Anyone have experience of health care systems in other European countries that works better than NHS

[DeidreInaQuandry]

For decades we've been told the NHS is in crisis/at breaking point etc

I often read on MN about how wonderful health care is in Germany, France, Scandinavia. So what are they doing differently/more efficiently and could we adopt it?

In UK I had relatives who lived in a time before the NHS

I believe you had to send someone to "fetch the doctor" (no telephone) and I assume that the doctor who came out to the patient had to be paid

Technology has moved on, so many people live longer than 100 years ago and with more complex illnesses

I suspect that the NHS could be managed better and expenses and resources used better

However I am a supporter of the NHS and we all pay via our taxes

Perhaps in the future we will receive a letter or email informing us where the money is spent on the NHS (like the council tax information letter)

My experience of Germany is that the quality and infrastructure of the hospitals reflects the decades of additional funding when compared to the UK.

I don't think the quality of the medical staff is any better and I think they are very old fashioned about some things, but they appear to be much less overworked and understaffed than in the UK.

Individual patients have more choice.

hoplesslydevoted I disagree with smears. Here in the US I have an annual check up where I have a smear. That check up caught an abnormality and my obn did some blood work which showed a hormone imbalance. The hormone imbalance was affecting my thyroid function. One simple pill that costs me $4 a month fixes the hormone imbalance.

I think smears should be given annually once you are sexually active and/or if you smoke. NHS is willing to let those under 25 die by telling them they don't need a smear and they are not at risk. They are at risk if they are sexually active and/or smoke and those abnormalities should be checked out. Sadly I know someone who lost their 18/19 year old DD to cervical cancer. Here in the US DHs colleague has a DD who is 23 and has stage 4 cervical cancer. They caught it early via her annual smear and she won't make it until Christmas.

DH is Danish and his family use the Danish system. They all have top up insurance that they pay for prescriptions and therapies (physical therapy and psychology) and self referrals to specialists. Still took them 3 years to diagnose my SIL.

I agree with others, we need to have an honest and frank conversation about how we are going to pay for medical care.

I have had to use the Italian health system and always found it to be very good. I was hit by a car when I was studying in Perugia And I had to be hospitalized a few years ago in Florence., I have seen reports on France 24 about a lot of dissatisfied health workers in france.

I'm in the German mutual system - not on the bones of my arse [grin,] but getting exactly the same care as if I was. It's very, very good, just as described above. I've never waited in a&e, the kids have their own paediatric GP whobhas services onsite such as x-ray and blood/urine testing etc (they could test our kids for strep while we waited). A my GP similarly well equipped and very short waiting times, much easier to see specialists. Some people on high incomes opt out of the system, but it's not to get better care, it's because the system is so expensive for high earners (it's a proportion of salary, 7% I think) that they're cheaper arranging insurance privately.

I'm really enjoying this thread as the usual NHS threads are always like "well if you don't like the NHS you should be grateful that we don't have the US system). As if the NHS was the only way of delivering socialised healthcare.

I just wanted to repeat this from page one....

Even in these countries that have semi private healthcare, their governments still spend more narional GDP on their health service. Our health service is starved of funds

Imagine what the nhs could be like if they got the same spent on them. Those other govements are only subsidising the health system, and still paying more.

In France we get to see a GP on the same day or next. We have the same GP, not one in a huge surgery. An appointment costs 1 euro and the appt takes as long as it takes. No 10 minute slots. It does have to be paid for through taxation but it works.

I'm in the UK, I get to see a Dr the same day (I may have to wait if it is 8pm or a Sunday), the appointment takes as long as it takes, although if you know it's going to be a long appointment you request a 'double' appointment.

I normally see the same GP but if it is his day off or I want a home visit it might be one of the other 3 in the practice I see.

I pay my taxes so I don't need to pay even 1 euro to visit my GP, which is good because sometimes in the past I have not had 1 euro and sometimes I have needed to see the Dr 3+ times a week.

I was admitted to hospital with what turned out to be an ovarian cyst, I had an X-ray and an ultrasound scan, as well as blood tests in the middle of the night.

The healthcare I access is the most efficient in terms of treatment per £ in the world.

I have also worked both for the NHS and in the private healthcare sector. I have never seen an NHS patient sent for tests they don't actually need. I have never seen an NHS patient told, there is nothing wrong, but we will repeat this test next year just in case.

I think smears should be given annually once you are sexually active and/or if you smoke. NHS is willing to let those under 25 die by telling them they don't need a smear and they are not at risk. They are at risk if they are sexually active and/or smoke and those abnormalities should be checked out.

There is a huge difference between routine smears and smears due to symptoms. I knew a 17 year old who had them every 3 months because she needed something checking.

Smears are not routinely done in younger women because of the number of false positives. Many many GPs do them routinely once you are sexually active, I had my first at 17.

I've got experience of Germany, Belgium and the Netherlands. All have a basic health insurance that you pay then the top ups. Holland is the most expensive so far in total but it's very transparent with its cost (e.g. Your inhaler costs 25€, blood tests are €xx).

Hospital care in both Holland and Germany is top notch and I've been seen quickly, efficiently and very well cared for. I can see my GP within a day (within an hour a few times), I was in A&E and xray for less than 45 minutes and the staff were great.

Belgium annoyed me as I was paying quite a lot for health insurance but GP 's were over capacity, poor quality and not helpful at all. Hospitals tended to be older with older equipment too.

I love the NHS and wish that it was given more funding and support. I'm outraged at the way that it's treated as a political piece by the government. I'd also say that my treatment under the NHS when I still lived in the UK has been nothing but exemplary.

Scandinavia. Clean efficient hospitals. You pay a bit but children under 16 free. I have never understood the love for NHS other than that it is free. I dread to think I would ever be seriously ill in Britain and went home to give birth to my children after experiencing a British hospital where the care, management of my labour and maternity ward was.... I still cannot speak about it The NHS should start charging and people should stop over using it.

Want2bSupermum the evidence shows that routine smears before 25 are harmful as they cause more harm through unnecessary investigations than they help. Yes sadly there will be a very small number of women with cervical cancer without symptoms at that age, but a much greater number who will have unnecessary surgery, with risk of complications

If someone has symptoms of cervical cancer at any age they should have investigations (and would have these with the NHS)

The NHS is obviously not happy to let girls die. Performing a smear is cheap, it obviously isn't a cost cutting exercise, it is trying to use tests responsibly

I'm struggling to think what hormone imbalance could be detected by a routine smear but wouldn't produce other symptoms. Did you have an ectropion, was that what your Dr saw?

I think someone made the point that in many continental countries the government doesn't provide the service but instead enforces insurance.
Therefore they are more efficiently run. The NHS is just inefficient as it has loads of pointless managers and few people to take decisions.
I reckon the uk will have a French or Spanish model in time.
Both work better and both are reasonably priced.

I have never seen an NHS patient sent for tests they didn't actually need
Well I can tell you lots of NHS patients don't get the tests they need when they actually need them! I have seen waiting lists for investigations get so long now that diagnoses are getting dangerously delayed. Part of the reason cancer survival is so much better in some European Countries is because of a proactive approach rather than reactive, Cancers are often diagnosed at an earlier stage.

Our breast screening program would pick up more cancers for example if it included an ultrasound too - as a lot of other Countries do.

I don't know...I see what people mean about not understanding the value of healthcare when youve never paid, bit when I had to fork over €500 for getting my broken leg seen to I was thinking how there have been times in the last few years where that would have really been difficult for me. Not that much comfort that an unknown percentage would be reimbursed in an unknown period of time.

I'm in Australia. Not European but still interesting to compare.

There is a public and private system here, like the UK, but many people pay for private insurance, so they can be seen quicker, by a specialist they choose, often in a swankier hospital with fancy meals. You still often end up paying a fee on top of your insurance though when you access private care, because the insurance companies don't usually cover the full cost.

Anyway. I use the public system here. Some notable differences. Contraception is not free, and the initial upfront cost of long acting reversible contraception puts people off using it, rates are much lower than in Europe.

Ambulances are not covered by the government. If you need to be taken to hospital in one, you will be out of pocket. A life threatening emergency call out can cost you up to $1000 without insurance.

Physio, speech therapy, OT, podiatry and psychology services are not covered by the government. You need private insurance to access them.

Prescriptions are not free (like Scotland). Some are subsidised, but I've had hyperemesis this pregnancy, and the cost of antisickness medication has been eye-watering. I've tried to go without it numerous times because of cost and can't manage to.

GP care is a private system. It is down to the GPs discretion whether they accept a lower fee paid fully by the government for the consultation, thereby giving you it for free, but you don't find this out until after the consultation when you go to pay, so it's pot luck. This usually happens for students, kids and the elderly. If you are charged, you have to faff about getting half back as a government rebate, and paying the rest, usually about £25-50, depending on the practice. This cost has put me off going to the GP when I've considered it before.

There is a more consumer attitude toward healthcare. Like a pp said, tests and scans are sometimes done because patients expect them, rather than them actually offering useful information for your condition and being evidence-based.

Because health is a lucrative and expensive industry, alternative medicine is very popular, and pharmacies here have full aisles and large sections of various vitamins, supplements, natural treatments and homeopathy. Chiropractors, homeopaths and naturopaths are also very popular and used widely.

I've worked in the NHS and dear God, it might not be perfect in many ways, but it has a lot going for it.

The problem in the UK is not just that the NHS is underfunded and not perfect but also that a significant number of patients have no awareness or consideration of costs as we don't pay anything at the point of care so they waste prescription medication, DNA appointments and expect attention and prescriptions for things that they could manage themselves with a little commonsense and a trip to the local pharmacy.

This. I work in a GP practice and people's expectations are ridiculous. We see the same patients again and again for the most minor issues that in no way need a GP input, people not only DNA'ing GP appointments but needing to be re-referred back to consultants as they have been discharged for DNA'ing appointments with them, people wanting EVERYTHING on prescription as then it's free - I would love for people to be charged for appointments as I think we take the NHS so much for granted.

Fast. Cheap. Good. Pick two. Every system I've experience of is 2 of those three things.

I think charging for GP appointments puts barriers up to accessing care when people need it.

But I definitely think charging you for wasting time if you DNA without notifying is a good idea and might make people value the appointment more.

I used to work in Germany for a few years a while ago. I also had DC1 there.

Care was so much better. much better access to specialists. everybody woman has a gyn whom she sees every six months for a check up... I have still friends there. for lots of surgeries (open heart, knee surgery etc) they offer 3 week rehabilitation in specialised regards centres where you stay also overnight. here you are chucked out a week after the operation.

my antenatal care with DC1 way solo much better than that with DC2 (born here).

but you have to pay into health insurance. cannot remember how much but it was a lot.

I'd be more than happy to contribute a few extra £££ to the NHS. what you pay is what you get.

It's a shame we are not having an intelligent debate about the alternatives instead of pretending the NHS can go on as it is - it simply was not designed with current costs or demandin mind. Better to make a positive choice for social insurance rather than sleepwalk towards a US system.

I found younggirl's post very interesting and totally agree. Germany's system of a heavily regulated insurance industry where no conditions can be excluded and the government pays for those who can't afford it sounds ideal.

I never understand why there is outcry at any reform to 'our' NHS when the current system is not fit for purpose.

Does anyone know how countries with an insurance system deal with people who enter the country without insurance then require urgent treatment (ie so called 'health care tourism')?

"I'm in the UK, I get to see a Dr the same day (I may have to wait if it is 8pm or a Sunday), the appointment takes as long as it takes, although if you know it's going to be a long appointment you request a 'double' appointment."

Please realise that this is not the case for lots of people in the UK. For me it's ALMOST IMPOSSIBLE to see my GP. I have to call early morning exactly two weeks before I want the appointment. My GP, like most women GPs is part time. She works Tuesdays and Thursdays. If I want to see her two weeks from next Tuesday, I must call Tuesday morning, not Monday or Wednesday. If I have a long term problem and am willing to wait three weeks, it doesn't matter - the only option is exactly two weeks from morning of phoning. Of course when I try to phone, the line is busy and I can't get through.

Unless I've got a terrible emergency, I realise I have more chance of an audience with the pope than with my GP.

"Many many GPs do them routinely once you are sexually active, I had my first at 17."

That was the case 20 years ago - the system has been changed more recently.
The age of 25 is in England, it's lower in some parts of the UK. This kind of thing is not an exact science.

Does anyone know how countries with an insurance system deal with people who enter the country without insurance then require urgent treatment (ie so called 'health care tourism')?

Well, in Australia you would be faced with a bill, and it would be expensive.

Even when you're accessing government care ('Medicare') you have to show your medicare card all the time, which you only get given if you are a citizen or permanent resident.

The medical care I received in Belgium was generally much better than here, but you do pay for it. I could get a GP appointment (any GP I want - I had the king's GP at one point) the same day. I could go directly to a specialist if I wanted to. They are willing to look into any problem and you don't have to feel guilty for going to see them. If I was a bit tired people would say "go to the doctor to get your bloods done" or "when was the last time you had a checkup", both odd suggestions to someone who's used to the NHS and only going to the doctor if you're really ill.

However, I paid for it 3 times, a part through direct tax, a part through my monthly payment to the mutuality (non-profit insurance company) and a part on the day (some of which would be reimbursed). I once had a colleague with money problems who delayed going to the doctor for that reason (just like in this country she would have been waiting for an appointment). When she saw him he let her pay later once she'd been "reimursed" by the mutuality. There are also other options for people on very low incomes so everyone has access.

Hospitals over there have to employ lots of admin staff to deal with the payments in a way that NHS hospitals don't have to so it's not more efficient.

Obviously the ideal for me would be the quality and ease of the Belgian system, but free at the point of delivery. I believe that could be achieved by paying a bit more tax.

Re: cervical cancer screening, it's a myth that earlier is better.

Starting age in England is 25. Scotland was 20, but is changing to 25. Australia used to be 18, is changing to 25.

Screening tests aren't 100% perfect and can identify you as testing positive when you're not, leading to unnecessary investigations and invasive treatment. This is more likely to happen in younger age groups with cervical and breast screening. It's about weighing up the risks and benefits at certain ages.

Saying you're getting better health care because a country screens earlier just isn't necessarily true.

My experience was in the Netherlands while we were living there for work. On the very few occasions we had to use the service we found it very efficient and effective.

On one of these occasions DH had accidentally cut off the end of DS' finger. Straight to GP, seen within a few minutes. GP phoned the two local hospitals to find out which was best for the injury. Printed out a letter which DH took with him to the hospital where he was greeted by a plastic surgeon practically needle and thread in hand.

One thing I did notice in NL was a different attitude to personal health. Minor ailments would be treated at home with OTC products. Only going to GP if there was no improvement in a few days.

I will say that when I have needed the NHS in a crisis (RTA, DVT, overdose) the service has been excellent. A little scruffy round the edges, could do with a lick of paint, but the medical service itself couldnt be faulted.