Not on a theoretical level, but how would you practically have to pay costs, access specialist doctors?
I’ll start with the German system. Here you are either automatically insured in one of the public insurances (there are many), which marginally differ in their cost (think single digit euro differences) and have to cover basically the same procedures. If one reaches a certain income level, being privately insured is possible.
If you are publicly insured, you wont see most costs, as these are directly handled between your insurer and the doctor/hospital. For some medications and procedures there are co-pays that are flat fees (5 Eur for Medications, …).
Access to specialists mostly need a referral from your family doctor.
In private insurance, often you yourself will be billed and you will need to hand this to your insurance company.
The good side is that in most common situations I have never needed to worry about cost in public insurance, wait times for referrals can be very long and understanding what you need to get certain care can be very difficult. Private insurance often has better payment schemes for providers and less artificial limits on number of patients or which doctor is able to provide services, so access to most care is faster and more widely available.
Access to specialists mostly need a referral from your family doctor.
That hasn’t been the case in many years now, you can just make an appointment without a referral.
In private insurance, often you yourself will be billed and you will need to hand this to your insurance company.
An experience that’s quite common, as public insurance only covers the absolute bare minimum for dental health (including only the visibly ugly fillings). So many (at least many compared to people having general private insurance) people tend to have additional private dental insurance, and there it works exactly like that, you pay, and then you send the bill to your insurance.
one of the public insurances (there are many)
For those wondering how you decide, it’s mainly about the extras. The one I’m at (TK) is well known for having an English-speaking hotline, which is great if your German isn’t that good, as they also can make appointments for you. One other feature I accidentally found once is that they support OAuth for netdoctor (digital dermatologist visit), while others have to send in forms.
It’s mainly small stuff like that, niche procedures that get covered, paid exercise, and obviously (because it’s Germany) what and how much esoteric bullshit they cover.
Access to specialists mostly need a referral from your family doctor.
That hasn’t been the case in many years now, you can just make an appointment without a referral.
Well, for most specialist. There are still a few cases were it is required, e.g. radiologist.
Also with public insurance you might have to wait longer for your appointment with a specialist - but if you have a referral from your family doctor, they can add a urgency note (Dringlichkeitsvermerk) on it and you will get an appointment faster. With that you can also call the health service hotline (116117) and they have to find an appointment for you.
Ah, probably true, they are extra special specialists though (as in there’s (afaik) not a radiologist practice you can go to.
Seems like one of the best types of systems in the world to me. Public insurance should have to compete with private insurance.
In edge cases it is possible to be uninsured though. For example mentally ill people who drop out of a job and fail to get their paperwork done will be uninsured after 3 months or so. Social workers need to help them, but sometimes the ill people hide or refuse help.
That is not correct anymore - they are absolutely insured as long as they are entitled to Bürgergeld,even if they don’t actually get it or have the three month block in it. The problem is more that the insurance works retroactively in that situation and they often are billed privately by health care providers (which is somewhat illegal) and some of these claims “stick”, especially if you don’t have the resources to fight it.
Sweden: Healthcare is mostly tax-funded. There is a small fee (for adults between 20-85 ) for each appointment. This fee lies between 150-330 SEK (~15-33 €), depending on which region you’re in. Emergency care is usually about 10 € more (40€), and an ambulance trip double (so ~60€). If you’re admitted to a hospital the fee is 120 SEK/day (in my region). Total fees paid for appointments during a year is capped at 1300 SEK (130 €), after that they’re cost-free.
The above is regarding “necessary” care, so things like cosmetic surgery, vasectomies, etc. you’ll have to pay more.
Access to specialist doctors varies, some you can contact directly (usually private practice), and others you’ll have to first make an appointment with a general practitioner at a health center, then get a referall if they deem it necessary. In my region there’s quite a long wait time for many specialists (I had to wait 6 months for a head MRI), and sometimes you’ll have to travel quite far because the care is only offered in one hospital in the region (My wife had to drive 200 km for a surgery).
Expanding on this: what is deemed necessary varies a bit between regions, in my region a vasectomy is covered, so total cost (3 visits) would be ~45€. Waiting time is about 6 months. But waiting time also varies a lot.
UK here. Everything is free at point of use (paid via taxes) except prescriptions. It’s around £10 per item. But they are free if you have certain long term health conditions, are pregnant etc.
To see a specialist your doctor writes a letter and they contact you.
And dentists
Australia here.
For most medical services, the govt will reimburse you a set rate. The GP or specialist can charge you whatever, sometimes the same as the govt reimbursement, sometimes quite a lot extra. You don’t pay anything at public hospitals (which are nice).
I recently had some great problems, I stayed overnight in hospital twice, for a total of 3 nights in private rooms, had an internal scaffold inserted in my artery. i also had numerous consults with specialists and drs.
The whole thing cost me about $500, a few days work on average wage.
That seems quite high for hospital (or quite low for private), what were the costs?
Hospital was free.
I’ve been to the GP a bunch of times, cardiologists also, then meds also.
Canada. It’s free, but slow.
They’ll keep you alive, but it’s up to you to stay healthy. Little prevention support around here.
Define slow. I have to wait months or more for an appointment in the US. Is it that slow? Emergency visits take hours, sometimes charging people who wait but don’t get service. Is it that slow?
Not the other poster but a Canadian too. It varies. To see my GP I can get an appointment within the week, usually same day, though most people here need to wait a couple weeks. Then there GP refers me to specialists, that’s usually between 1-6 months wait.
Emergency yeah you are usually looking at 4 hours wait absolute minimum. Though you don’t get charged for it at least. Though I guess it depends on severity, they will prioritize by how serious it is not by first arrival.
The other thing the other poster didn’t mention is that medication is not covered so you have to pay full for that unless you have insurance. Also for some reason dental isn’t covered at all without insurance (or I think recently for low income families but I’m not 100% sure if that’s implemented yet or not)
So, plus or minus a little, it is similar to the US, but free.
Depends. I have had a bunch of specialist appointments for cardiologists, endocrinologists, reproductive health specialists and pulmonologists. The average wait for an appointment is about three months.
We are very fond of calling the Canadian system slow but my understanding is it’s decently comparable to a lot of the States and is actually pretty impressive considering how spread out and small our population is.
Doesn’t it vary quite a bit by province?
Not only province, but doctor/hospital but mostly urgency.
If you’ve got something critical, it’s super fast, otherwise it can be pretty slow.
Examples:
went to the emergency for something stuck in my eye, 3am. Went in, waited 3 minutes to be checked, saw a doctor 15 minutes later, by the 1h mark I was out with 1 nurse and 1 doctor who had seen me and removed what I had and another nurse who had given me a vaccine shot.On my way out, I talked to someone in the waiting room I had seen at 8PM getting a softball to the side of the eye, she finally saw someone around 11h after getting to the E.R. (they quickly evaluate the urgency when you arrive).
Almost 4 years later, I’m still waiting for my vasectomy appointment.
Woah seriously for vasectomy? I’ll want one in about a year should I try to get an appointment now? Though to be honest I wasn’t sure if it’d be completely covered or not.
U.S.A., I have a “high deductible PPO” plan, more or less what my parents would have called “Major Medical”.
It covers only some preventative care, for $0 out of pocket, whatever is mandated by the government basically so annual wellness, annual woman-care, birth control, one dermatologist visit.
Then nothing, until we spend some ridiculous amount in one year, I think it’s $7,000? At which point it starts paying 80% until we have paid an even bigger $, then it pays 100%.
So we don’t have healthcare, exactly, we have limited liability for healthcare cost.
Specialist I can just schedule, do not need to be referred by GP. Prescriptions are subject to that same high deductible.
This plan costs, out of my paycheck, kind of a lot for family coverage, and employer puts back some of it onto a “health savings account” that can be used to pay towards the cost. Not anywhere near that $7k but some, and what is not used stays in there. I also put money in that account out of my paycheck to build it up so that when we do eventually have a bad year again, the money will hopefully be there to use.
Yes it’s complicated.
This is the plan the vast majority of people in the US have. It’s dogshit.
Yes it is. And besides the premium and other costs, we also pay taxes for care for the sickest and the oldest. These private insurers are cherry-picking the group they insure and still charging the outrageous fees, raking in profit and outsourcing the more expensive groups to the rest of us to pay for. So I get about half of my paycheck as netpay after medical, tax, HSA and 401k; same as someone in a socialized nation, but without the assurance of healthcare or a pension.
In Poland, it doesn’t. They just steal our money without anything in return you have to wait for years to get into surgery what you pay taxes for.
That is not true. Not fully true, and the true part is blown out of proportion by various populists (especially right-wing, who would like to replace what we have with USA model or worse).
Most basic health care is organized by the government and paid through taxes and social insurance (which is obligatory). Unfortunately it is not financed enough and it shows, more in some areas and less in others. GP access is quite good, especially in larger cities, unless someone didn’t care to choose his ‘first contact clinic’ right. Those clinics are mostly private, but working on government contract. One can usually get a GP appointment within a week, often same day. Urgent GP appointments are available 24/7 through special ‘holiday and night health care points’.
Things became worse when popular specialist help is needed. One needs a referral from his GP and may need to wait months for appointment. There is the point were people who can afford that, would often go private. That and dentists / orthodontist.
Big problems are in children psychiatry, mostly due to lack of funding.
Medicines are much cheaper that in USA. When prescribed by a doctor they are usually partially or even, in some specific cases, fully paid by government. That is not make it affordable for everyone that needs it, but it is not very bad.
When something very bad happens – serious accident, cancer, etc. then the public health care gives the most. Public hospitals will do what they can (with limited funding and overworked personnel) for free. People are not sent away because they are poor and won’t have huge debt to pay just because they got sick.
There are private insurances, or rather subscriptions services. They used to give better access to basic health care that the public services, but recently they don’t offer much more. And you must pay for the public service anyway. They usually totally fail in more serious case (chronic illness, cancer, serious accident) – one would get to and be treated by a public hospital too.
In short:
Pros:
- health care is basically free for everybody by principle
- GP access is good, and serious cases are handled quite well
- medicines are available and prices are not horrendous
Cons:
- not all the free health care is practically available, sometimes available appointments are months or years in the future
- dentists, orthodontists – not really available via public health care and private options are expensive
- doctors, nurses are other personnel are underpaid and overworked
- there is a lot of bad PR around health car here – this doesn’t help improving things
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Yeah but can not live to see thia surgery. Sometimes people wait even 10 years.
Sounds a lot like the UK.
USA. Others have covered cost but I’d like to add how long it takes to see a doctor.
I have an established primary care physician that I’ve seen for years. Now though if I want an appointment I have to wait at least two months. So I have a membership with an urgent care near me that puts a $180 cap on visits to their chain of urgent cares. There is obviously no on going care with them but most of the time that’s okay.
A friend of mine doesn’t have an established PCP and to get one he must wait at least a calendar year….
So many people in the US complain that if we had a single-payer system, that wait times would be horrendous.
Well, here we are with the worst system in the world and still horrendous wait times.
I had an appointment for my annual physical in June that I had to reschedule. I called a couple of days beforehand, and the first time they could see me was in November.
We really are lucky as Americans not to have the crazy long wait times that other countries do, right?
I haven’t seen my pcp in like 3 years. $200 to go in for no reason and have them tell me I’m fat? No thanks.
I should probably diy bloodwork though just to make sure I don’t have elevated white blood cell counts or sth
Edit: the wait for pcps is structural bc they don’t earn the same exorbitant salaries as specialists but still have to pay backbreaking med school costs, so there’s a shortage.
Ouch. The primary care situation in some parts of Canada is grim too but at least my appointment wait times are 1-2 weeks
Where do you live that makes you wait a year for an appointment with a PCP? I’ve only ever waited a month or more for a particular set of specialists where I’m at.
The south.
The deep south? Texas? Florida? I ask as a Texan.
Holy shit, that’s crazy. So if you have like, a really bad cold or something and need to see the doctor, you’ll be recovered by the time you get an appointment??
Makes me pretty grateful to be able to get same-day appointments, or at worst, the day after.
I can see a PA same day at a urgent care but not a doctor. So I can get meds for common things. But no ongoing care.
If you’ve recovered from your cold before you can get to a doctor, then you didn’t need to see a doctor. It’s almost as if humans have some kind of immune system to deal with common viral infections
Fine then, “if my vagina is leaking a green fluid and smells really disgusting” is that a better hypothetical for you???
Better, yes.
If you are wondering why it takes months to see a GP it’s because fully 50% of my consults are healthy people with self limiting viral illnesses.
Each one of those appointments makes me unavailable to see someone else who may or may not have offensive vaginal discharge.
If people just got out of the mindset of “my kid has a cold, I need to see a doctor to get checked out” or even worse " I have a cold, I need antibiotics" then maybe I can spend my day treating actual medical problems instead of telling people to go home, have some vitamin C and drink plenty of fluids.
I open Google, search “am I gonna die”, and if it says probably not, then I ignore whatever it is and hope it goes away. And if it says I am, then I wait for the end to come.
USA USA USA
Here in the US, if you have health insurance, any time you go to the doctor it’s $200. That’s if you have a doctor to go to. So we mostly don’t go, until it’s really bad, then maybe you have to go to the hospital, which may be a few thousand bucks on the low end and bankruptcy on the high end. You have no idea what you will pay when you go, they send you a bill in the mail that arrives 2-3 weeks later.
So we pretty much avoid interacting with the medical system at all costs.
If you do want to see a doctor or specialist it’s pretty easy since they are businesses, you just call them up and make an appointment. But what do I look like over here, John D. Rockefeller?
Then we die young of easily preventable diseases.
Your experience is real and is the case for millions of Americans, but healthcare insurance plans vary widely.
I work in a union job for a large nonprofit and I have excellent insurance. Visits to my PCP for preventative care are free, visits for anything else is $20. Specialists are generally $25. It’s also $25 for urgent care, $150 for the ER, though that’s refunded if you’re admitted. Hospital stays have no copay or deductible if they’re in network. All the major medical facilities near me are in network.
Monthly I pay ~$300 for my insurance, which is 12% of the cost, the other 88% is paid for by my employer. That covers me, my wife and my daughter.
Last year our insurance provider had a greater % of profit from our companies plan then legally allowed, so they had to refund a portion of our payments. My company refunded all that to us, so I got about a months worth refunded.
I’m fairly certain I’m in the top couple percent for healthcare quality, and it’s a real draw to me staying with my employer, though they’re great in pretty much every respect so it’s not the only draw.
I strongly support single payer healthcare because my experience is not the norm in the US and everyone should have the health security I have and feel.
Romania you pay taxes from your salary or if you are a student then you are automatically covered. To access specialists you need a piece of paper from your designated doctor that confirms from him/her that you need a specialist.
The reality tho is that the state of the medical system is bad. Understaffed and equipment older then 40+ years.
In NZ for basic healthcare, you call to make an appointment with your GP, go in later that day, they give you a prescription and you pay $5 for the medication and about $40 for the appointment.
For specialists in the public sector, there is a long waiting period, like a few months sometimes. You can pay for a private specialist, but it is of course expensive. Completely depends on the type of specialist etc.
Dental is not covered by public health care because we still live in 1864 apparently where barbers are meant to be pulling our teeth, but we are getting very close to having dental as part of public healthcare.
A huge amount of medication is subsidised here, basically anything life-saving like insulin, asthma medication, etc. I have an infinite supply of paracetamol because I just get it prescribed when I go to the doctors and pay nothing for it.
It really blows my mind that the US has an objectively vampiric and unfair healthcare system.
Also hospital is free and ambulances ask for a donation of like $100.
Canadian here - pretty good outside surgeries. We’ve got a serious shortage of specialist surgeons up here so you’re usually best going out of country for important non-emergency surgeries.
In my day job I track the US Healthcare system and it’s even more of a shitshow than you imagine.
I walk into the emergency ward, take a number, give my id to a clerk, sit down and browse
redditLemmy for a couple hours, see a doc, get some treatment if needed, and leave with a prescription, maybe a referral, and probably a parking ticket.Canada, eh?
Healthcare is all free to the patient (the one caveat being a small, fixed charge for prescription medication - which is free for some groups), all paid for via national taxes based on wealth. UK.
If we need a specialist Doctor, we are referred to one. There’s no money involved for the patient whatsoever.
Attaching an unaffordable fee to healthcare would be a clear barrier for anyone who is not upper class, and this would be seen as deeply discriminatory and thus unacceptable.
There is also a private health care sector, with its own hospitals. A lot of consultants work in both the public (NHS) and private sectors, e.g., one day a week they will have a private clinic at a private hospital. The private sector is funded by insurance, and this is often a perk offered by employers. Waiting lists are generally shorter in the private sector, but, in my experience, the expertise and level of care is no better than the NHS.
Note that the prescription charge only exists in England. Medicine is free in Scotland, Wales and Northern Ireland
Personally I think the English deserve it tho 😂
