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.
It's a mess.
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
Some countries forbid two tier systems entirely for this reason, like here in Canada.
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.
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.
Perpetuating a myth doesn't make it more true.
See my reply about Germany/Berlin above.
It also doesn't mirror my experience in India (2004) and Sweden (2015) where I needed to use the resp. medical system.
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”
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.
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.
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.
My Canadian uncle had to wait months for cancer specialists.
They we should use averages. Compare costs, or life expectancy, or some other measure.
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.
Not all health problems are healthcare problems.
The service is rationed in the US too, just on a basis of money instead of time.
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.
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
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.
... If you're rich relative to the general population, then you can go to an expensive private clinic and be seen quickly, yes.
I doubt that's the case for public hospitals and in any case, I've been inside public hospitals in Indonesia, Cambodia, and Vietnam (all for other people's needs, nothing major thankfully). Trust me, you do not want to get treated in one of those and as a westerner you'll never even see them unless you friend gets bitten by a monkey in the Cambodian jungle (for example) and there's no private clinics nearby. I always assumed the casual attitude towards hygiene that Asian people have wouldn't extend to hospitals. I was wrong. There were literally blood stains on the wall in the corridor. The toilet was a hole in the ground with a bucket of water and a scoop to wash your hands and ass with. There was no soap. This wasn't a small hospital, it was the main hospital for a city of about 200k people.
Delhi’s nominal per capita income is north of $6k. Even if you’re plain average, a $60-80 one time scan is within reach.
2. You typically don't need MRI scams all that often
Government rate is $120 per imaging session, with standard 1/3 deductible. Minimum wage in Tokyo at this moment is $1336, so more like 3-5% after additional diagnosis and fees.
Just the scanner install, service contract and chilling is 6 figures, and the staffing is a significant sum. Maybe the throughout is very high (scan quality low)?
It’s more that I’m aware of MR equipment costs, and I can’t see the equipment being discounted.
Salary of medical assistent around 3 dollars per hour.
A few k per month would definitely make the purchase worthwhile.
The image quality is going to be unlike what you get from a higher spec machine, but does that matter most the time?
A crappy picture can be diagnostic.
Do you know the model or make of what they are using? I’d be interested to see what they are like.
I struggle with the idea that 10 MRs a day would support a business anywhere, so seeing numbers is really interesting.
Hmmm, might be generalising a bit too much there.
As a generalisation (too, heh) people in Japan seem to be fairly careful with hygiene.
In Australia (where I initially moved from), the term "Asian" does indeed refer to people from East or Southeast Asia.
But it turns out for people in the UK, the term "Asian" refers to people from India (and immediate area I guess).
(!) For East/Southeast Asia, they use the term "Oriental".
It sure surprised the heck out of me.
You're totally right to call me on that generalization. I meant the parts of Asia I've personally spent time in: India, Sri Lanka, Nepal, Bangladesh, Myanmar, Cambodia, Indonesia, Vietnam, Laos, Philippines, and to a lesser extent Malaysia and Thailand.
Other Asian countries like Taiwan, Japan, Korea, and Singapore don't deserve this shade thrown at them and I apologize.
I know people would say "adapt to the place you're in". But I draw the line in a few places. Burning trash and mistreatment of dogs are what push me past that line and turn me into a shouting maniac.
> Tons of hospitals in India are spanking clean
Private hospitals. Lots of commercial places are kept spanking clean. It's weird though, it rarely extends to the neighborhood. I'll never stop finding it weird to see a stylish hotel with manicured grounds next door to a literal dumping ground that they don't seem bothered by.
Now it costs around $300: https://www.tokyomidtown-mc.jp/en/pdf/optional_menu.pdf
How can it ever be bad to have more objective data? Having a test result to ignore is still strictly better than not testing at all. You still have the option to ignore or discount the test results if you want to. If you’re forced to do otherwise that’s entirely a human problem, not a technological one.
That’s why you base healthcare on data. And that’s what the data shows.
If MRIs lead to unnecessary biopsies, then don’t do the biopsy. What exactly does the data show? If doing a test leads to an unnecessary biopsy, how can it be the test’s fault? Tests aren’t moral agents. The MRI machine can’t make any healthcare decisions for anyone.
Well the exception being Singapore. That was expensive but covered by insurance so it still cost $0.
Edit: another thing. What is with the west more or less forcing natural birth and kicking you out of the hospital the next day? I would have to give birth in a western country. Thankfully my kids were born in Asia. Hospital took care of baby and mum for 6 days then we left the hospital. Cost was 2 weeks salary.
So in systems like the UK, you can walk into an MRI, you just have to pay privately for that access.
Unless it's an emergent procedure, in which case it'll be done same day or within the next 72 hours.
I’m a massive advocate for socialised healthcare, but NHS emergency departments have been farcically bad lately.
https://www.theguardian.com/society/2023/apr/13/accident-eme...
I’m not sure what going on here, as an MR could be done for that tomorrow. However I’d guess that the hold up is a free healthcare system specialist.
If it was a private referral or after an accident, you’ll get seen much sooner. Unfortunately the public system is under pressure.
What the hell is "the west" in this context? Do you have experience with every health care system in Europe? Why is "NZ" considered "the west"?
> In asia you can walk into a clinic and see a doctor in 30m.
You can in many places in Europe too.
The flip side of the asian systems can be incredibly overworked and stressed health care workers. I know the service in Taiwan is fantastic (though a bit stressful, was way busier than in Norway), but I also know a nurse working there saying the working conditions are quite awful. They also encourage doing way more testing than necessary. That makes it so testing is pipelined and efficient. You get economies of scale. But doing this is generally considered a very bad idea, because you can get false/misleading diagnosis and undergo unnecessary treatments with potentially bad side effects. Along with all the wasted time and resources that could have been spent working on actually sick people. Which in asian countries can mean that poor people don't get the resources they need to get treatment.
> The Western world, also known as the West, primarily refers to various nations and states in the regions of Australasia,[a] Europe,[b] and the Americas.
> but I also know a nurse working there saying the working conditions are quite awful.
I can imagine during covid the conditions were awful. But on a day to day basis the hospitals are pretty quiet.
The hospitals don’t do more tests. It’s more people taking advantage of their health card. For example our daughter was in hospital for ~7 days. It cost $65 USD.
People get health check ups often cos it costs almost nothing. Visiting a clinic costs $5~ and people often want antibiotics when they have a cold even when advised it won’t help as it’s a virus not bacterial.
The healthcare system in the west is just plain stupid.
In asia you can walk into a clinic and see a doctor in 30m. Want to get a X-ray or mri etc at hospital? An hour?
Yet in NZ a friends sister has been waiting 4 months now to have her shoulder checked by a specialist.
It’s easier to fly to asia and see a doctor than it is to try see a doctor is a western country.