US vs UK Healthcare
 

A fellow boardie suggested this thread to me and I thought it was a splendid idea...to explain the differences betweem the UK and US healthcare systems from the inside. There's a lot of ground to cover but I can certainly touch on a few points to get the conversation rolling.

We watch programmes on TV about American hospitals and are duped into believing everything is so advanced that the NHS should aspire to it, but having done the swap, my opinion has changed. The NHS may be struggling financially, but it's heart beats in the right place and its care is second to none. There is an unspoken standard in the NHS that is universally applied across the UK, no matter where you work, and somehow I believed that it would be international but it wasn't. I'm not here to disrespect US hospitals but there are many differences which are hard to accept when you come from a background such as the NHS. I can only speak about the hospitals in which I have worked in the USA, and I know they are not good ones, so maybe one day I'll find one that is of a similar standard to the ones I've worked in in the UK.

I think the biggest shock I had was thinking that American hospitals would be so much better and more modern....but in fact I've found them to be far more backward with old equipment and lack of resources. The single biggest annoyance though, was the division of tasks amoung various disciplines which made care very fragmented. In England I would deal with all the care of the patient...drawing up drugs, making plans with doctors, care of the ventilator etc. In America they assign a different department each of these tasks which means you end up waiting for people or waste time on the phone calling people up when in England I would have just done it and got on with it in half the time. In England I could make changes to ventilator settings and gave all respiratory treatments and took care of the patients airway. Here in the US they have Respiratory Therapists, who do a great job but detract from my job because I no longer have control over that aspect of my patient. I also seemed to have a better grip of what was going on because it was my responsibility back in England. It's easy to forget things when other people are involved.

Another annoyance is that I find American medical professionals to be so far up their own arse (scuse the term) and can be so anal about trivial things. They're really obsessed with bits of paper that take up so much time when you could be caring for the patient. Everything they do is the longest route possible and it's just frustrating. For example, in England if I thought a patient needed a specific drug, I would grab the doctor who was on the unit, explain it, get a prescription right there, take the drug out of the cupboard, mix it up and give it, and then document it. In America, you have to call the doctor on the phone who is not even in the hospital, wait until he calls back (if he does call back), he'll probably say wait until a different doctor comes in. Maybe the next day the message gets through, then you have to order it on the ancient computer system and wait for pharmacy to send it up, blah blah blah. Such a waste of time. In my previous job here instead of one large chart with all my info on it, we had 7 different pages, mostly of repeated information, where nothing flowed nicely and you could not see exactly what was going on. In my last job here, we had computer charting which I assumed was going to be really cool and save time, but no...I was wrong. It was extremely laborious and time wasting, taking up as much as 20 minutes over every hour, and you could not see a continuous flow to help you get a grip on ongoing care.

On TV you see all the state of the art equipment and think it's the Holy Grail over here, but to be honest I've seen better equipment in a deprived Inner London hospital on the NHS. The care in the NHS in my opinion is faultless. and I was one the the biggest complainers back in England. I totally swallow my words and take them all back now. Another thing is that in the NHS you feel safe. It's a job for life, and your opinion counts. If you are concerned about something or think something is unsafe you are within your rights to abstain from that procedure and document why. In America you get disciplined and most likely fired for voicing your opinions. I got into trouble for refusing to give a dangerous drug via an innapropriate route even though I could give evidence as to why it was not safe. In England you are told that if you are trained in a particular way and disagree with something you are right not to do it. It's the opposite here, and it was a nasty shock. Another nurse I know wrote a letter of complaint to the hospital in the US about what she percieved as unsafe practise in her department, and was fired the next day! No explanation! That would never happen in the NHS. It takes a lot to lose your job in England and there are proper procedures to go through.

I've witnessed some serious medical errors in both countries, but the way in which they were dealt with were very different. In the NHS there are procedures to help prevent an error from reoccuring and they promote a no-blame system which means that you can report safely and know that it will be investigated with a view to improving that chance of happening again rather than placing blame. Here in the US I saw somebody die because of an error and though I tried to report it several times there was an element of silence and sweeping things under the carpet to prevent a scandal from damaging "business".

These are just a few things that I have noticed while working over here, and I'm sure it's not the same across the board...only my observations. I hope to find a system with which I am happy and think that maybe as a foreign nurse I was duped into inferior hospital systems. This time I shall be in charge of where I go and can maybe find a hospital worthy of its International reputation. I'm sure some of you have observations as patients at the receiving end of care and I'd be interested to hear your experiences.

Re: US vs UK Healthcare
 

Whatever the experiences....I definately appreciate the NHS a lot more now that I don't have it to hand, just making an appointment to the dentist or whatever, and it not being too much of a hassle, ok, had to wait a bit, but to be fair, I'd rather just wait a week and not have to pay all that much, if anything, than to have to pay for private medical insurance like Bupa...

Re: US vs UK Healthcare
 

I've copied your post in full into a word doc which I shall email to the next person who gripes about the NHS and/or tells me how much better healthcare is in the USA. Thanks for taking the time to write it.

Re: US vs UK Healthcare
 

Not trying to be a dissenter here, and I'm not. You readily agreed Rockgurl that you'd only experienced, I guess, a few bad hospitals... I must say I'm not a nurse, the only experience I've ever had in hospitals have been the clerical side and of course being a patient in the UK and the US. I had very good care in both instances. I'm not knocking the NHS either, but I think with perhaps your limited access to better institutions it might be a bit premature to knock the US system? Not sure, just my opinion.

I think my biggest and most important gripe with the US system is the requirement to have medical insurance. I find it very sad that right now if I needed to go to the doctor for anything, I'd be out of pocket big time. In fact its not just sad....its scary. :scared:

Re: US vs UK Healthcare
 

Yup, tell me bout it, or if you get involved in an accident and getting a bill from the fire brigade and ambulance for rescuing you...

Re: US vs UK Healthcare
 

That happens in the UK too. It is just sent to the auto insurance to pay. If you don't have auto insurance or are only insured 3rd party and it was your fault, you have to pay out of your own pocket.

Re: US vs UK Healthcare
 

Yeah, but you don't expect to have to provide the infomation while your being cut out of the car and then left there if you can't show funds...

Re: US vs UK Healthcare
 

Great article, Rockgurl, and definitely a good subject for debate. Like many items this side of the pond, the debate is blinkered with the early indoctrination of “we have the best, biggest and freest�, and consideration of anything else is therefore tagged by some meaningless phrase such as “socialist� so it can be conveniently ignored. The attitude is so different in the UK… However, I think the US healthcare system is in such dire straits that it will self destruct in the near future.

I would only concur with you where you state that the procedures here are to first try sweeping a mistake under the rug, then if that fails finding a scapegoat to blame and fire. In my experience, this is endemic throughout all workplaces in the US, not just the healthcare system. There seems to be the following philosophy behind this: do all possible not to provide ammunition so a client can sue but, if this fails, provide a scapegoat so you can show the court you took firm action in order to mitigate the damages. It’s a pretty brainless philosophy producing a high employee turnover rate that never actually solves any problem. Would seem to be much better to me to ask why we *****ed up rather than who *****ed up.

As a very occasional user of the US health care system, I can’t say I’m particularly impressed. My company, as they delight in telling us, cough up around $400 a month for our healthcare. I pay nothing out of my pay check, but the co-pays are high at, for example, $25 for a doctor’s visit. I’ve not been over impressed: the waiting times to see the PCP (GP) are about what I experienced back in Blighty, I sat nearly 2 hours in the waiting room for a booked appointment last time I went, he doesn’t actually do anything at his office except write scripts so if, for example, you need a blood draw you’ll be packed off to another office, there’s always a stack of paper to fill out for any visit to another office, which seems much more interested in how you are going to pay and how you’re not going to sue them rather than what is actually wrong with you.

Medical billing in the US is an art form rather than a science. Or perhaps I should just say pure fraud? The system is simply not understandable and I’m certain they make it up as they go along, then add a few zeros to the end. Even my insurance company (the second partner in the fraud!), seems unable to understand their own system. When the PCP said he wanted me to have an ultrasound, I actually called them and asked if this would cost me anything extra. They told me $25. The actual bill was $147. Like most, I just gave up and paid. The paperwork was unintelligible and there’s a limit to how long I can be bothered to fight for a small sum. They cry that the free market is best, but the reality is that there is no free market in the US healthcare system. They have deliberately hidden their charges behind reams of paperwork in such a way as to make comparisons between different providers near impossible.

Surprisingly enough, many states do actually have socialised medicine. In Arizona, we have AHCCS, but you can only qualify if you are poor or illegal. It’s actually the best insurance money can buy (or not in this case!) with no or minimal co-pays and transportation provided by cab to all your appointments.

Read on another board a post by a Brit who has lived in the US for 20 years married to a USC who, after presumably a previous healthy life, collapsed in the street with a heart problem. After, two days in hospital and a large bill, the insurance company dropped him as fast as they could. No other insurance company would take him on, so they decided to return to Blighty. Don’t know what Mrs. FB and myself would do if one of us got seriously ill. For most over here the only option is to go BK to protect your assets, but then we always have the option of returning to the civilisation of Europe.

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I concur with Rockgurl.

All i can suggest is do everything you can to get John Kerry Elected. His plan isnt perfect but expanding the Congressional system to those who want to buy in seems good to me. I would buy in.

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I concur with Rockgurl. I'm shocked at the level of treatment. Even a third world country like S.A. used to have better service from their government hospitals than what I've experienced here.

Re: US vs UK Healthcare
 

I feel you really need to look very hard at the pros and cons to both situations. Its extremely easy to break down into a "this system is better than the other" type argument, without really taking a good hard look at both systems. When I originally signed up to this forum I was still living in the UK and read with interest Rockgurl's posts about how bad the NHS was, I even told my husband...look at what a nurse from the NHS says about the NHS! But, in all honesty, Rockgurl wasn't the first person's account that I had read concerning the NHS. I was extremely homesick at the time and thought I just really wanted to get back to the US. On arriving here I've had to remember what it was like before I left, namely the lack of medical care unless you're very well insured....in fact its actually become worse while I was away.

On the flip side, I'm now very homesick for the UK (I'm a very complex person!) and I long for the easiness of the NHS, plus the fact I could go to the doctor or hospital without having to cough up a dime. However, like a lot of people, I forget about the negative sides of the NHS. To be fair, both the US and the UK have negative sides. For the person that needed to go back to the UK because of heart problems, I'd be curious to see if that person wasn't put on a very long wait list to even see a cardiologist. In fact when I was there a year ago people were having to go over to France to have surgeries because the wait list was so very long.

Again, I'd like to say I'm not being negative about any one system. I'm extremely dismayed at things here and find it very sad that this country can't see past wars that are ridiculous and see the need in this country.....it really makes you wonder how people can live with themselves.

Re: US vs UK Healthcare
 

Yes I agree that it's impossible to say if one system is better or worse than the other. All I can do is to draw comparisons and weigh up the conclusions. As a patient I may very well prefer to be in the US (as long as I have insurance). As a nurse I can definitely say I prefer to be in the UK. Can't win them all and you have to do the best you can with what you have. Surely a combination of both would be the ideal. I've never liked the idea of healthcare being part of a "free market"....it never leads to better service, only better profit margins.

People in England may wait longer for care, but I suspect once they get that care it's excellent. Over in the US I've seen people denied care on the basis that they don't have insurance so basically it's not financially viable and so they've been left to die. Even when you do have insurance, it's the insurance companies that decide if your illness is viable and if they're willing to pay for it or not. God forbid they decide your illness is a pre-existing condition and you might very well be faced with an enormous bill or no treatment at all.

On the flip side, I think care in England can be delayed unneccesarily due to the huge demands on the system. People can't get to see a doctor and so get sicker and sicker until they end up needing hospital treatment which will end up costing more. If only we could have a combination of ideals, where working people of a certain age pay a premium, but if your income is below a certain margin you would be entitled to free healthcare....like a two-tier system. That way the premiums paid could contribute to the system as a whole. I know that's the idea behind NI contributions but it's not working in its current format. It definitely needs revision, but I am opposed to a private insurance takeover...that would be a disaster and leads to what has happened here in the US.

Re: US vs UK Healthcare
 

I agree totally with Rockgirl on this. I've found in 12 years here that the level of care is far superior in the UK with the good ol NHS. As for waiting lists- well it can take as long here to get treatment- some people have to fight with insurance companies to get permission to have treatment, which can take months. EG my friend who needed a hysterectomy had to get three opinions on her condition before the insurance company finally gave the go ahead to have the op, which caused months of unnecessary suffering. another Brit friend of mine in CA went to a doc in UK while she was home on a visit and was told to see a specialist immediately about a mole on her foot- back in CA she went to her doc she was told it would take 3 months to get seen so she went straight back to Britain, saw a specialist, had biopsy and the mole removed all within two weeks! It was cancer.

My daughter is pregnant and I'm appalled at the level, or rather lack of care, here. She had hyperemesis G and lost 18 lbs in the first 4 months of pregnancy, ended up in ER 3 times for IV because she was dehydrated... and she has not had any of the routine tests that should have been done. The last time we ended up in ER, she was throwing up violently and feeling faint, her eyesight blurred.. we waited 5 hours in the waiting room before she was put in a treatment room and then another hour before a doc arrived and she was put on IV. The treatment room was disgusting- dirty swabs on the floor, layers of dust over the equipment and what looked like dried blood (or could have been coffee) up the walls...yuk. This was Sarasota Memorial, the main Hospital inSarasota, which was voted the number 1 place to live in the US. The next time this happened I took her to the Doctors Hospital- which was a shorter wait 3 hours, and then she was put on a drip, without seeing a doctor, and shoved out in a busy corridor on a trolley for hours...wearing a scanty hospital gown and no sheet even to cover her....but at least the place was clean. I'm more upset about her treatment than she is, because she doesn't know any different- I know the level of care that pregnant females get in UK.
My daughter in law received no after care at all, apart from one doctors appointment about a month after her baby was born...all a far cry from the health visitor and midwife who comes round every day for a while to check on you and the baby in the UK. And the routine tests that are given to the baby in the UK...many children don't get them here.

I could relate numerous tales of bad treatment here (one of my friends was so irate by the way her 80 yr old mother was treated in Sarasota Memorial that she grabbed a doctor and had him up against the wall by the lapels and told him to do something- the woman had been shunted around on a trolley in corridors for 2 days in severe pain with no treatment), but it would take too much space.
I get fed up with the gripes about the NHS by Brits who really don't know how well off they are- sure there are mistakes and the system is overloaded, but the care IMO is second to none and its free...sure everyone pays NI, but no-one has to worry about how to pay before seeing a doctor and how much treatments cost or whether your insurance company will drop you because you've been diagnosed with a major disease. A Brit couple in Orlando had to go back to UK a few years ago because their daughter was diagnosed with a hole in the heart and they couldn't get insurance for her.

Let's face it, in UK the government has a vested interest in keeping people healthy- the US government has a vested interest in the pharmaceutical companies and medical system making big profits.

Rockgurl, most of the British Nurses who come out to Sarasota end up going back to UK, and a british Doctor who became a friend of mine out here ended up going back to the good old NHS because she couldn't stand the callous system here. A doctor here told me that British nurses are in high demand in the US because they are so well trained...what does that say?

Re: US vs UK Healthcare
 

Interesting thread for those of us yet to make the move!

As a side point, can those of you who don't have work-related heath care give an indication as to roughly how much per month it costs? Coming from a system like the NHS / National insurance, it's slightly worrying that we will have to cough up a significant amount each month...but how much?

(both in early 30's, no kids, non-smokers, average weight)

Mike

Re: US vs UK Healthcare
 

It depends where you live and loads of other factors. For Ok insurance that you buy on you own, look at about $150-$250 a month. Check out www.ehealthinsurance.com for an exact idea.

I also agree very strongly with rockgirl on everything she says. I am retraining here in cardiovascular perfusion (operate the heart lung machine) and am amazed every day by the technology and at the same time backwards and old fashioned way things are done here. I have mostly found nurses to be generally poorly trained compared to the UK. RG is right about the use off RRT's having to operate the vent etc....in the UK the nurse does it all. It lends for a very disjointed care, but a very profitable one. The biggest disgust for me was the amount of money that goes simply on paperwork....i was told about 33% of the TOTAL bill...what have you heard RG?