermatology and people suffer with skin complaints that are quite serious for far too long before being referred to dermatologists, who can often cure skin complaints quickly and easily. This isn't an issue of funding, but of the inherent nature of gatekeeper systems and ensuring that the gatekeepers have enough up-to-date knowledge to do their job.

We've used healthcare in the UK, IItaly, UAE, Bahrain and the US. The US gave us the best. NHS like a pp said is great if you have something seriously wrong. But rubbish at preventative care .My mother was recently sent home by her GP saying she was fine as we've been worried she has started with dementia. They did a few written tests which she passed, nothing else. She isn't fine. She's on a different planet. We've no idea how to push this forward. It's like they are waiting till her condition worsens before they do anything.

The US may be good at preventative care if you have tons of money. I have relatives who have Type 2 diabetes in the US. They get nowhere near the level of preventative care that people do on the NHS.

Bobochic and direct access systems suffer from patient misuse, misidentification of the problem as well as risk allowing patients who are hesitant to approach a doctor to fall through the cracks. Now if we are finished listing the inherent weaknesses of both systems we can go back to public health research conclusions which suggest that there are no significant differences between the two systems in practice. (Not to point out the obvious, I.e. lack of further training among GPs IS an underfunding problem).

"Bobochic and direct access systems suffer from patient misuse, misidentification of the problem as well as risk allowing patients who are hesitant to approach a doctor to fall through the cracks. "

patient misuse and misidentification of the problem I can understand, though GPs can also refer to the wrong specialist and then you have to count all the GP visits in the wasted time as well, but I don't understand "risk allowing patients who are hesitant to approach a doctor to fall through the cracks". Why would they fall through the cracks any more than with a system that requires you to go to a GP.

Also, many (most?) countries that have direct access to specialists also have the option of going through the GP if that's what the patient wants.
What bothers me about the GP gatekeeper system is that the advantage of going to a generalist who knows you is that they should have a holistic view of your health, but in the last few years I've heard of them having a really stupid rule of 'one problem at at time'. That means you can't give them the whole picture.

Patients who are hesitant to approach a random doctor may feel more comfortable talking to a GP with whom they have established a relationship over years. This may affect disproportionately patients with mental health issues, or health problems they perceive as embarrassing. Also some patients present with a different problem than the urgent one they have either for psychological reasons or because they have not realized the significance of their symptoms.

Restricting visits to one problem is the result of underfunding and shorter appointments.

The GP relationship can also feel intrusive and patients can prefer to see doctors with whom their relationship is more distant/formal rather than less.

I am sure there are people who do feel that way, but public policy is often based on numbers which generally suggest that the doctor patient relationship is important to most people.