This is also how it works in US, you just go to imaging place and they do it immediately. You just have to pay for it. In countries with state controlled healthcare, service is rationed.
> In countries with state controlled healthcare, service is rationed.
Americans really love eating up this meme.
I can get scans any time in Japan and I never wait. If doctors think it’s an emergency, they’ll do whatever scan is necessary then and there. If not, they’ll pull out a calendar and ask me to pick any day that’s convenient for me.
Meanwhile my friends in the US are waiting months for basic shit. My dad visited me in Japan in December and had to visit a dentist for emergency care and was offered to do surgery on the spot. He decided to delay it until he returned to the US. The earliest available appointment in his area is next month.
It’s insanity seeing Americans parrot this stuff. It’s North Korea-level propaganda. Hell, it’s worse. North Koreans have no access to the outside world so you can’t blame them. Americans just actively turn away anything in favor of “well a guy who knows a guy said he saw a guy on tv who heard about a guy who once heard a story about a guy from a guy in another country said those people wait a long time for health care!”
But the strangest thing is countless Americans, including myself, will pop into any thread to talk about how they have endless bad experiences with health care in the US (I’ve been forced to wait forever and then still charged out the ass because my health insurance was randomly rejected), while most bad experiences with other countries is seventh hand info. Americans complaining about health care in countries they’ve never been to far outnumbers people with first hand info—usually the ones with firsthand info are saying “it’s pretty good out there”
As someone who lives in Sweden I can assure you that the 'meme' is 100% true here. There is no way you are getting an MRI unless it's literally life and death, without either waiting 4-6 month or having private health insurance.
As someone who lives in Norway (permanent resident) I'm quite surprised that Sweden is so bad. A couple of years ago I visited my GP complaining of a small hard swelling on my foot. he said it's probably just a ganglion and that he could fix it if it didn't improve by itself but that he would like an MRI scan first to check exactly what it looked like. It was obviously not even slightly urgent but I still got the scan with a month. In Norway such scans are normally performed at a specialist company (Unilabs in this case) even though it is all paid for by the health national service (except for about 150 NOK egenandel, that's about 15 USD copay)
I'm in the US and have had multiple MRI scans happen either the same day as an appointment or the next. Compared to that, even a month seems pretty long.
It wasn't urgent, I wasn't in pain, there was no rush. If it is sufficiently urgent it's possible to get an MRI within minutes of arriving at a major hospital.
Consider that Americans tax payers pay about $5k/year on average for Medicare and Medicaid that most of them don't (yet) qualify for before they even starting to pay those private insurances. People in most other countries can pay a lot privately before getting close to what the average American tax payer pays for healthcare.
The point is that it's an option that is available. Most people in Europe just has a base level health coverage that means most of us don't feel it's justified to take up additional cover.
Yea, don't get me wrong. At the end of the day there is no way I would want to trade the Swedish system for the US system, no matter how flawed I find the Swedish system.
Consider that your experience is not everyone’s experience in America. My American wife was able to get emergency dental care within two hours at a dentist who she’d never seen before.
My Canadian uncle had to wait months for cancer specialists.
Life expectancy in US has more to do with very bad lifestyles of Americans, mostly obesity and drug abuse, than with quality of healthcare, which in fact is superior. We are great at keeping alive very unhealthy people. As a food for thought, consider that Japanese-Americans have higher life expectancy than Japanese in Japan.
> Life expectancy in US has more to do with very bad lifestyles of Americans, mostly obesity and drug abuse, than with quality of healthcare
Obesity, diet and drug abuse are healthcare problems. Dying is a healthcare problem, and that’s why I suggest using average lifespan as a crude measure of population health. Population health is something a unified healthcare system should be tackling, with obesity and addiction help and care.
US healthcare might be superior for some, but population health is poor relative to the cost paid. The expense is spectacular when compared to other countries.
My point is that the reason the American population health is bad not deficiencies in what people typically understand as healthcare system (that is, hospitals, clinics and doctors). If prices tomorrow went down by 90%, and healthcare availability skyrocketed, we’d still have population that’s unhealthily obese and addicted to drugs. At the same time, countries that are much poorer, and have much worse access to healthcare, often have much superior population-level health.
Totally depends. Mostly on where you are in Germany, and to a degree whether you're willing to call a few different doctors. An acquaintance with a shoulder injury got an appointment with an orthopedic specialist within a week, who recommended an MRI. The second hospital she called just happened to have a free MRI slot the next morning.
Personally, I never had to have an MRI, but when I needed to see a specialist for acute back pain, I got an appointment (and a fix) within 24h. I have never in my life waited months for an appointment with any specialist.
This is all on public health insurance (and without any additional charge, ie. the MRI was "free"). Relatives tell me it's much more difficult in other places in Germany; I sometimes wonder if they should just get an appointment here, Germany isn't that big.
I wish we could have it both ways somehow: a baseline level of widely available cheap care and an expensive tier for people who'd pay anything to get quick care.
I'm not a policy expert so I won't pretend to understand all the problems involved or the potential solutions.
But as a patient I have a disability that makes it so the state covers 100% of my health expanses. I've been needing to see a physiotherapist for 3 years but can't find a single one that does home visits. Because of the dwindling number of physiotherapists even those that receive patients in their office sometimes have to see 5 patients at a time. So I have great coverage for terrible or no care at all.
I was so desperate I called every physio in my region and told them I'd pay them any amount to come see me, but they can't take my money because the price of their service is regulated and they'd lose their license.
Same thing for public hospitals, I came in Friday with three broken bones they wanted me out by Saturday, they didn't have a single available bed in their orthopedic unit and they needed the E.R bed back as soon as possible. All that because we decided to regulate the maximum number of doctors so now everyone has to go get care at the hospital instead of at home care by their local doctor.
We do have some pretty stellar private hospitals though but it doesn't help because you don't choose where you get sent to when you call an ambulance.
>a baseline level of widely available cheap care and an expensive tier for people who'd pay anything to get quick care
We sort of have this in Croatia, public care and a lot of private options. It's not that great because :
- There is a tension with public system where doctors from public care move to private system, you hear about doctors working at a private clinics while they are on shift in public hospital, or referring you to their private clinic if you want to get treatment in reasonable amount of time
- Private clinics usually don't cover everything, they focus on the profitable stuff. Like we had two smaller earthquakes (~5) around the time my wife was pregnant and both times they were evacuating pregnant women out in the street because the public hospital buildings are >100 years old. Private option was expensive and in case of complications they would still need to ambulance you to a general hospital
- Medical tourism eats up private capacity - this is kind of a mixed thing because medical tourism also keeps the field growing/investing much more than domestic demand alone would
There's another consideration too: the wealthy people stop caring about funding the public tier because they can afford not to care about it, lobby for policies to cut public funding to lower taxes. Two tier systems typically degrade the public tier over time.
Depends. There is rarely a private ER, and as you say, private care will often focus on the higher margin items so the lower margin stuff might be left to the public option.
Some countries forbid two tier systems entirely for this reason, like here in Canada.
> I wish we could have it both ways somehow: a baseline level of widely available cheap care and an expensive tier for people who'd pay anything to get quick care.
I think that's quite common? There are both public and private clinics in Norway, but public health care only covers the public ones.
My wife and I visited a private clinic in Denmark to get NIPT test even though it was covered in Norway, because the process was longer in the public system (not too bad, but wasn't too expensive to just pay to have it done fast and we wanted to take a trip to Denmark anyway).
I know there's kind of a mix in Taiwan too.
The argument against having policies that encourages private clinics is that wealthy individuals with a lot of political influence might try to push for funding cuts for public clinics if they don't depend on them. And the best doctors might prefer to work for private clinics if the pay is better. All-in-all I think a mix is best though.
> I wish we could have it both ways somehow: a baseline level of widely available cheap care and an expensive tier for people who'd pay anything to get quick care.
That is the case in most countries with universal healthcare.
Very few countries restrict your ability to pay extra for "top up" insurances and services.
E.g. in the UK about 10% have private insurance. These tend to be cheap because they basically expect you to use NHS for emergencies, and to try to go to your NHS doctor first, but ask for private referrals if there are waits on the NHS, or for "extras" like regular comprehensive checkups.
The NHS itself is also allowed to offer some extras. E.g. many NHS trusts runs private clinics to maximize utilisation.
We have an expensive tier here in the UK. Not many people use it. When they do it takes doctors and nurses away from treating more urgent needs in the NHS system.
It's absolutely insane. I had a knee MRI in SF 5 ears ago, and the out of pocket cost, with insurance, was $900. Insurance paid around $2000. And the wait was 3 weeks. I found a private imaging place that could do it for $750 next day. Called the insurance company and told them that we could both save some money on this, and got "that's not how it works." Bureaucracy is societal cancer.
You can wait months for a specialist in the US. Especially a neurologist (as in an MS forum). And then, you have to get one in network OR pay more - and your insurance might not cover it.
You have business rationed health care, and some folks are going without. Some folks are now thinking about different programs for poor folks... but we know those don't cover everyone with need.
On the other hand, I now live in Norway. The health care system, in general, works. I'm never going to be bankrupt due to medical expenses and I know other people aren't using riskier and harder to use insulin because it is all they can afford. I can get to the doctor in a timely manner and if there is a wait (for non-critical things), there is an actual safety net that means I can take the time off work while I wait for the MRI to open up. Even when there is a wait, it isn't nearly as bad as it would be in the US.
yep getting a neurologist here in the states is a nightmare. Both of my neurologists typically book 3-4 months out. When I first began needing neurological care my primary Dr. told me he had a patient who had a stroke and needed to wait a month to see a neuro.
pro tip for others: if you you really can't wait for care, just keep calling your doctor's office every day asking about recently cancelled appointments. I usually get in fairly quickly this way though it's pain
In Italy you can wait (lenght depends on the seriousness of your problem) and pay nothing, or you go to the very same public hospital, pay and do it right away.
Oh, it costs 200-400eu. About 1/10th and what its asked for here in CA. Healthcare in US is a little bit scammy....
At most a few countries worldwide has anything resembling "state controlled healthcare" (in fact, I cant name any - Norway used to a couple of decadds ago, but bow have plenty of private providers)
Almost all countries with universal healthcare have widespread private services.
Many have their universal services provisioned entirely or in part from private providers.
When I had a gastroscopy a while back it was done in a private hospital but arranged by the NHS and paid by the NHS.
If I want a private MRI there are dozens of providers in London.
We believe in healthcare for all, so we endeavour to allocate limited resources carefully. And this is one of many things that contributes to a society where I feel safe sending my kids to school without Kevlar.
The problem is decades of underfunding of health services. Neoliberals in charge like having reasons for increasing privatisation of healthcare, so they underfund, reduce quality, increase wait times, and attempt to get the public on board with more privatisation.
