General Question

augustlan's avatar

How does universal health care work in other countries?

Asked by augustlan (47677points) August 26th, 2010

Please note that I am not asking how well it works, though if you want to add that at the end of your answer, I’d appreciate it.
I’m talking about the nitty-gritty, nuts-and-bolts of the thing:

Is there even such a thing as health insurance or is there no need for it in such a system?

How does one make an appointment for routine services? How long of a wait is there? How about for surgery and the like?

How are doctors paid for their work? Does the government pay their salaries? Is any part of their pay based on number of patients seen/services provided or is it a flat salary? Do all doctors make the same salary? Are specialists paid more? How about a 10 year veteran versus a doc right out of med school?

Is the patient responsible for paying the provider a co-pay (portion of the bill) for services received? If so, how much? How is that determined? How is it billed? At the time of service? Later? Is it different for routine versus specialized services?

How much of an individual’s tax bill goes toward universal health care? Do families get a break on that?

Note: I am in favor of Universal Health Care for the United States. I’d just like to understand the ins and outs of it all a little better. Thanks!

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10 Answers

harple's avatar

That’s a lot of questions, of which I can only answer some, but I shall give it my best shot, and try and do it in the order you asked… I am talking about the NHS in the UK…

Yes, people do often choose to take out health insurance (and it is often offered as part of a pay deal if you work for a large firm). Generally speaking, this is to avoid the long waiting lists should anything major happen to you, but as with anywhere (I imagine) you can only get health insurance if there is currently nothing wrong with you (or at least you would pay a lot more if you have a history).

Routine services, as in going to the the GP (general practicioner) when you have the flu, or a pain that won’t go away, or uncontrollable this that or the other, or for jabs etc – in most places you can call first thing in the morning and make an appointment for the same day. Although you’ll obviously be on time for the appointment, the doctors are often running late, but this is accepted.

Waiting for surgery varies about the country (they talk here about the “postcode lottery”) and varies depending on what it is you need… They do understand “urgent”, although their opinion of urgent can vary from the person living with the problem.

Doctors Surgeries do have targets to meet and are rewarded on achieving their quotas on these… which is why they are so keen to get you in for a smear test etc… I believe that the GPs are financially involved with the practice they belong to, perhaps someone else can answer that more fully.

Specialists are absolutely paid more, as are experienced doctors. My understanding is that a fully qualified GP is most likely earning a 6 figure salary, but my goodness, they have trained hard and work long hours for it.

There is a flat rate for your perscription, currently £7.40 I believe. So if the doctor perscribes some form of medicine for you, you pay this. People under a certain income bracket or over a certain age, or students, do not have to pay this. (Interestingly, if you live in Wales, you also do not have to pay this.) Some doctors are generous enough to let you know what you need without perscribing it if it is something you can buy over the counter for less money. You pay your £7.40 at the chemists when you collect your medicine.

I think I’ve answered as much as I am able to…

MissAnthrope's avatar

I’m sure other people can answer this in more detail, but I can share what I know from having spent time in Italy. I believe taxes are higher than we are used to in the States; however, from my experience, there is no charge to go to a doctor. When you need to go, you go. I have never witnessed anyone paying for medical services, other than having to pay the traveling emergency doctor in the village, who rides around and makes house calls (the charge is 50 euros). Prescriptions are offered at a greatly reduced price, which is essentially the government covering most of it and the person paying a co-pay. I have never heard anything about wait lists for hospitals for serious cases.. my step-father had a heart attack 4 years ago and was easily rushed to the hospital and treated immediately.

Anecdotally, my ex developed a serious case of hives as a result of an allergic reaction to new medicine she was prescribed before our trip. Her entire body was covered and she was in a lot of itchy discomfort (as well as looking like a leper or something). We were visiting my Italian friend, when, after querying the pharmacists, we realized my ex would have to go to the ER. We did wait a while, seeing as it wasn’t a matter of life or death, but it was maybe 2 or 3 hours at most (I have spent 5 hours in American ER waiting rooms). She was seen, diagnosed, treated, given a prescription, and sent on her way. She was so utterly confused at the end when no one was concerned about payment. She asked a couple of people who she should pay, and they were very amused in a kind way. No payment necessary, she was sent on her way.

I rather like the idea that we should treat our sick people as necessary and not charge them thousands of dollars for the privilege, you know?

Lightlyseared's avatar

In the UK medical healthcare is free at the point of use (dental and optical care incurs some charges and a lot of people prefer private dentisits to NHS services). It is based on clinical need not abilty to pay.

Access to healthcare is controlled by your GP who will then refer you to hospital specialists. You can’t make an apointment to see a specialist your self without a referal from your GP unless you go privately.

The target for treatment is 18 weeks from seeing your GP to starting tratment (be that surgery or whatever) however waiting lists are often much shorter. The hospital I work at has zero waiting list for major heart surgery, for example, so if you require heart bypass then they can treat you remarkably fast. Sometimes waiting times can be imposed so as to limit the rate at which patients are treated so as to limit expenditure but this normally only done for minor surgery (it’s still annoying though).

For patients who attend a GP with symptoms that may suggest cancer the target is 2 weeks from seeing your GP to starting treatment.

The NHS costs about 10% of the money the government raises from taxes (this is very aproximate so don’t quote me on it).

Dr_Lawrence's avatar

In Canada, all provinces have universal health care but there are variations in how this is implemented within the federal guidelines.

Some provinces have premiums on a sliding scale based on family net income, while others fund health care through provincial taxes on income.

Doctors are paid by the government, not the patient.
Hospital expenses are also paid by the government.
Medications are paid by the government in a few provinces, with a deductible based on family net income.

Most provinces cover eye exams and eye surgery, but not glasses, contacts or lenses.
Ambulances are a patient expense, but group insurance or personal insurance may cover all or part of such expenses.

Most provinces cover chiropractic services but with limits on the number of visits per year or the fee that the province will pay.

Doctors are not permitted to extra-bill patients or offer premium care or faster attention for additional fees.

Plans cover all legal residents equally with NO EXCEPTIONS.

People are encouraged to see their doctors during office visits rather than to use the ER for routine care. Non-emergent cases at the ER can face very long waits behind Urgent and emergent cases. The seriously ill are seen with little or no delay.

Non-urgent diagnostic exams (e.g. MRI exams) have have wait times. The same is true for non-urgent surgeries (joint replacements, reconstructive)

Wait times in doctor’s offices can be somewhat longer than in countries where patients pay very high fees (e.g. the USA). Doctors get paid less per visit and try to see more patients per day to compensate. On the other hand, doctors do always get paid without sending accounts to collection agencies.

Megan64's avatar

I’m a dual citizen, and have experienced the awesome French healthcare system. I wasn’t a French citizen, yet I was able to benefit from the healthcare as a citizen of the EU. I got same or next day appointments for E20,00, mammogram (2 week wait) for E100,00, urgent care and an ambulance ride for my daughter for E37,00. No one ever asked me to fill in any forms or for proof of insurance. E20,00 for regular visits, or visits for mild cases. I paid all at the time of service. Civil, sane, professional, quality, simple, reasonable, fair, humane. These people that are opposing national healthcare don’t know what they’re talking about.

These answers to your question have convinced me to leave the U.S. Maybe not today or tomorrow, but soon, and definitely before I retire.

augustlan's avatar

Thank you all so much! I’m definitely getting a better grip on this now. In general, are people in these countries happy with the way things are run in the health care system?

Lightlyseared's avatar

@augustlan Yes. People in the UK like to complain about the NHS but I doubt you’d find that many who’d like to swap it for the system the US seems to find so appealing.

Pied_Pfeffer's avatar

My SO lives and grew up in England. He and his parents are very happy with the health care system. Through his job, he has the option to sign up for private healthcare and the company would pay for it. He doesn’t because he likes and trusts his doctor.

A few of my U.S. friends are all up in arms about converting to a NHS because they’ve read a few reports about long delays to get into the emergency room in the UK. It’s a shame that they succumb to the sensationalism of a couple of stories vs. questioning it and doing some actual research.

ETpro's avatar

The countries with the best systems, such as France, all rely on private hospitals and doctors, with a government, single-payer insurance system paying the bills. Wait times in the top systems are no better or worse than in the USA, but everyone is covered, healthcare outcomes are far better than ours, and their per-capita cost is almost half that of what we have been paying to leave 50 million of our citizens without insurance of any kind.

Gor a comparison of healthcare outcomes among various systems, see the WHO study. This study looked at each nation for longevity, deaths from preventable causes, infant mortality, and deaths in childbirth. The USA came in at #37, at the very bottom of the developed world. But we are number 1 in costs per capita.

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