Tuesday, 26 February 2013

American healthcare; a new perspective.

 Unfortunately, none of the doctors I've come across so far look like McDreamy...

I've always been rather rude about healthcare in the US compared to the UK. In general I tend to sing the NHS's praises, and I approve of free-at-the-point-delivery healthcare in principle, whereas an insurance-based system is unfair, too open to random money-spending (and charging by insurance companies) and in the end, no better than what we have at home.

And I still hold by most of that. I hate that one's decision whether or not to visit a healthcare provider is always clouded by "how much will the co-pay be?". That some medications are not covered by your insurance. That if people lose their job, they lose their insurance. Or it changes, and they have to change all their healthcare providers. It's definitely unfair, it's confusing and I think most British people would be shocked by it. One of the best things Obama has done is to try to reform healthcare in the US. (Not that he's really succeeded - the Republicans are making sure of that.)

I tend to laugh when Americans knock "socialized medicine", because they seem to have this great fear of the unknown, when their own system is far from perfect. For example; in the US, you are often kept waiting for routine appointments, and there is no apology given. Medical receptionists are notoriously grouchy and unhelpful here. Emergency room visits are all very similar to what would happen at home. (Note: it is nothing like Gray's Anatomy, ER or House.)

Having said all that; my recent healthcare experiences have taught me that there are some advantages to being in America. You can, for example, go and see a specialist with literally a few days' notice. You don't have to be referred by a GP (GPs/primary care practitioners here being a bit different from what they are home, and generally, not that helpful). You simply ring up - yourself - and get an appointment, often that same week. If you are anxious to get on with things, that is definitely helpful.

Yesterday I spent the morning at our local hospital (for which The Doctor works) having a series of investigations. I have to say, it was extremely efficient - hardly any waiting around, everything happened like clockwork, the staff were kind and courteous, the environment was squeaky-clean and pleasant. From my experience of similar appointments within the NHS at London teaching hospitals (which were only ever pregnancy related, I must say), this was a definite improvement. By the way, I don't blame individual doctors or nurses in any way; the NHS is simply run off its feet half the time. In some ways, it's a miracle that anything happens at all.

But that is private healthcare. Would my Hispanic cleaning lady get the same treatment at the local public hospital, using Medicaid? I doubt it somehow.

Still, if there is nothing else good about my ongoing horrible situation, at least I am finally able to compare the two systems from an informed point of view. And no, I haven't found Dr. House yet.


MsCaroline said...

I'm with you about healthcare in the US: it's very good for people with excellent health insurance. For people without excellent health insurance, it can be a nightmare. We have always been fortunate enough to be in the former category, but I am constantly surprised at how many of my friends and colleagues do not seem to realize that they are all balancing on a knife's edge, so to speak. Sure, you have great healthcare- NOW. For my friends who stay home with their kids and depend on husband's job to get health insurance, they're just one pink slip and one catastrophic illness/accident away from financial ruin. Unless they have millions in the bank, which most of the people I know do not. Most people I know have HMOs anyway, which are socialized medicine (even if they don't realize it.) We've been pleasantly suprised by the excellent quality of healthcare here in Korea - modern, clean, efficient, and FAST. The longest I ever waited for an appointment was 10 minutes - and that was because I was a walk-in, and the doctor apologized for keeping me waiting! I anticipate a minimum 15- minute wait as a matter of course at all US dr.s offices, even if I'm the first appointment of the day. I could go on, but I won't. I'm glad you are getting good, efficient care, and I hope that all of this will lead to some answers for you.

Iota said...

I think it varies hugely. I experienced speedy, clean, efficient, friendly appointments, but I did also have times when I sat in waiting rooms for a long time, was then moved to a small room and waited for a long time, etc.

American healthcare facilities are definitely cleaner, though. And nicer waiting rooms.

Have to say, one of the big advantages here in the UK is the lack of paperwork. The NHS does it all for you! In the US, there are always bills in the post, and the system is so incomprehensible that there's always some following up to be done. That aspect can add up to a big stress. It's very liberating to walk out of an appointment here, and know that that is it. Job done.

Expat mum said...

IN the US it depends what type of insurance you have and where you live. If you have PPO insurance then yes, you can go to any doctor without having to be referred, but generally, with HPO coverage you have to stay within a metwork and you have to be referred by your Primary Care Physician.
Here in Chicago, I took one of the kids to a dermatologist two weeks ago. Despite having the best healthcare coverage, they told me I had to wait till they opened up the MAY calendar. (They then called back to say they had an opening the next day.) My annual OB/GYN appointment has to be booked about 3 months ahead and I always have to block off the whole morning for an appointment that probably takes about 20 minutes to execute.
And yes, as Iota says, the paperwork here is a nightmare.

nappy valley girl said...

Ms Caroline - Korean healthcare sounds good - is it private, or public?

Iota - yes, the paperwork. What a nightmare. And the bureaucracy. And the letters you get after every hospital visit, asking if you want to sue anyone....

Toni - We do have the kind of insurance where we have to go within network, which is basically our local hospital. Luckily it is a large one with many local doctors in the network also. But people keep telling me to go to Manhattan and see this doctor and that doctor, and I can't because of our insurance. Not that I actually believe it would be much better, but it's such a different system from in the UK.

Melissa said...

Bugger finding dr house, hope you find some answers.

Michelloui | The American Resident said...

I think it varies a lot in the UK (from my experience)--I had my daughter at the Royal London and I'm now know a large DGH in Essex quite well. The DGH is fantastic overall, the London was a nightmare. But I still sing the praises of the NHS because over the years I've watched Amerian friends and relatives experience so much stress and worry because of the way the US healthcare system is run. I shake my head in dismay at those signs that people wave in the States "No socialised healthcare!" What's so evil about free healthcare?

It's good to hear the good points from you, especially as I have so many friends and family using the US system, sometimes I feel their anxieties too much (especially the aging parents) and feel quite distressed.

Wishing you good results from your investigations! x

Nota Bene said...

What about George Clooney...hasn't he popped up yet?

nappy valley girl said...

Melissa - thanks. That is what I need. But I think they need to come from a diagnostician.

Michelloui - Yes, I do think US healthcare is quite scary - I would not want to be here forever and have to navigate it. And I am quite sure it varies hugely in the UK.

NB - surely all he did was flirt with the patients? At least House came up with answers (even if he nearly killed the patient first).

About Last Weekend said...

We do kaiser and everyone is horrified here that we've opted for what they think is such a low level healthcare provider. We've found it great and they are quick about appts with experts. But like everything you have to be your own advocate. But my friends have found that with really pricey posh health care too.
Funnily enough I learned my lesson with private in London - we always went public and it was fine. My friend went private and she had three caesarians just because they have no tolerance for any kind of risk. As her husband said its a high price to pay for a gin and tonic after giving birth.
I find here also in the US that women routinely are scheduled for being induced.

Almost American said...

I have pretty good health insurance, but I have to get a referral to see anyone except my PCP or OB/GYN.

My doc decided a couple of years ago that I should see a dermatologist, and I had to wait SIX MONTHS for an appointment. Optician's visits have to be booked 3 to 4 months in advance. So much for shorter wait-times in the USA!

I hope the most recent tests get you the answers you need!

Anonymous said...

I am so sorry about your health situation. This is stressful, I know from experience.

I saw three primary care physicians and could not get answers. Feeling very sick.

Finally, a medical technician doing my bone density test asked me about my medical concerns. I told her and she referred me to a physician outside of her hospital and said her problem was solved.

I scheduled an appointment with said new doc, got a diagnosis and am now getting treatment.

If you want to come to MA Dr. Emsbo at Visions Medical in Wellesley, MA is a wonderful diagnostician.

Maybe she could recommend someone in your area?

My thoughts are with you. Wishing you well. Susan

Anonymous said...

So funny, but dr emsbo was one of my attending physicians when I was in residency! I always liked her and glad to hear she's doing well in Wellesley.