Giantaxe

Every insurance company does this too.

scrubbedexpat091

We certainly have postal code lottery in Canada when it comes to healthcare.

A medication or treatment might be available in one province but not another.

I cannot get a certain treatment in BC but if I lived in Ontario, I could although there would be a significant wait.

Giantaxe

Whereas in the US, beyond what's mandated by the ACA, we have an insurance policy lottery.

morpeth

Good post and highlights the point that the tremendous costs involved in US medical system. Duplicate tests I have noticed, as well as how complicated the administration is- all the different forms a GP's office has to fill out for multiple sources of payment. I remember during the failed 'Hilarycare' proposals in the 90's part of the proposal included estimates of the millions support millions of dollars that would be solved just by having one standard billing form.

MidAtlantic

I would prefer the outcomes of NICE, made on a rational public health basis, rather than insurance companies with decisions made on the basis of what is best for them.

Rockgurl

I'm in no way justifying costs but as a veteran nurse and someone who's about to graduate as a nurse practitioner, I understand the world of healthcare more than most. Hospitals are absolutely enormous undertakings. Imagine what that 15 minute actually generates in terms of personnel and real estate. The front desk person has to check you in, the CNA has to take vitals, the nurse has to assess and give meds, the phlebotomist has to draw blood, the lab has to test it, the transport person has to take you to the CT scanner, The radiology tech has to perform the scan, the radiographer has to read it, the NP or MD has to assess you, formulate a plan of care, perhaps referring you to another provider who also has to formulate a plan of care, the front desk person has to check you out, and finally the housekeeping staff have to clean the room.

Also take into account the monitoring that you had on when you were in the ED has to be installed and maintained by a biomed engineer and all the electronic documentation has to be designed, implemented and maintained by a team of analysts, and then the billing department has to analyze your bill and gather all the costs. It's absolutely overblown and gigantic. That 15 minutes just made you pay for all those people's jobs and the technology that was used. That doesn't include all the quality control measures that are silently happening while you're sitting there. Every single second is being billed by multiple areas at one time.

Providers have to follow a specific plan of care and so if you came into the ED with abdominal pain and I was your provider, I'd be duty bound to rule out all the differential diagnoses so you won't sue me if I miss your gangrenous appendix. I can't just tell you to take an aspirin and go home or I wouldn't be doing my job. I can't miss...not even once, so therefore I am going to order every test known to man so I can rule out worst case scenarios and not have you die. It's hard to understand if you've not been exposed to it, but having been in healthcare 25 years I've seen it all and I can see how those costs can easily be generated.

Rockgurl

That's actually not how it works at all. If you do a simple urine test and see trace protein or glucose, that's going to generate a whole host of other possible differential diagnoses that also have to be followed up and ruled out. Each test adds an element to the skill of diagnostics and forms a spectrum or a picture. All of those elements have to be taken into consideration with a whole host of other results to formulate that picture. Each body part does not exist on its own....the body is a single organism with many parts, and it's the skill of the provider that allows accurate interpretation and an accurate diagnosis and treatment plan. That's the thing about healthcare...we all make it look so simple but nobody else has any idea how complex it all is.

uk_grenada

Absolute Bottom line, the nhs in the uk costs 1800 pounds per person per year, thats it, all of it, hospitals, doctors, drugs etc etc. Yes its a massive sum - 250 billion, but so what, its efficient.

America is - health wise - still a 3rd world country. Sure you can buy a flashy new operation for lots of moolah, but until you have a government mandated tax funded free at point of use system that actually covers everything, you’re a peon to the bosses of big corporations.

petitefrancaise

really? I'm guessing you'd have a different opinion if you had a loved one being denied treatment just because of where they live and knowing that they would be able to get treatment/medicine in almost every other country?

I remember "cyberknife" lawsuits in the UK not too long ago and patients being surreptiously sent to Toulouse by the NHS ( where I lived at the time) to be treated with it because they were being noisy about it in the UK. He who shouts loudest, lives in the nicer areas and is able to self-advocate gets the treatment and not the poor bugger who thinks the doctor knows best? The docs will quickly tell you how frustrating this type of situation is and that patients die because of it.

My brother was diagnosed with a congenital heart defect and it took 6 months to wait for an NHS consultant appointment. He couldn't work in the meantime so he paid for a private consult with the same dr within a week. Don't get me started on that! My brother's kids also had to be checked out, 3 months wait. In France, me and my kids had appointments within the week.

The NHS is drastically underfunded and I most definitely would not hold it up as a prime example of health care. Going up to EU levels of funding would be ?2-3% more of GDP but that's not going to happen.

mrken30

We waited 2 weeks for a hernia op, and that's only because the surgeon was off to Hawaii for 2 weeks. So I guess it depends where you live or your health provider.

MidAtlantic

I'm guessing you would have a different opinion if you had a loved one being denied treatment just because of an insurance company and with no possibility of raising the necessary funds.

petitefrancaise

In no way am I saying that either system is best. I am just saying that keeping funding as low as the NHS does is not good either.

FWIW. If a loved one ( or even me) was sick in the USA and without insurance to cover treatment, then I'd go elsewhere. France for example is incredibly cheap and very, very good. The hospitals/doctors don't care who pays their bill and in most cases the fees are set at a reasonable level by the government. My friend runs a company that takes patients from the USA to France for treatment and even has contracts with some US health insurance companies who will do this because it is so much cheaper.

I posted a link earlier in the thread which talked about why the insurance owned hospitals are not always the cheapest place to go to even if they are your insurers... it's basically just another way of boosting profits that they would otherwise not get.

mrken30

The NHS is far from free. It's a 12% tax that working people have to pay in addition to their income tax. I pay a lot less than 12% for my healthcare in the US.

https://www.gov.uk/guidance/rates-an...s-2016-to-2017

morpeth

The NHS for sure has faults, many, but at least in UK anyone can get medical treatment which is not the case in the USA- I find it outrageous the system in the USA that results in many simply not getting any or most of the treatment they need. Sure the NHS is far from "free", but if one had to chose an overall system who would chose the American system ?

MidAtlantic

Well we agree about that and about France!

I also have family in France and it seems that their experience of health care is superior to both the UK and USA.