yellowroom

Home visits seem to be completely unknown over here - well in my corner of Virginia anyway.

My elderly dad was very poorly with a bad chest infection in the New Year, and my mum called out their GP a couple of times. He was as re-assuring for my mum as he was in treating dad.

My colleagues were astounded when I said GPs will do home visits for certain vulnerable patients. I pointed out that in healthcare terms, it was better for him to stay at home where he wouldn't infect other patients, or pick up something else at the surgery. Besides which, he was so weak Mum wouldn't have been able to get him down the stairs (she had to call out an ambulance at one point as he fell over in the night going to the loo and couldn't get back up). So the other option would have been ambulance and hospitalisation, and probably pick up pneumonia while there.

Definitely better for both the patient and the budgets for them to be looked after at home as much as possible IMHO.

(he's made a pretty good recovery now, tough old bugger).

robin1234

Hmm.. It seems to me that Medicare is not actually a "healthcare system," it is merely a government administered way of accessing the regular American healthcare system. The healthcare available to Medicare recipients is as good or bad as the healthcare available to any other US resident who has decent insurance.

The bad thing about Medicare is the complexity of getting full and optimum coverage, but the care you get is dependent on where you live, your choice of provider, etc.

The complexity comes from having to sign up for part A, part B, part D, and a medigap policy, at the right time of year. And having to reassess the part D choice each year. And having to do that when you are 65, 75, 85 years old etc., and probably living on your own. (Note that for the sake of simplicity, I'm leaving Medicare Advantage out of the equation.)

AmerLisa

They haven't had to really deal with it then....

I am amazed and utterly pissed off at how we deal with our elderly in this country! My grandmother worked very hard all of her life, her values, as I'm sure a lot of people from this era were, what we could all take a page from. Yet hard work meant nothing in the end and luckily from us (myself and my husband) we were able to barely keep her afloat in an assisted living facility that wasn't covered (none of them are, apparently) by good old Medicare. And when she became bedridden, a week before she actually passed away, and I thought costs would skyrocket for quite some time because we didn't know how long she would linger, we were told that a skilled nursing facility wouldn't be paid for by Medicare, and we would have to apply for Medicaid.


My point isn't to say that private would be better, it obviously wasn't in this case because we didn't have that option. And I know my grandmother isn't the only one to suffer this issue, because obviously the rules weren't made just for her. But there just has to be some kind of happy medium without all of the malarky to get there.

scrubbedexpat099

My Parents and Grandparents said the same about the UK system.

In both cases they worked hard to pay for people then receiving benefits, not to pay for their own at a future point.

Giantaxe

I think it's more indicative of their experiences with private health insurance companies being even worse!

scrubbedexpat099

I remember talking to a remote inherited American Relative who was railing against socilaised, so I asked her who she bought her Medical Insurance from, she said she did not as she was on Medicare........

AmerLisa

I can't even imagine.... But then again, I'm pretty fresh from all of this experience and perhaps not making the most objective opinion.

But I will say that I'm sat in my home office surrounded with stacks of bills wanting my attention that were hers, I suppose my grief over her passing will have to wait.

Giantaxe

I'm sorry you're going through this. It is indicative of another hidden "cost" of the US system of healthcare access.

scrubbedexpat099

They are talking about a lifetime limit of GBP75k in the UK.

It is a tricky one, unlimited demand, limited resources.

Middlemore

The NHS struggles under the burden of immigration. Period.

I worked in London for a few weeks at the end of last year, (keeping my UK RN registration), and learned that 90% of patients are non-English speakers, 60% of births are to non-UK mothers, and interpreters are paid £100 per conversation.
Certainly in the 6 weeks I worked I could count the number of English patients on my fingers. And in A&E I see anything from 40 to 80 patients a day.

I have no understanding of the politics behind this, but why on earth does the entire world turn up and use the NHS for free, when it is held together by a minority of folk who paid taxes and NI all their lives?

yellowroom

That's "social" kind of care (ie help getting up, washing, getting dressed etc), which people have to pay for now anyway in the UK. Not medical care.

I'm not sure how I feel about the social care limit. I thought the whole point of building assets during my working life was to be able to cash them in and make sure that I will be comfortable in my old age. I can't take it with me.

On the other hand, social care is so expensive, it's entirely possible to burn through some modest lifetime savings in a matter of months and then be stuck not being able to afford the nice private care home you are in.

I've never been sure as to why someone should have the asset of a big old house but expect the state to fund all of their old age care. On the other hand, why penalise the thrifty pensioner by forcing them to sell all their assets when the spendthrift in the next room is being entirely funded by the state (something my grandma used to complain about bitterly).

It's quite a dilemma and one I've not been able to get my head around. I want dignity and respect for all old people, but how fair is it to tell an elderly, sick and vulnerable person they don't get the services they need because they made some poor financial decisions 30 or 40 years previously?

yellowroom

I think you'll find that if it wasn't for immigration, there wouldn't be an NHS.

It wouldn't surprise me for some areas of London, but that doesn't mean that those patients are not legally in the country, working (or part of a family with a breadwinner) and thus contributing to the cost of the NHS through their taxes!

London is not representative of the rest of the UK.

Middlemore

I don't have access to data regarding who works and who doesn't, other than the hospital pharmacy gave up trying to charge for prescriptions as so few people are earning.
I think it was only around 12% of patients who had ever paid tax or NI, but that is from memory, I would need to clarify that.

There is a growing 'entitlement' culture, which is expensive, It means that people call ambulances for no good reason, when a bus or taxi ride would have sufficed. But they aren't going to pay for a bus when there is the free taxi with blue lights and sirens, are they?

It costs around £500 per ambulance callout in London, there are in the region of 8,000 a day, and from memory, approximately 78% of these are unnecessary.

I understand there is a system in use in either Aus or NZ, which i learned about from a paramedic on an exchange contract.
I think they have some sort of prepay system, a bit like the London Oyster card, which pays around £25 for am ambulance callout.
If 3 people are in agreement that the ambulance was necessary because of a life-threatening condition, then the £25 is refunded. Those 3 people are the paramedic attending, the receiving/triage nurse and the doc.

They do not have the service abuse and waste that the NHS has. Is there a lesson to be learned here?

scrubbedexpat099

If it is free why not?

If you have paid for it, why not?

Giantaxe

The lesson I've learned is that this is indicative that "The NHS struggles under the burden of immigration. Period." is but a small part of the puzzle.