To ask you to tell me about healthcare systems in other countries?

[allthatmalarkey]

Following on from this: AIBU to not understand the english attitude towards the NHS?http://www.mumsnet.com/Talk/amiibeingunreasonable/3415497-AIBU-to-not-understand-the-english-attitude-towards-the-NHS

If you've lived in countries other than the U.K., US, and Australia, please tell me how other healthcare systems work - how they're paid for, whether they're as fair an the NHS in terms of tackling health inequalities (e.g. poverty, mental health, not favouring the richest re treatment), how much GDP is spent in them compared to the NHS 8.5%, are their outcomes good. Can you compare them to the NHS - which do you prefer?

Australian here.

We have a public and private system, which run alongside each other. More people have private health insurance here than in the UK, but those with private health insurance can still access the public (Medicare) system and public hospitals.

Private health insurance can be:

1. Extras cover

and/or

1. Hospital cover

Extras are things like dental, podiatry, physiotherapy, optical etc. For these, your health fund will pay an amount toward the treatment, and you simply pay the gap. The amount you pay depends on the treatment, the fund and the annual cap.

For the most part, the public system is free at the point of use. You can go to a bulk billing doctor and not pay a cent to see a doctor. Alternatively, you can go to a billing doctor and (possibly) get a better service, and you will be expected to pay the gap between the cost of the appointment and what Medicare covers.

Medications, prescription drugs etc. are scarcely "free". Most are paid in full; some are part of the Pharmaceutical Benefits Scheme, which lowers the cost of prescriptions. Pharmacy is also an option for Extras on PHI, so you can lower the cost of repeat prescriptions this way.

Ambulances are - for the most part - not free at the point of use. Most state ambulance services incur a large fee if used without insurance/cover. PHI includes ambulance cover, but you can pay a small annual fee (as little as $10 per person) for ambulance cover alone.

I don't think that PHI is a negative thing here. If you can't afford it, you are automatically entitled to a fully functioning, free at the point of use, system with a lot of exceptions for low income earners on things that do incur fees/costs, and the system is efficient and stable. We are nowhere near as understaffed or under-resourced as the NHS. I have never had to wait in a public hospital waiting room for longer than 30 minutes, and I have never known someone to wait more than 15 minutes for an ambulance. I have PHI but that is because I tend to have more dental issues than the average Joe, so it ends up being worth my while.

I think it's a great system, but it's not put on a pedestal in the way that the NHS is, and I think that that is a good thing. It's not above criticism.

I should add that I think it should be that those who are better off financially should be encouraged to take out PHI, as it lowers the burden on the public system. I can afford to pay something towards my health, so why should I expect it all to be given to me for free? Others do not have the luxury of choice, and they deserve to have a public system which functions well.

I live in Belgium. It spends 10.4% of GDP on healthcare. Taxes here are really high generally (and obviously pay for many things other than healthcare).

However, healthcare is excellent. You have to join a mutuelle (a kind of social insurance thing) and it costs around €35 3 times/year for a whole family. You then have a card which you use to see a doctor, get medicines etc. To see a doctor you pay around €25 for a GP, around €35 for a specialist (these are rates outside of Brussels, some doctors charge a lot more - especially in the big cities). You get reimbursed by the mutuelle about €20 for a GP and about €25 for a specialist. Some specialists charge more, but the reimbursement rate is usually fixed (there's a ceiling). To see the ENT with my son yesterday for example, I paid €45 and will only get about €27 reimbursed.

When you get a prescription, the pharmacy automatically does the "reimbursement" part before you pay. So, antibiotics for my child a few weeks ago only cost me €2 in the pharmacy.

You can get an appointment with whatever specialist you like, you don't need a referral. I can easily see a GP the same day. My kids go to a paediatrician, and I can get an appointment with her the same day. Dentists and some specialists like opthalmologists can take a bit longer, maybe a couple of weeks. Scans and blood tests etc are prescribed by a doctor and you can get an appointment to have them done wherever is most convenient. I recently got a breast scan done at a local radiology centre and was given an appointment the same week I called.

Women are followed by the same gynaecologist throughout their pregnancy and he/she delivers the baby in the hospital where they are affiliated. It's fantastic, especially if you have had a history of complications like me. Just like with other specialists, you can pick whoever you want - you call them and get an appointment. No referrals.

Hospitalisation generally costs a little bit, but it depends if you want an individual room or not. The standard mutuelle cover will cover you in a double room and for most costs. However, some hospital groups are more expensive, and many people prefer an individual room. So, for that you would need a hospitalisation insurance to cover the costs. Most Belgian employers provide this for their employees, but if you have to take it out yourself, it costs about €150 per year for the whole family.

I absolutely love the system here. Yes, you pay a little to see a doctor and to get a prescription, but you can get an appointment easily which I think makes it well worth it. Hospital care is amazing - my 3 year old got grommets fitted 2 weeks after the problems being first identified. I have had 4 births, 3 of which were pretty complicated, and my care was second to none, and cost me overall about €150 after my hospitalisation insurance paid their share. One of my kids spent 6 weeks in neonatal intensive care after being born prematurely, and his care cost us absolutely nothing. The bill of €18,900 was settled by the mutuelle and my hospitalisation insurance.

What i like about the Australian system is that it does give people more options and a lot of people use both systems.

• people without private cover can choose to see a private specialist (usually only the first appt is pricey and Medicare pays a chunk) but have admissions in public. Lots of people do this so they can see the same person each time and choose their doctor

• a lot of chronic but non-life threatening illnesses are managed privately taking the strain off the public system

• Access to psychologists is generally good (unless living remotely) with this free under certain programs for children in families with lower incomes. For most people the government will pay most of the fee (Medicare) with out of pocket costs about $60 where we live.

• there are literally about 100 private paeds speech pathologists locally, most very good, so waiting for months and months like some seem to on the NHS isn’t necessary for some families. Private health will pay some, or there’s a process through the GP can brings the cost down. There are still public speechies.

• everyone can access free public hospital care

I know you weren’t asking about Australia, OP, but it seemed misrepresented on the previous thread. It has concomitant private and public health systems.

RedDwarves has explained the Australian system well.

You said OTHER than Australia, but (based on the other thread) literally nobody seems to understand Australia’s system either.

Saudi Arabia here. Free healthcare for Saudi nationals only. Privates healthcare for all expats. I legally has to be provided by their employer/sponsor but the level of insurance varies greatly. Some employers may provide full cover. Some may only supply emergency cover.

You don't have to join a mutuelle in Belgium, depending on what the employer offers. We have private health care with Allianz as opposed to using the Belgian mutuelles, but that is through dh's job. It is somewhat more expensive than the Mutuelle, but covers us world wide.

We get 100% of some of our costs back for dh's Type 2, and my autoimmune disease, but we pay bills in full and then reclaim from Allianz.

Prescription drugs are expensive here, but things we are told are expensive in UK, (like an MRI scan dh had recently), are not. I think the costs of the scan was sub €150.

Healthcare here can be streamlined if you can get it to line up correctly. I like the fact that my next haematology appointment is made as I leave the last one, plus I am given the sheet for what they want on the blood test. Beats the two hour wait for being stabbed in my local hospital in Devon.

I lived in Israel and live in UK for last 3 years. Israel has a system where you join one of the privately run Patient Funds (Kupat Holim) which recieve money from the government collected as a health tax.
Additionally all the funds have higher tiers of insurance to which most people subscribe, but these are very cheap relative to US for example. e.g. about 20-30 pounds a month will cover you for everything including expensive operations and cancer treatment overseas.
The basic tier however is still far better than the UK. Waiting lists are shorter, hospitals are better staffed and equipped, specialists are available to see on short notice, usually for a small fee (about 10-20 pounds).
For example in pregnancy you get seen regularly by an OBGYN and have scans whenever you want, whereas here you have to have some kind of extreme emergency to see a "consultant" (blessed be they) and they don't even have a US in their office, or the ward!
Emergency service is also much better in Israel - When you call an actual person with some medical training answers and not what you get here which is basically the receptionist from the "computer says no" skits. To compare with the US: nobody will ever ask you for insurance before treating you, and they will do their absolute best for anyone. In any case the most you would be billed (as a resident) is about 150 pounds.
To sum up - the UK has a lot to learn from other countries and they really should give up on this "totally free" healthcare idea which is completely impractical and doesn't work well anywhere.

The US system is always mid interpreted on MN.

We pay $70 per person per month insurance. Our excess is $1500 per person per year. DH is able to save $1500 tax free through his company.

My daughters and myself have ongoing health issues. Some weeks I’ll have pennies left until I next get paid. Any healthcare system that required payment would have had possibly fatal outcomes for us as I genuinely wouldn’t be able to afford it. We already don’t have TV or Internet. I couldn’t “find” that money from anywhere!

@MaryCraven
In my example (Israel) like I said, the basic tier is completely free, and covers a wide range of illnesses (including most chronic illnesses and cancers etc), with most medications being free, especially for low income families. It is all funded by the voluntary contribution of more affluent families who then get slightly more coverage and somewhat quicker access.
That there is no option to contribute more in the UK essentially pushes more affluent people to give their money to private healthcare and increases inequality

I grew up in Germany and everyone has to have health insurance. If you are on benefits, it is paid by the state, on an income below a certain threshold it is paid completely by the employer.
Health insurance for people in employment is roughly 15% of their gross salary or wage, half is paid by the employee, half by the employer.
High earners can either opt to stay insured with the public insurances or go with a private insurance.
I am not quite sure how it works for pensioners.

You get a card which you can take to the doctor or dentist. There is generally no additional pay for GPs or specialists for the run of the mill stuff, but there are treatments that are not paid for by insurance and have to be paid for.
That depends quite a bit on the insurance itself, some are quite basic, other have a lot of incentives and offers.
In addition to that you can have a supplementary private insurance to have a single room in hospital and guaranteed consultant treatment.

If you want to see a GP you make an appointment, if they think you need a referral they write it there and then, so you can contact a specialist of your choice.
For some specialists you don't need a referral, you just make an appointment, for example gynaecologist, ophthalmologists, dermatologists, ENT or pediatricians. However, the waiting times for the preferred specialist can be quite long. If it is urgent, you can ring your insurance who have the duty to get you an appointment within two weeks, but this might not be the person you wanted to see.
To see a specialist, you'd go to their surgery rather than a hospital.

Adults have to pay a fee for every pack of medicine they get, depending on the package size (N1, N2 or N3), but only up to two percent of their annual income, or if chronically ill 1%, after that prescriptions are free. Some people who are chronically ill can reach that threshold by the end of January, especially if they are on a low income or pensioners.
If a medication is cheaper than the lowest co-pay you have to pay in full and the insurance also does not pay for over the counter medications.

If you require hospital treatment, there is a co-pay of €10 a day for at most 28 days a year, after that it is free. This does not apply when giving birth or for anyone under 18. There are a few more exemptions, but they are a bit complicated.

We're in Spain. We have CAP, the NHS equivalent. Free.

It's excellent. Doctors appointments within a day. I needed 2 MRI's in the last few years. One was the next day and one was the same day (doc said needed one at 10am, I had the MRI at 5pm).

Things are fast here. I need an operation on my foot, had the specialist appointment a couple of months ago. I went to the appointment at the hospital, specialist said he needed a more recent x-ray. Told me to go and wait down the hall in the x-ray dept and my name would be called. Had x-ray within 20 minutes. Told to go back and wait in the waiting room by specialists dept. 15 minutes later he called me in. Looked at the x-ray, looked at his calendar and said he could operate in 3 months and gave me a date. He apologised it would be 3 months but his calendar was very full.

Dentist, they are fast and good. Checkups and for any work on under 18's are free. Over 18's you have to pay for any fillings etc, but it's not much.

I love the system here. It's so smooth and is very good.

Oh and basic prescriptions you pay for. DH was prescribed some medication a year or so ago. When he went to the pharmacy the medicine was 22 cents. DC has a nut allergy and we carry an epi-pen, they cost us €23.

If you were on cancer meds or something like that it would be free.

South Africa, absolutely sod all, there is a govt funded service but it is rudimentary at best, be prepared to bring your own bed linen to hospital.
There are private insurance schemes which can vary but like all insurance you get what you pay for and you can only claim so many times per annum.
A friend was told he needed an mri but as his insurance had run out they refused. He then phoned around and found a clinic which would do a cut price mri if he paid cash. 400 Pounds.

Another friend was ejected from her bed following surgery cause the insurance maxxed out

I know of people asked to hand over a credit card in A&E when they arrived with their wife who had a nasty fall and broken her hip.

It gets so people sometimes choose between food or paying the insurance.

Australian, have worked in Aus and UK as allied healthcare role (radiology/nuclear medicine type of thing). The healthcare system in Australia is good for patients but phenomenally shite for some employees. Privatisation of pathology labs, radiology services etc means the private companies treat their employees like trash and pay them trash because they can get away with it. Frankly it's disgusting to pay someone with the equivilant experience and clinical responsibility as nurses half the wage of a nurse. I also find the staff within the public sector in Aus far far less professional than in the UK to work with. This probably isn't obvious to patients but I had many many many moments in Australia where I thought "how the actual fuck is this nurse/lab scientist/whatever practising with the sheer level of incompetence they are displaying right now?" Imo UK healthcare staff are far more likely to ask if they don't understand xyz whereas Australian staff will just barrel on and do what they think is best without checking first. Also feel that Australian staff where much ruder when being told they'd fucked up and would deny it, shift blame etc and there was far more of a culture of bullying in Aus in every hospital I worked in. UK staff (especially junior doctors) are more likely to admit to me that they fucked up and fix it. Yes this is a generalisation but was my experience at least. I feel much more respected and appreciated in my profession in the UK than in Australia.

I'd much rather be in the UK as an employee than in Australia.

Canada here. I think every Province is slightly different. But in mine we pay $75 a month for our family health care (people who earn less than the threshold don't have to pay). We have to pay for prescriptions (low earners don't have to) and dentist. People who are employed full time get medical benefits which includes dental and prescriptions and some include much more. People on part time get no benefits so many low paid jobs are part time to avoid the extra cost to the employer .

There is a shortage of doctors so it can be difficult to find a family doctor, also it can take weeks to get an appointment (they leave same day appointments for children and urgent matters). Lots of people go to 'walk-in clinics' where you never see the same doctor and there is no knowledge of your history but you can see a doctor on the day you need to.

Our local hospital is crumbling and overcrowded. I had to wait 6 months for a sonogram and when that wasn't enough another 6 months for an MRI- and then they never got back to me about the results. It's pretty depressing!

I put it down to Canadians not being complainers! Also a small population spread out so we need lots of medical facilities but there isn't enough tax money to do it well. The ageing population doesn't help either.

The MRI machine for our hospital was paid for by private donations and is on a trailer so it can travel between hospitals. If you can't rely on the government, you do it yourselves I guess!

Op I'd like your permission to ask posters on this thread about a particular aspect of this situation but don't wish to be rude and hijack thread.

Canadian here as well. In our province we don't pay healthcare premiums. Everyone who is a citizen or permanent resident is assigned a provincial healthcare number. This also serves as your ULI, or Unique Lifetime Identifier. This number is on all of your records.

I've never had a major problem with finding healthcare. Then again I have lived in rural communities most of my life. If you need a specialist appointment, then yes, you might need to wait.

Basic healthcare is covered. This means that hospital stays, medically necessary procedures, and regular doctor visits are covered. So are some allied health services (for example, they will pay for your first 3 physical therapy appointments). Home care and public health (vaccinations, school health, and newborn visits) are covered.

Here's what we have to pay for:
Cosmetic procedures
Employment physicals
Sick notes for work
Forms filled out by a doctor (e.g. for disability)
Prescription meds in the community
Private room by request in a hospital
Birthing centre (midwifery care is covered and hospital birth is covered)
Ambulance trips
Dental care
Eye care for healthy adults (covered for children under 18 and adults with health issues such as diabetes)
Glasses and contacts
Allied health (e.g. counselling, physio more than 3 visits, massage, chiropractic, etc.)

You can get additional benefits either through your employer or on your own. For example, Hubby's work offers benefits through ManuLife and mine offers them through Blue Cross. For people whose work doesn't offer benefits, sometimes they can purchase health insurance privately. Most colleges and units have student health plans. These still don't always cover everything but are a big help.

There are some private services you can purchase. For example, there are private home care companies such as Nurse Next Door and We Care. Publicly funded home care will provide a certain number of visits but if you need more you can go private. There are also public and private care facilities. (Public facilities have nursing care covered but residents pay for room and board. The rates are set by the province. Private facilities require that you pay for everything.)

Forgot to mention: travel counseling and vaccinations are also not covered. If you're going to Timbuktu and you need hep A and typhoid and yellow fever vaccines, you have to pay for those.

Flu shots are covered for everyone in my province but that isn't the case everywhere.

I live in Italy. The equivalent of the NHS is the SSN which is free/low cost at the point of delivery and funded by taxation. It was created in the 70s to replace an insurance-based system and was inspired by the NHS. The ageing population means it's under increasing strain. Italy generally ranks highly in the various healthcare league tables and spends around 9% of GDP on healthcare. However, like pretty much everything in Italy there are huge regional variations, especially between the richer north/centre and the south. I live in a relatively wealthy region which ranks highly for healthcare.

Inpatient and primary care is free. There is a co-pay system of capped charges for some appointments with specialists, diagnostic tests, and prescriptions. There are exemptions for pregnant women, unemployed people, low income pensioners, various serious conditions etc. Depending on your income, you can also claim these expenses back when you do your tax return.

Everyone registers with a family doctor (or paediatrician for children), who will visit you at home if you're ill. Like UK GPs, they handle referrals to specialists, but these are extremely easy to get (you just ask!). In my experience waiting times are generally 1-3 months, but might be more depending on what you have.

Italy has a high ratio of doctors to population. Italians are health obsessed, visit the doctor regularly, and expect thorough checks and tests as well as generous presciptions. Preventative care like annual gynaecologist check-ups, dermatologist mole checks, and 'MOT'-stye blood tests is encouraged. I've had numerous conditions (including congenital ones) picked up in the 5 years I've been here by cardiologists, gynaecologists, opthalmologists at general check-ups. I suffer from mild anxiety and saw a psychologist within two weeks. Prenatal care is very thorough and stuff like prenatal pilates/ yoga/ aqua classes and baby massage are also free in my area.

Lots of people top up public healthcare with private care - for example to avoid waiting, have a more convenient appointment time or more comfortable surroundings. A private appointment with a specialist is not terribly expensive and you can slot easily back into the public system once you have your results/if you need further treatment. Patients keep their own medical records and results which makes it easier to swap doctors/hospitals or clinics. Private doctors are notorious for not paying taxes.

I grew up in Germany. The explanation of a pp is pretty good.
I have never had to wait for an appointment in Germany on public insurance. And crucially, I've never cone across the weird notion that goung to the Doctor when you're sick is wasting the Doctor's time (as opposed to their job).There's no competitive not going to A&E. An out of hours sprained ankle? Let's go to A&E to get it X-Rayed just in case. You might wait a few hours, but I think no one makes sick people feel guilty for trying to access medical help.

Im in the USA. I pay just under $400 a month for my health plan. I have a $4000 a year family deductible. This means the first $4000 of health care costs a year are mine to pay. I pay $500 for an ER visit and $60 for a doctors office visit, that is even if I have met the deductible. I am allowed 10 visits a year for mental health appointments, they will cost me $125 a visit.
On the other hand I was sent to the ER last week. I arrived at 530pm and had my appendix out at 11.30pm. I had bloodwork, an ultrasound and a cat scan to diagnose said appendix issue.Oh and loads of morphine.
I was discharged the next morning at 9.30am after a great breakfast .
The nurses, aides, doctors and surgeons I encountered during my brief stay were fabulous. I was treated wonderfully, with kindness and humor.
Im DREADING the bills coming in now.
My local hospital has a terrible billing dept, they dont like to set up payment plans and literally send you to collection if you cant pay in total in 3 months. There goers my credit rating, off to keep my appendix company. It will be interesting to see how much this all cost