retzie

How??

Despite living here for 11+ years, I still can't get my head around any part of the health industry in this country. The "I'm alright, Jack" mentality doesn't even hold any water, when you look at the insanity of out-of-network extortion, as detailed in the other current thread.

It's so very, very wrong

petitefrancaise

that's because poor dental health is still viewed as self-inflicted and avoidable. They're right too. Richer people have better teeth not because they have better access to dentistry but because they have better access to information/education and easier access to good food - better quality food costs more. The single biggest determinant of a child's dental health is the primary income earner's profession ( ie income). In the UK and France (probably USA too but I haven't checked) the single biggest reason for an under 5 yr old admission to hospital is for tooth extractions. Plural. Too decayed to be restored and too traumatic to do in a normal dental setting.

durham_lad

vespucci

No. It's not as avoidable as cigarette and alcohol-related illnesses which are covered. I expect it's probably to do with what's a matter of life and death and what isn't.

durham_lad

scrubbedexpat091

True it is hard to eat healthy foods when low income, even getting food can be a hurdle, there have been times I couldn't even buy food, and relied on food banks, and lets say the food from food banks isn't always the healthiest, really depends what they happen to have on the day you visit, vegetables & fruit were rare, mostly mac and cheese, soups, baked goods donated from Starbucks and such, ramen was a common item as well.

spouse of scouse

I got home today after a 2 week stay in a private hospital. My health insurer has been sending me copies of 'account paid' statements for the various providers, hospital, theatre, surgeon, physio, anesthetist etc etc, presumably to point out to me that my insurance premium is a bargain. And given that we pay $6,500 per year in premiums and the charges for this admission total around $70,000, then I guess it is a bargain. Mind you, Australia's universal health system (Medicare) would have reimbursed my insurer for around $40,000 of that.

scrubbedexpat091

Does that $6,500 a year cover everything in full? I mean like do you just pay the premium and you can access medical care with no further costs, or is it like the US where you pay the premium but then have to pay co-payments, co-insurance and random other costs on top?

Canada we don't get to see how much the healthcare actually costs, the government doesn't bill or send out invoices so Canadians have very little concept just how much healthcare costs, the providers direct bill the government and the patient is never involved in the billing.

Shard

How does Aussie HS compare to NHS or the Canadian system.

Also, as you seem to know much about RC/crowns, I had an RC a year ago, and we filled it to see if it would 'settle'. After a few months it did settle. But then this summer part of the filling came out and I didn't get it seen to until now. A crown has been recommended. Do you think I did any 'damage' by not getting the crown earlier? TBH I had forgotten that I had a RC on that molar.

spouse of scouse

Health cover in Australia is hell complicated JS (much like anywhere else then!).

First of all, every Oz citizen and permanent resident is covered by Medicare. This entitles people to free in and out patient care in a public hospital. Everything is covered - hospital bed, doctors, surgeons, theatre, medications etc. People who are working pay a Medicare levy of 2% on their taxable income, although people earning less than $22,000 don't have to pay it, and seniors and pensioners whose income is less than $35,000 also don't have to pay the levy. People who aren't working aren't required to pay the levy.

If your GP 'bulk bills' to Medicare, then there's no out of pocket for the patient. My GP doesn't routinely bulk bill so I have a co-payment of around $30 per visit. But like most doctors, she'll bulk bill for follow up visits for the same illness.

Specialists/consultants in private practice don't bulk bill, but will give low/no income earners substantial discounts. Medicare also rebate a proportion of specialist fees, up to 80%.
If you see a specialist/consultant publicly, ie in the outpatient centre of a public hospital, then there's no fee to pay.

There are a few reasons why people take out private health cover on top of Medicare. One is there's usually no wait to see a specialist, whereas public patients can wait months for conditions not classed as 'urgent'. Take a hip replacement as an example. A privately insured person could choose their own surgeon, be seen by that surgeon within a week, and be operated on in a private hospital the next week. Someone with no private insurance could be waiting months, although that does depend somewhat on the area they live in.

Another reason for taking out private health insurance is the Medicare Surcharge. In an effort to reduce the load on the Medicare system the government 'encourages' better off people to take out private insurance. If a single earning more than $90,000 per year, or a family on more than $180,000 per year doesn't have private health insurance, they will pay an additional levy (surcharge) of up to 1.5% on their taxable income, on top of the 2% they already pay.

Some people, and I admit that I'm one of them, also prefer the comfort of being treated in a private hospital. I was shocked to find out that patients in public hospitals are now put in mixed gender wards - I don't fancy talking about intimate health issues with the hairy arsed bloke in the bed next to me being privy to all the details! For my recent hospital admission I had a private room with en-suite bathroom, 3 course meals with 3 choices for each course, better nurse/patient ratio etc etc. I couldn't afford private cover when I was younger, but now that I can I'm very glad to have it.

The 'stinger' that gets some people with private health cover riled up is that, while you'll leave a public hospital stay with no out of pocket to pay, private patients in private hospitals have to pay for their medications, physio visits etc. However, Medicare rebates are given for most of those things.

I probably haven't even covered half of the heath care system here, like I said, it's complicated! Feel free to ask any specific questions you have, I'll answer them if I can

spouse of scouse

Hiya Shard. For a bit of info re the Oz health system see my post to JS.

I don't really know that much about dentistry, just that it costs a shed load of money to get any work done here! I can't see that delaying the crown would have made any difference though - if the root canal had been successful then you wouldn't have been getting pain whether or not you had a crown.

Meant to say earlier, NO dental treatment for adults is covered by Medicare. Basic treatment for kids is provided up until they leave school. Private health insurance offers payments up to a limit for each type of treatment per year, that's fine for fillings etc but the allowance doesn't come close to covering major treatment like crowns or implants. I have a full lower jaw of dental implants (4 on 4), the cost was $45,000 and I got $1,000 back from my private health insurer.

scrubbedexpat091

Almost sounds as complicated as the US system except sounds like everyone has some basic level provided. Makes my head hurt, guess I have gotten to the fairly simple Canadian method, although it does very a bit province to province as healthcare is a provincial responsibility to manage.

In BC we have a couple small private facilities that can do minor things, but we don't have what you would call private insurance, closest is extended health insurance which covers things not covered by the provincial plan, I can't for example get insurance to speed up being seen by a specialist or speed up getting a hip or knee replacement, its all based on how urgent your medical situation is, its all triage based and the hospital food generally is of poor quality in my experience, but there are not at point of service fees, we do currently have monthly premiums and those making under 40,000 get a premium discount, and some employers cover the premiums, but come January the premiums will be gone, and replaced with a payroll tax on employers.

When we go to the doctor they have our provincial health # and they direct bill MSP (medical services plan is what its called in BC) and MSP provides the payment, same with lab work, x-ray. Prescription drugs coverage is a little sparse in the public system, there is some limited coverage, income based with a deductible, so many have extended health plans either self pay or via employment that helps cover prescription drugs, but there are special programs for say disabled they get extended health via the government so have most prescriptions fully covered for example.

spouse of scouse

I know the word 'minefield' is overused on BE, but heath care in all the different countries we talk about really does seem to be a minefield!

Re prescription drugs here. People on a low income, seniors, pensioners and those on benefits pay $6.50 for each prescription. Once they reach a limit (have paid around $350 in a calendar year) then all their prescription medications are free for the rest of that year.
Working people who aren't low income pay around $30 per prescription. If they reach around $800 paid in the calendar year, then they only pay $6.50 per prescription for the rest of that year.

retzie

Thanks. It's not so much a surprise that lobbying was behind it. But that there was so much MORE lobbying than all the rest (and I really don't think very highly of the rest). Boggles the mind.

Lynn R

[QUOTE=Jsmth321;12738800]Does that $6,500 a year cover everything in full? I mean like do you just pay the premium and you can access medical care with no further costs, or is it like the US where you pay the premium but then have to pay co-payments, co-insurance and random other costs on top?

/QUOTE]

Here in Spain, we currently pay just under €1,800 per year for private health cover for the two of us. That covers everything (if we want it to, as we are also covered under the state system so have the choice of which to use) apart from medications. If I am prescribed something by a doctor in the private system (eg my cardiologist) I make an appointment with my doctor in the public health system, tell him what has been prescribed and he gives me a prescription for the same thing, so that I only have to pay 10% of the cost. We don't have any deductible or co-payments with our private health insurance. Last year I had open heart surgery to repair my mitral valve, in a private hospital in Málaga (owned and run by the same group as the Madrid hospital where former King Juan Carlos has just had a quadruple bypass). Had all the pre-surgery tests there including a transoesophageal echocardiogram carried out under GA in their ICU, was admitted the day before surgery for cardiac catheterisation, had the surgery and then (unexpectedly) had to spend the next 8 days in the ICU as my heart rate had gone haywire and they had to keep me on an external pacemaker until it settled down) followed by a further 2 nights in a normal hospital room (single room with a sofabed where my husband could stay overnight if he wished, and ensuite bathroom). Two follow-up visits to the surgeon for check-ups post surgery, and ongoing annual check-ups from my cardiologist as well. There was not a single extra charge for any of it, and I never see any details of costs from either the hospital or my insurance company, I just do not have to concern myself about that. There is no subsidy to that private system from the public healthcare system, except that in some circumstances (if treatment cannot be carried out within certain timescales, for example) the public system will send patients to certain private clinics or hospitals with which it has contracts for them to be treated there, and pick up the bill.