Junebug72

back about five years ago my husband had a week in hospital for swine flu and pneumonia three different ct scans at same hospital and would you believe this came back and was three different prices the total for his weeks stay was over $70,000 i really have no idea where they came up with this as i became ill with flu couldn't go in for three days and he had same pjs i left him in when i came back ,

GeoffM

Not really. The NHS have to cover their costs and in fact the private patients subsidise the facility to a certain degree. The point I was making was that it can be done cheaply - but then nurses, for example, only earn half of what they do in the US (£24k vs $65k). I recall the anaesthetist portion of the bill was £300 compared to $900 somebody quoted somewhere recently.

Beckyb

$50k for a c-section delivery! Covered by my insurance but my co-pay hit the $2k mark.

scrubbedexpat091

Do you have to pay part of your medical care in the UK? I ask as I have no experience with any other systems other then the US and Canada.

Canada's system varies a bit by province since its not run at the federal level, but in my province you get no bill or other related cost for an insured medical service. Doctor bills the provincial medical insurance scheme (different provinces have different names.) directly and then get paid based on whatever the negotiated rate is.

Hospitals are the same, no cost or bill to the patient for an insured service.

For uninsured procedures (anything not medically needed, cosmetic, prescriptions, and such. example: a pre-cancerous mole would be removed at no cost, but if there is no medical need to have it removed, then the patient pays.)but the service provider wont provide the service generally without being paid upfront for it, so still no bill.


Oddly one thing the US seems to be doing cheaper now is prescription drugs for generics with various pharmacies having the under $10 generics, we get royally ripped off on generics here vs the US.

Name brand is cheaper, but good chance a generic will cost more here then in the US,.

Michael

I'm not a Brit but from my understanding, there isn't any charge/copay for NHS but if someone takes out private health insurance, it's usually sort of like a PPO where you have a choice of doctors, hospitals, and often get quicker treatment as an out patient and at the hospital.

For example, hip replacement could possibly have a long waiting list but with private insurance, a person may be able to have it done in weeks.

Michael

Generic drugs have almost always been cheaper in the US than almost every other country but you had to know where to shop prior to the internet. That is because it is the about the only product/service in medicine that is truly competitive. When you have 10 or more places that sell generic drugs plus the internet and several manufacturers of the product, capitalism does work with everybody trying to keep their customers. Because of the internet, even small town pharmacies now have to compete on price. Now it is so easy by just checking GoodRx.

However for brand drugs, Bush gave the pharmaceutical companies a gift during Medicare reform by writing into law that the US government would not negotiate brand drugs prices downward for Medicare recipients and got nothing in return except a monopoly for each brand drug and they could charge whatever they wanted. Obama wanted to do something about that for Medicare recipients but when the pharmaceutical companies agreed to charge 50% of their brand retail price to fill the donut hole for prescription drug plans, Obama took the deal. The government is now slowly subsidizing the donut hole to be 75% covered and in 2015, the government will contribute an additional 5% and by 2020, it will cover 25% for a total coverage of 75% of the cost for brand name drugs. The government is now also paying part of generic and brand costs pre donut hole prices(prior to Obama, 0% was paid for by the government and pharmaceutical companies for generic drugs) but by 2020, the government will be paying 75% of the cost. Now that after I look at it, it appears that Bush gave away the store and just provided insurance companies a way to sell prescription drug plans. The only thing that Bush apparently did was have the government covered a significant part of the cost when seniors used so many drugs that they exceeded the donut hole. No wonder AI am paying so much for my prescription drug plan since I thought it was a benefit and now I can see that it was only a benefit to the insurance companies.

Donut Hole Phase Out

petitefrancaise

This documentary by Michael Moore is a good one to watch for a run down on the failures of the US Health system prior to Obamacare. Gives some comparisons to the Canadian,UK and French health systems too.
Sicko | Watch Documentary Online for Free

French dentists went on strike the other week because they're only paid about €50 for doing a checkup/xrays and a cleaning.

Michael

The US healthcare system might have a slim possibly that is will work if there was the ability to comparison shop but the AMA will make sure that will never happen.

Although I am left of center, I've seen to many of Michael Moore's documentaries to believe that he's not manipulating people and facts to get his point of view across. Like the right he manipulates facts and events to suit his purpose (not much better than reality TV). PBS Frontline documentaries are far superior to Michael Moore's documentaries and just tells the story and doesn't make judgments and has far superior production qualities such as the following stories.

Watch The Full Program | Sick Around The World | FRONTLINE | PBS

Watch The Full Program | Sick Around America | FRONTLINE | PBS

The above two documentaries tell the same story as Sicko but lets you decide what you are seeing and hearing.

Although Frontline is impartial and covers stories about both parties and things that both parties believe in (seldom flattering to either party), republicans seem to not like Frontline because it tells the story as it is and republicans often don't like to hear the truth when it is something they believe in. They then accuse Frontline of having a liberal bias but I have never seen that to be the case.

scrubbedexpat091

Ahhh I see. We don't have private insurance option in Canada, it's not legal.

We have private medical insurance available, but it only covers supplemental things that the public system doesn't cover or only covers partially like prescription drugs, private or semi-private rooms, TV's in hospital, vision, dental and so on.

Private insurance is not allowed to offer coverage for anything that is medically covered by the public system.

The public system is made up mostly of for-profit companies or self employed as the case with most doctors. Labs, doctors, pharmacies and such are all for profit enterprises and not employees of the government, the government only acts as the payer, basically a government insurance scheme.

Hospitals in my province are indirectly run by the government, independent health authorities cover certain regions and operate the hospitals within their regions based on funding from the government, the employees of the hospitals work for the health authority. But the government doesn't run or employ the hospitals directly.

scrubbedexpat091

We don't have the competition here on medications themselves, the government negotiates the prices with the drug companies and well not every generic from every company will even be available. Pharmacies themselves compete on filling fee and offering extra's.

Filling fee can be anywhere from 7 dollars up to 15 dollars. I have on medication where the pills cost 3.00 but the filling fee is 11 so 14 dollars in total. Luckily I have government prescription coverage, but the majority of Canadian's don't, so they have to either pay out of pocket directly, pay for supplemental insurance, or have benefits through work, or go without the medication.

Certain diseases have special coverage though, cancer, HIV, psychiatric meds and a few others.

My province also offers partial coverage depending on income, the more you make the more you pay out of pocket before any coverage kicks in.

It can be a confusing system sometimes, but you know you will never pay for basic medical services and just about everything is covered in hospital so you wont leave with any bills.

Michael Moore and most US media report on the Canadian system without really reflecting the reality depending on what they want to prove.

Most don't even mention that we have no national system for 1, every province and territory has their own system, what I get in BC is not going to be the same as if I am in Ontario, similar but different.

If I visit Quebec for example I would have to pay up front and then seek reimbursement from my home province. BC ans Quebec don't have a reciprocal agreement.

Medicare and Medicaid in the US is more uniform then our system in Canada.

The pro's in Canada out weight the con's though, so I'd never want to change to a US style system, not in a million years.

That link for RX prices is interesting.

Using my scripts of which 1 is name brand a puffer:

Cost in Canada 100 CAD (88 USD roughly) the price in San Diego according to that website range from a low of 195 at Costco to a high of 206 at Rite Aid.

My generic runs 65 in Canada (57 USD) and according to that website runs 12-13 dollars but its a cheap generic down there, when I lived in Palm Springs with my mom, I was only paying 8 dollars for it.

Unless there is no generic available, a generic is always dispensed, government and insurance wont pay for name brand if there is a generic.

MsElui

My hubbie had same surgery last year - numbers were in same ballpark (from memory)

dont forget to budget for any physio afterwards as well - which may be covered or not by your policy. Hubbie had appointments every 1-2 weeks for about 3 months.

He also had to rent a special chair recommended by the surgeon that had some kind of moving arm he had to strap his arm to that lifted the bad arm up and down in a repetitive movement - gradually getting a further range of movement over a few days. We had that a week or so. think insurance covered most of that. like this:
Also bear in mind you will get a big fancy padded sling thing that has large foam blocks to hold your arm up and away from your body. This has to be brought by you and we had 'bills' for all the incidental items used like the fancy sling, bandages etc - as well as the pharmacy bills for the pain meds they gave him (and the laxatives they also give because the pain meds stuff you up )
I also ended up going to walmart and buying several of the largest cheapo tshirts i could find (like 3XL) that he could wear and get on as easy as possible over the bulky bandages.

GeoffM

Pretty much it, though dental is only partly covered by the NHS - kids, pensioners, pregnant mothers (and for some time after - a year?), the more severely disabled get it free I think.

Prescriptions are about $10 per item, for 1-3 months, depending on the phase of the moon (like here I notice). No such thing as generics or brand: you get whatever you're given. Well, I never knew to ask for a particular brand anyway, and not sure what the answer would have been!

For private health insurance, you probably would get a choice of doctors, but in reality there aren't that many to choose from, and not that many private hospitals. It's not like here where you'd find a medical facility of some sort on every other street corner. As you may have gathered from my ramblings in the past, my treatment was actually done in an NHS hospital because, as my surgeon quite openly admitted, "their facilities are far better than ours" - though that may have been specific to my surgery. In fact there have been media stories about the smaller private hospitals having no doctors on duty at all overnight, meaning any emergencies end up at an NHS A&E (ER) anyway - take that story with a dose of salt. Many NHS doctors moonlight as private doctors though I'm not entirely sure why.

Michael

When I retired at age 57, I signed up for the VA medical health insurance since it was free and the Palo Alto VA ranks as the number 1 VA hospital (about 60 buildings). The Palo Alto VA includes the Palo Alto campus next to Stanford University Hospital but about 4x larger, the Livermore VA hospital in the vineyards of Livermore, and the San Jose outpatient clinic. I imagine it is setup similar to the NHS with a primary care physician and a phone nurse who has to recommend me to a specialist and everything is 100% computerized (I can get to my medical records, prescription ordering and history, send a private message to my primary health care physician, etc.) from my home computer.

Some of the things I don't like is that for normal scheduled appointments, I have to book those a month or more in advance and before I was on a PPO and could go to any doctor that I chose and my normal doctor would normally see me that day if I was sick.

The cost is $15 per office visit, $50 for ER, $50 for a specialist which included all the procedures including MRI, $0 for lab work, and $9 for a 30 days supply of drugs whether generic or brand. What I really like is their ER where when I go in, I'm usually seen within 15 minutes and if it is a simple procedure, I'm gone 15 minutes later. If I go to the ER with a broken leg and they take x-rays, see 2 or 3 doctors, and have everything done to fix the leg, the total cost is $50. For Veterans that are poor, everything is free. If a veteran has a military related disability, the costs are less than mine and could be free depending on the disability. When something is out of the ordinary that the primary physician can't handle, they are fast, efficient, and very thorough.

Although I have Medicare for the past 6 years, I normally still use the VA since I'm familiar with the medical staff, they have the latest and greatest equipment, and I'm use to the routine. They have a whole building dedicated to MRIs and CAT Scans or about 60 total. The equipment in their eye clinic is next to none. I had a simple floater, got a next day appointment, three doctors checked my eyes, and then they took pictures of the back of my eyes (took about a 20 minutes) for use in the future to compare to see if anything is changing.

However if I got seriously ill and ended up in a hospital, I'd probably use a private hospital since Medicare covers 100% for in patient care after $1,000 deductible (no extra charges including any drugs used in the hospital).

Steve_

Years ago I was living in the US, I had no insurance and ended up in hospital. I was taken in an ambulance and I was there for about 4 hours as I recall.

A couple of months later I got a bill for some insane amount of money, I can't remember now how much it was, but the bill was pages and pages long and covered all sorts of procedures including a breast biopsy! (Actually I got two bills, one was $1,200 for the ambulance, that I remember).

So I go back to the hospital and I couldn't for the life of me get hold of anyone in the billing dept. so I ended up talking to a doctor in the ER about it and when he looked through it he started to get very embarrassed.

What I established (although they didn't directly admit it) was that every procedure done to an uninsured person while I'd been there had ended up on my bill. So it was either utter incompetence or fraud and I tend to think the latter as I happened to notice I was the only white patient in the ER when I was there and I think basically they assumed I had insurance (but I didn't) and I would never see the actual bill.

Eventually I ended up paying virtually nothing to the hospital, because the paramedics had done it all before I got there.

Steve_

That movie is very misleading. A lot of stuff isn't covered, although it varies by province, but for example dentistry, optometry and outpatient physiotherapy aren't covered in pretty much every province. (And ambulance services have limited coverage.) You might be eligible for super basic care if you're on a really low income but that's about it.

My basic problem is that unlike most European countries, the bits that are nationalized (or provincialized) are total monopolies. A GP for example could take private patients in Alberta but if they do, they can never bill AHS. So it encourages people to become dentists and optometrists and there's a dentist on every street corner but a shortage of GPs.

And then Canadians always go, "but it's better than the US". Well that's a poor comparison, it doesn't compare well with many European countries.

But it's better than the US if only because it's simple to understand. And the cost of prescription drugs too makes a huge difference. But hey, we don't have a Gerald R. Ford-class aircraft carrier or any F-22s. Poor us.