National Health Insurance

There are several people on this board who are from countries other than the U.S. I’ve read postings in various threads about patients not having to worry about cost of care. I’d love to learn more about different countries’ health care systems, how they’re funded, and what does and doesn’t work in those countries. In the U.S., we hear that our healthcare system is so much better than in other countries. We also hear that people in countries with “socialized medicine” can’t get care or have to wait forever to get care and that taxes are high. I’d like to hear it from folks that are using healthcare in other countries. Where do you live and what’s it like to get healthcare in your country?

From http://www.medicareaustralia.gov.au/about/index.htm

Medicare and the Pharmaceutical Benefits Scheme cover all Australians and subsidise their payments for private medical services and for a high proportion of prescription medicines. Under Medicare, the Australian and State governments also jointly fund public hospital services so they are provided free of charge to people who choose to be treated as public patients. Australian Government funding of the 30% Rebate and other key incentives support people’s choice to take up and retain private health insurance.

People make their contribution to the health care system through taxes and the Medicare levy based on their income, and through private financing such as private health insurance.

The aim of the national health care funding system is to give all Australians, regardless of their personal circumstances, access to health care at an affordable cost or at no cost, while allowing choice for individuals through substantial private sector involvement in delivery and financing.

Medicare and the Pharmaceutical Benefits Scheme cover all Australians and subsidise their payments for private medical services and for a high proportion of prescription medicines. Under Medicare, the Australian and State governments also jointly fund public hospital services so they are provided free of charge to people who choose to be treated as public patients. Australian Government funding of the 30% Rebate and other key incentives support people’s choice to take up and retain private health insurance.

People make their contribution to the health care system through taxes and the Medicare levy based on their income, and through private financing such as private health insurance.

The aim of the national health care funding system is to give all Australians, regardless of their personal circumstances, access to health care at an affordable cost or at no cost, while allowing choice for individuals through substantial private sector involvement in delivery and financing.

Currently, France has the best health care system on the planet. It’s all public health based (altho presumably private cover is available). In France the citizens only really pay taxes for Health, Education & Defence. The rest is covered by local “de’partment” charges and tolls. Patients have choice of doctor/specialist, etc. They have the latest ‘hi tech’ gadgets you’d expect ot find in any U.S. hospital/clinic. They have also been running overnight dialysis for some years, incidentally. A few months ago there were huge rallies against govt.-proposed cost-cutting measures.

I love the way various U.S.government talking heads & pollies always knock overseas public health care systems and tell how they cost so much in taxes. I’m damned sure, if you tally up costs/benefits and then charge this back (@ cost) as tax burden and then compare this to the profit-making insurance company option of paying (if you can afford it!) medical bills, you’ll find inflated costs to patients and to insurance companies by medical facilities ‘milking the cow’ (resulting in higher insurance costs & so on).

Sure there are many examples of high tax countries -Sweden is the one that crops up a lot. Swedes pay the highest level of taxes (at least in Europe), but my God they get so much back in social services. Higher unemployment benefits, free kindy care, etc. Choose your system, I guess.

…and I see George junior has just announced tax rebates for the rich (costing ‘billions’ over the next 5 years!!). Jeez, wouldn’t those billions do well if ploughed into health care, instead of yachts, mansions & offshore accounts?

Australia’s system seems to work pretty well. Certainly better than most.

Canada has a public health system where the federal gov. dispense money to provinces for health. In Ontario at least there are no private facilities ( except of some minor clinics that are also funded by OHIP Ontario health insurance plan). The hospitals and doctors are covered by the plan, medication is not; after 65 drugs are “free” except of some copayments.

For specialist there are realtive long waiting lists, also for some expensive tests. When you are in the system there seams to be smooth sailing.

Now that my husband is predialysis at the hospital is a multidisciplinary clinic looking at him. The team has the dr. neprologist, a nephrologist nurse, a dietetician, a pharmacist attached to the neprology dept, an access nurse and a social worker. We also met a nurse from the home dialysis , and the hopspital will deliver the machine at home and do all the plumbing modifications. They are also arranging the supplies. The dialysis is covered by OHIP. Eprex is free from the hospital. The rest of the drugs are covered by private plans but not by government.
OHIP is also paying for out of conuntry dialysis at a specified rate and based on a certain schedule. ( I do not know exactly the details). From what I have seen at the hospitals the majority of pacients are brought in by Wheel Trans which is a subsidized form of transportation for pacients.

Pierre being from Ottawa maybe can add more to this, this is in a nutshell the Canadian model.

Our taxes are higher compared with US ones; but in majority covers health insurance and education. I am working in an University and our tuition is ( with all the hikes) around 800 Cnd dollars a year ( for the majority of programs exception being medical school, law and dentistry).

So the system is or is trying to be Universal and the what is called safety net is quite comprehensive.

OOPS I mean 8000 $Cnd a year!!

I don’t want to start a political discussion here but I feel compelled to comment. I understand your misapprehension because of the media coverage. There were no “rebates to the rich”. All tax payers in US, who were paying income tax had their income tax cut by the same %; people who were not paying any income tax can’t have their tax cut because they weren’t paying any to begin with. I don’t remember the exact figures, but in the US those earning in the top 5% pay well over 90% of all income tax collected. I was happy to see the $$$ stay in the private sector, in the hands of those who earned it, and act as an incentive to be more productive, instead of going into the hands of politicians who often do not use it wisely.

In fact, in the US if a person works, has a low income, and a lot of allowable deductions, they qualify for the EITC and they get a tax “refund” greater than the amount of income tax they had prepaid. (Yes, we have to prepay our income tax many months before it is actually due.) I know about the EITC because several of the years when our medical expenses were very high my husband and I qualified. It was nice to get back a government check larger than the amount of taxes we had prepaid!!

I found that the whole process of having kidney disease, being pre-esrd, starting dialysis, switching dialysis method, getting and being on the waiting list, etc., is all pretty seamless here in Ontario. There are no invoices of any kind, at any time. They tell you where to go and when, you go, and that’s all there is to it. All you have to do is show up.

The dialysis clinics are very well-run, because efficiency is the name of the game, not profit. But it’s not just efficiency at the dialysis clinic itself. Everything is integrated together rather than each thing being separate. So, if the dialysis clinic neglects something that results in more hospitalizations later on, that’s the opposite of efficiency. Even the kidney research centre is part of the overall system, and so there are many clinical trials. For the patient, there is integrated follow-up once you get to about 30-35% kidney function or before, and at every other stage of the process. In fact, Canada, and my city in particular, Ottawa, is a world leader in having developed this kind of integrated progressive renal insufficiency and renal failure care. And of course we know that daily nocturnal in its present form was largely developed in Toronto.

Here on this forum, we talk in terms of people being to do their own dialysis at home, but I know that not everyone can do that, and not everyone is up to it. I know people who have not passed the training because they get too flustered. And there are people who are just too sick to do this at home on their own. So, it’s nice that there is fairly easy access to para-transport buses, and it’s not too hard to get disability if you have to. If you can’t afford drugs, there are two different programs for that in Ontario. One of them, the one I’m on, only costs $2 per prescription. All drugs that are given while on dialysis are free, since that’s considered to be within the hospital setting. The hospital bills the government for it, but the patient never sees that.

I’ve never had significant waiting for anything. In my renal case, I had the pre-dialysis treatment options classes at the appropriate time, the fistula surgery at the appropriate time, and even an education evening for people on the tranplant waiting list.

Now, healthcare is a provincial responsibility in Canada, not a federal one. All provinces have to conform to the national health act, but there is leeway in how the provinces deliver the actual service. So it might not be exactly the same everywhere. And of course, like in any other country, you do have better access to these kinds of services if you live in a major urban area.

Pierre

I hear the saying alot that Canada’s healthcare system is way way better than the one in USA ands that medicines are much more affordable. Is that a myth? Or is that a fact? :?:

What ideology practice you think both USA and Canada manage?

Over here in the USA, working class people who own their own homes and later become chronically ill lose their homes down the road. For example, there was one case I read of a married couple, one of the spouse started dialysis and in order to still keep their house and get benefits from medicare they had to divorce… :?

It’s not a myth that prescription medications are cheaper if you have to pay for them. The government of Canada regulates the price of medications to allow for reasonable profit and recovery of development costs, but no more. The pharmaceutical companies are not free to set whatever price the market will bear. That’s why if you live anywhere near the border with Canada, you will have heard of seniors crossing over on bus tours organized specifically with prescription meds in mind. I’ve never paid more than $10 for any medication, so I really have no idea what they cost if you had to pay full price without any insurance.

We have our right wing true believers too, especially out west where they are a little giddy on oil and gas revenues, not unlike what you would see in Texas, for example, but traditionally, Canada is more European in attitude, in that the majority of people believe that government does have a role to play in leveling the playing field for everybody. So, everybody pays for healthcare through their taxes, and everybody has the same access, even the poor who don’t make enough to pay taxes. The wealthy can always jump the queue by going to the U.S. or overseas, I guess, if they can pay. Our system isn’t perfect, but it’s as good as anything in the world.

As far as I know, people who need to get on government disability are expected to use up their resources first. I mean, if you have half a million invested in mutual bonds, then you would probably not qualify for disability. But, if you have a house and a car, that doesn’t factor into it. The only problem is that you might not be able to afford staying in the home (property taxes, maintenance costs, etc.), and if you have a car, you still have to pay for it, the insurance, the gas, the maintenance costs.

But let me state flatly that I have never encountered a waiting list for renal care at any level, and I’ve had kidney disease since 1977. I did wait a few months for my kidney biopsy in 1993, when I lived in a poorer province, but there was really no urgency for that anyway.

Pierre

Regarding your question Gus, there is now quite a waiting list in urban areas for specialists, and my husband fistula was very much delayed at our hospital, but then the nephrologist step in and send him to another hospital were it was done in one week. In case of emergency you are taken in right away. My husband drugs for HBP and colesterol , diabetis cost quite a big amount but we are coveed by my employer, so we pay only the deductible. Eprex which is extremly costly is covered by hospital.
That being said the drugs cost about 1/2 to 1/3 from US and there are more generics.
If you cannot afford them ( we have afriend who is quite old and does not have the means) his family doctor wrote to the drug manufacture and he got them free ( the drugs were not covered by medicare he is over 65).

I check with my pharmacist and all the drugs that my husband is taking will be free ( except of a copyament) after he will be 65.

So the system is not perfect but is the best and we are really lucky to be here.

Is me sadsam, no my husband is not yet on dialysis, we just have the fistula

Oh okay, do you know whether he will go in-center or dialysis at home?

Yes, we will do home ( probably initially 4 times a week - is a questionof funding-) , will go through training inhospital. see our posting under Update.thanks for all the good wishes, fistula is healing fine

My goodness, luck to both of you on the process. :smiley:

Some of my new posts are in a round of way looking for the answers to the questions. I stated that I’m 49 , had a birth defect (still do of cause) and really never had any problems till I started in with renal doctors. And even when I first started never really had problems went to see renal dr. twice a year (2001) before that it went to a urologist since 73. It was not till I went into dialysis that I ran into major things that I was unaware of, because I never looked into dialysis. Maybe it’s me, but I had so many other things going on that I never really thought of it, I knew that I was not alone in my problem and that other people had far more harder lives than I ever did or will. As far as (N I) I don’t if that is answer to our problems in the states. I try to read and listen and understand as much as I can with how other systems work. (Thank goodness for the media and the computers ) I really don’t see anyone system as having all the answers to all the problems. In the US it seems to work better if the person or condition have a lobby group. I was just reading in the NYT’s that junior diabetes have really good lobbying group.

I think we need to look at the whole package before we jump to (N I or anything) for here, I’m open to any talk. Besides isn’t that what medicare and I think each state has some type of health plan for thoses that can’t afford insurance. I think that if there was a package that is the best, people would be running to it or the media or some group would be getting the message out. The changes that having happened are done or are getting done because of some grassroot group got the ball rolling and people hooked to the cause. Here in the states it seem to also help to have someone who is know to be the spokesperson. But if someone unknown is strong minded enough than maybe that person can start something. ( Beth, you might have started some good talking points for us in the US). Before I start to write my elected officals I want to get as much as I can on what is happening to others in the US. I take that maybe the northwest part of the country might be more forward thinking in the treatment of dialysis?

bobeleanor :?:

A good website for information on the uninsured is the Kaiser Family Foundation which is a nonprofit organization unaffiliated with Kaiser Health Plans.

Reports cite that 45 million people in the U.S. are uninsured. Some have questioned this number saying that people don’t report their health insurance accurately. However, as a social worker I’ve seen a myriad of reasons why someone doesn’t have health insurance. I am most concerned about how lack of health insurance affects access to health care and even preventive care that could have led to diagnosis and treatment of kidney disease before it became kidney failure, access to innovative therapies, and access to transplantation.

There are many myths about who has or doesn’t have health insurance. You might want to follow some of the links to read the fact sheets and check out the rest of the site. I was appalled when I read how many employers (even employers of 1,000 people or more) do not provide health benefits. It’s pretty shocking.

I’m not necessarily advocating national health insurance. However, I do believe that the U.S. healthcare system is not working very well for the money spent on it. Perhaps there are other systems that work better and could serve as a good model. I’m looking for a system that provides incentives for good customer service and quality patient care instead of paying obscene compensation to CEOs and executives in corporations and insurance companies. Now I’ll step down off my soapbox.

Hi

Your right about all the myths. i think where you work and your veiws on life also might tend to shade a person thinking. we hear some many stories from some many sides. i think that there is some truth to the whole thing. yes we have a lot of prolems in the US, but i also think we have a very apathy nation. problems don’t mean much to most people till it hit them. plus you the single person who see things and want to make changes you are faced with many folks who put you down and say it can’t be done. It is not easy to make changes. I have no question that there are people who don’t have help , but i also know that there is a wealth of people who are more than willing to help.

bobeleanor :smiley:

Beth,

I have to agree I see alot of problems with our health care system. Which I don’t know if socialized medicine has or not. For one thing after you have worked all your life and bought your home if ESRD should happen to you with the co-pays for hospital, doctors and prescription can force you into medicaid. Once on medicaid you are allowed to have practically nothing in terms of cash, burial expense, and even your house.

A nurse at our center was from Scotland and he said should he ever be told he would need dialysis he would be on the 1st plane back to Scotland. He was very frustrated that he had to check with insurance companies to find out if a drug the “doctor” order would be paid for. In Scotland if the Dr. orders it you get it. You don’t have to sacrifice your home and income to get medical assistance.

I have a hard time accepting that medical decisions are made by insurance companies and not by doctors. A doctor in our town now has his license under suspension. Why, he had a patient who need a drug and was only allowed 3 a month per insurance. The only problem was it was for migranes and sometimes the patient had 2 a month and sometimes 5. So he wrote the patient another prescription so he could have 5 if he needed them and that where he got into trouble.

I doctor on an elevator one day was talking out loud. He said I can’t believe it I have a patient who is to ill to go home and I have to make up a
problem because the condition that is causing the problem only gives them so many days hospital stay. Can the doctors call to get exceptions made, yes they can. But I have heard numerous doctors complain that when they make the call to the insurance company they don’t get to talk to anyone who even understands what they are saying or asking for.

I have heard one of things that are a drawback to socialized medicine is the waiting lines say for hip surgery but then I have to remember … I know patients in our area who had to wait in the local hospital for a larger hospital to have room to do the procedure they required. I also know when my nephews wife needed surgery she had to go to another hospital because the closest one was full…so do we really have it any better?

I think HMO’s hurt patients way more than helped them. It’s cheaper out of pocket expense for patients, but they give up the freedom of choice and it’s a constant rangling for doctors to get things covered. We have one of the top cancer institutes in the U.S. within 100 miles of us. A patient in our town wanted to go there when he was told he had cancer. He couldn’t because it wasn’t in the HMO. His cancer was of such that a place that specialized would have been of much more benefit. He died without the opportunity of being able to try some of the newer methods for cancer treatment. Would they have saved his life (who knows) and we never will the HMO prevented the opportunity.

I don’t promote socialized medicine either; I don’t have enough facts but I surely don’t believe our way of doing things is benefiting ALL patients and I surely can’t see where it is helping in the line of medicine.

I do believe we all should have the right to live and one of the blessings in this country should be to give its citizens regardless of who they are the opportunity to the best medical care. It’s the one thing all humans have in common the need for medical care.

We’ve screwed it up someplace.