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I think that's why we call it the emergency room. For things that are urgent but not an emergency, we have urgent care facilities. And for regular issues, you see your regular doctor.
This where a real deficit is. Perhaps they exist in some areas but they are close to non-existent in others.
Quite honestly, a bit of "mid life crisis", together with "did I really give the US a chance when I was there so many years ago? what if I don't take this opportunity?"
In the months leading to making a final decision when we were 'Hoo-ing and Ha-ing" about whether to make the move or not, we were looking at purchasing a new home. "bang for your buck" regarding what we could get for our money property wise here in comparison to what we could get back home was certainly an incentive. (Who from Scotland, would turn down the idea of having a pool outside?? And yep, our salaries here are better (however I'm ever conscious that the additional money we earn here can be wiped out in a flash the moment we become ill)
Also the perception that COL is cheaper here was an incentive, although that being said, having lived here for a number of years, we are learning that that is not the case. We paid far more for fuel back home but less for groceries. Paid less for car/home insurance and property tax at home but more for social activities/eating out. It all swings in round- abouts. Also being from Scotland where the weather can be truelly abysmal , better weather was an incentive too Lots of different thinking processes and rationals contributed to our final decision to move, as you would expect when you have a family. The decision is not to be taken lightly. I love my home country, its the most beautiful place on earth (on a sunny day! , however I also love our life here, we have some fantastic friends and I continue to be passionate about my chosen career and truelly want the very best for you all. Back home, I had reached a position within Management that had gradually removed me completely from the clinical floor. I missed doing what I loved the most. I was offered a good position here, I took it, worked on the clinical floor for a while, then found myself yet again, being dragged back into management, kicking and screaming!! Me and my whacky ideas for improvement did touch a few nerves evidently.
Yes I could have gone back into clinical back home, but all things considered we decided that a move might be a good idea and it was a "it's now or never" decision
As I said before, America is a fine country and I have been overwhelmed by the friendliness and acceptance of the people here. If I may be blunt and as I intimated before it's the healthcare that lets this country down. The healthcare delivered in itself isn't awful, its merely all the red tape and processes that surround it, costs incurred, together with it being one big massive for profit business for far too many people. And how on earth you all understand the workings of insurances and the billing malarky is beyond me. I feel I should return to University for a BSc in Understanding Medical Insurance in the USA! Everything is made to be so complicated.
Better answer - very credible . Sounds like other stories I've heard from other people. Works the other way around too. In Tokyo a few years back - we ran into a chef from France who had worked in Atlanta for quite a while (we had enjoyed his cooking in Atlanta a lot). He accepted a "job of a lifetime offer" at a top restaurant in Tokyo. He clearly enjoyed his work - but said he missed his house/yard/garden/etc. in Atlanta (hated the small apartments - the crowded subways - the super high cost of living - etc.). His wife and kids missed it too. He and family are now in Singapore (Tokyo restaurant closed). Wonder how he likes it there?
I think there are actually few middle and especially upper middle income people in the US who are at "risk of ruin" solely as a result of medical issues. Recent bankruptcy studies have indicated otherwise. Usually - there's a cluster of factors. Which includes not having savings/accumulating a fair amount of non-medical debt - and losing a job. Most family units today don't have the safety-net of a non-working spouse/partner entering the workforce if the "breadwinner" loses a job - and double income family units tend to live on both incomes - and then some. Medical bills can and do enter into the equation - but they're often the "frosting on the cake".
Also - although you may be confused when you look at the US system - MEGO when I look at the UK medical system. A while back I asked a question about how much a couple might pay in the UK to get a good private policy - which some people in the UK do. Because it was seemingly impossible to find that information on line without jumping through a lot of hoops (like giving my occupation and address in the UK). Never really got an answer (not surprising - because I doubt there are (m)any UK based people here).
I guess it's all a question of what you know about - and what you're used to. Also - your motivation. A lot of people here are lazy. They'll stand on line for hours to buy the latest iPad - but won't spend 10 minutes evaluating savings plans - insurance policies - etc. These are boring things to be sure. But they're also necessary in terms of financial planning.
Finally - I wouldn't automatically assume that the grass is greener elsewhere for anything medical - much less everything medical. Getting an annual check-up in some places may be easier than getting it in other places. Mileage may vary when it comes to a liver transplant. The variations aren't only between countries - but within countries too:
Among Mayo Clinic Jacksonville's services are organ transplants, with the liver transplant program considered to be the largest in the nation (245 transplants in 2004). The program has the highest survival rate and the shortest wait time until surgery among the top programs.
Places in the UK like London may have some unusual situations. Because it has lots of very wealthy people - and lots of very poor people too. That shows up in medical statistics - even though the UK health care system is supposed to be egalitarian:
I don't know if the NHS was ever a paradise - but it certainly isn't now. And - as it strains to meet the needs of an older - less healthy - increasingly fat population (problems other developed countries are facing) - proposed partial solutions like this are on the table:
...Further, for the most part drugs being developed for the past few decades in the U.S. have little to no increased therapeutic value...
Perhaps for most people. But - if you have MS - or kidney failure - or similar - there's a lot of new stuff out there. Perhaps we should just let everyone with MS get all crippled up - just give them their once every 5 year wheel chair and hope they die soon? Or perhaps we should let fat people who get diabetes and then kidney failure die? No drugs - no dialysis? Does that work for you?
And what have I forgotten? Various arthritis drugs (RA and psoriatic arthritis). Who cares if Phil Mickelson can't play golf or grandma can't button her sweater? There are lots of cancer drugs too (especially the newer ones targeted to specific genetic cancer forms - "designer" cancer drugs).
And let's not forget AIDs drugs - which have turned a death sentence into a chronic manageable disease (albeit at great cost). They're just ****/drug addicts for the most part who engaged in unsavory sexual practices. Why should we spend money to extend their lives?
There are probably others.
Which drugs will you seek to abolish access to when you're on a "death panel"? If a drug can extend my life - or improve the quality of whatever life I have remaining - I would at least like to be able to have the option of using it. Would you take that option away from me - or other people? Robyn
I think that's why we call it the emergency room. For things that are urgent but not an emergency, we have urgent care facilities. And for regular issues, you see your regular doctor.
Yep, granted it was my own ignorance The UK equivalent is called A&E....Accident and Emergency. We go there for minor injuries. I had never heard of walk in clinics etc and being a newbie to the USA, I learned a costly lesson!
Better answer - very credible . Sounds like other stories I've heard from other people. Works the other way around too. In Tokyo a few years back - we ran into a chef from France who had worked in Atlanta for quite a while (we had enjoyed his cooking in Atlanta a lot). He accepted a "job of a lifetime offer" at a top restaurant in Tokyo. He clearly enjoyed his work - but said he missed his house/yard/garden/etc. in Atlanta (hated the small apartments - the crowded subways - the super high cost of living - etc.). His wife and kids missed it too. He and family are now in Singapore (Tokyo restaurant closed). Wonder how he likes it there?
I think there are actually few middle and especially upper middle income people in the US who are at "risk of ruin" solely as a result of medical issues. Recent bankruptcy studies have indicated otherwise. Usually - there's a cluster of factors. Which includes not having savings/accumulating a fair amount of non-medical debt - and losing a job. Most family units today don't have the safety-net of a non-working spouse/partner entering the workforce if the "breadwinner" loses a job - and double income family units tend to live on both incomes - and then some. Medical bills can and do enter into the equation - but they're often the "frosting on the cake".
Also - although you may be confused when you look at the US system - MEGO when I look at the UK medical system. A while back I asked a question about how much a couple might pay in the UK to get a good private policy - which some people in the UK do. Because it was seemingly impossible to find that information on line without jumping through a lot of hoops (like giving my occupation and address in the UK). Never really got an answer (not surprising - because I doubt there are (m)any UK based people here).
I guess it's all a question of what you know about - and what you're used to. Also - your motivation. A lot of people here are lazy. They'll stand on line for hours to buy the latest iPad - but won't spend 10 minutes evaluating savings plans - insurance policies - etc. These are boring things to be sure. But they're also necessary in terms of financial planning.
Finally - I wouldn't automatically assume that the grass is greener elsewhere for anything medical - much less everything medical. Getting an annual check-up in some places may be easier than getting it in other places. Mileage may vary when it comes to a liver transplant. The variations aren't only between countries - but within countries too:
Among Mayo Clinic Jacksonville's services are organ transplants, with the liver transplant program considered to be the largest in the nation (245 transplants in 2004). The program has the highest survival rate and the shortest wait time until surgery among the top programs.
Places in the UK like London may have some unusual situations. Because it has lots of very wealthy people - and lots of very poor people too. That shows up in medical statistics - even though the UK health care system is supposed to be egalitarian:
I don't know if the NHS was ever a paradise - but it certainly isn't now. And - as it strains to meet the needs of an older - less healthy - increasingly fat population (problems other developed countries are facing) - proposed partial solutions like this are on the table:
because its not about health care. its about sneaking in the bill to the customer. the government and mr obama are actually trying to get u to pay for something, havent paid for anything in 50 years, its all been free or put on the tab, a tab we never pay.
if americans who are used to everything free and high quality begin to have to pay, we will see new faces in DC, and not b4.
to americans debt is meaningless but reaching into your wallet is not.
Thank goodness they are finally doing something about those not entitled to use the NHS...one of my pet peeves and frustrations with the system!
. Funny - every time I mention something like that here about the US - I'm accused of being heartless . But it's hard enough to take care of people who are legally in developed countries - especially older people - much less those who are illegal.
Don't know how old you are. But - at my age - 66 - well my family has 2 distinct sides. Paternal was everyone lived almost forever (grandfather died at 96 - grandmother at 103) with a minimum of muss and fuss or health care (although they did need help as they got older and were unable to take care of themselves in terms of cooking/getting dressed/etc.). Maternal was everyone died young (55-65 or so) from heart disease. Again - with a minimum of muss and fuss or health care.
Modern health care brought an end to that. Now - people on the maternal side of my family live into their 80's - or even 90's - as a result of things like coronary artery bypass surgery. Very expensive - and their quality of life after extensive medical intervention isn't necessarily the greatest. My late mother - who probably would have died in her 60's from heart disease a generation before - wound up dying of colon cancer in her early 80's. At great cost (and she wasn't in the best of shape either for perhaps a decade before her death). My late uncle was ditto my mother - except he wound up with 10 years of Alzheimer's (my mother had signs of early Alzheimer's when she died - that's another thing that runs on the maternal side of my family) - again at great cost and with not a great quality of life for a long time.
Note that most of this isn't lifestyle related - income related - or similar - it's just genes for the most part. My father is still alive at 95 - and 2 of his 4 siblings are still alive too at 90+. Even my uncle who smokes a lot of cigars.
It's a conundrum to be sure. For individuals - families - and countries. I don't want to spend the last 5 years of my life pooping in adult diapers in a nursing home because I've forgotten what a toilet is for. OTOH - I get sufficient pleasure out of various intellectual pursuits that I'll be content to indulge them as I age - if I can - as my body gets worn out. Don't know what the future holds for me - nor do any of us.
In all honesty - I don't think any developed country has figured out the answer to these things at this point. China - a second world country - is now pretty much allowing 2 children - to deal with elder care problems. But I doubt that will work in many first world countries where there's no tradition of children taking care of aging parents. Robyn
And this is one person's opinion of how things work.. maybe that ONE person didn't run into problems but has this poster ever tried to get an elective, but necessary surgery? That is what we are talking about, not getting care for a heart attack, of course they are treated in the proper time. But people that need knee surgery or other elective surgeries that are necessary, DO have long waits that we do NOT see here. It is what it is. Sure, when you average out the wait for open heart surgery and a knee replacement, that "average" wait isn't going to seem that long. How about looking at the wait times for procedures like knee and hip replacements and other similar surgeries. I guess the people I know that have had to wait 2 years are just lying, even though they report their progress, with dates to back that up. It would be one thing if it was the rare case, but it's EVERY person I"ve chatted with from Canada, UK, etc.
As for this so called "red tape"...people make it a lot more complicated then it has to be. It's different then what healthcarefirst is used to, that is all. It's actually a heck of a lot easier here trying to get elective surgeries done, going on the reports from the people I know getting the actual surgery done. In Canada and various countries in the UK, it's a 3 month wait to go in for their evaluation, then it has to go to a committee to decide if they qualify, then it's an 18-24 month wait to actually have the surgery because there are only 1 or 2 doctors in each area that performs the surgery. Then they can only have one done. Here, you call the dr, go in for your appointment, get your tests done, have your surgery...all in a matter of a few days or maybe a couple weeks.....and your counterpart in Canada or whereever still hasn't gotten in to see the dr for his first appointment.
Firstly this is not just "ONE person's opinion", its my EXPERIENCE..coupled with the THOUSANDS of patients I have treated over decades in two countries UK and USA. The two countries in which I have lived and worked in healthcare and experienced that
healthcare as a patient. I would not profess to knowing anything about any other country as I have not lived and worked in healthcare there and so I refrain from passing judgement or on having opinions.
To be fair Golfgal, you do have a fair point in regards to the elective surgery services within the NHS. It is not the best in terms of waiting times to be sure and it is unfair that folk have to endure pain than is longer than acceptable. I myself have not had to have elective surgery and my partner has only had elective C-sections so that probably doesn't count. I do know that elective surgery waiting lists differ across geographical areas, some hospitals are doing a better job of managing their waiting lists than others, so there is likely significant variety across the country in regards to how long people are having to wait. I can only comment on my own country - Scotland, which is fairing pretty well. My own father has waited 3 months and has his back surgery on Monday. Its fairly extensive and filled with risk and complications so there had to be some decisions made around whether he should have it or not in light of his other medical conditions.
My father in law had both hips replaced 20 years ago, had excellent life out of them and is now awaiting his revision surgery(which is pack and parcel of THR surgery). He waited 6/7 months I think it was for his left hip (he actually got an earlier date but was coming over here for a vacation and so deferred) and he is now waiting for the next one to be done. I'm not sure how long he has waited so far to be absolutely frank. I'll make a point of asking him when he comes over again later this month But again, I'm not sure where you are getting the "your only allowed one" notion from! Granted they won't perform two at the same time...that would be a functional mobility nightmare for anyone to recover from!! But in all genuine honesty, I would far rather pop a few more pain killers for a few months (which incidently are supplied at no cost...or a 3uk pounds cost flat rate for those that need to pay (ie age 16-65..for all prescription drugs btw...ALL of them...for whatever drug it may be!!) than lose my life time savings. Elective surgery waiting times are most certainly an area for improvement ,however your healthcare needs over the span of a lifetime are going to very likely exceed that of an elective surgery procedure!...so logically, waiting times for elective surgery being one of the main weaknesses of NHS care, I can live with.
Waiting times...absolutely one of my biggest headaches back home . I was required to report on all patients who had waited longer than 2 weeks to be seen from point of referral and I had to report on what actions were being put in place to improve upon the these waiting times on a monthly basis. All sorts of initiatives were being implemented to address waiting times including new electronic appointment systems that were more efficient and timely, and "waiting time monies" ( additional budgets) being allocated for increased staffing and resources to reduce waiting times.
I have no doubt that there are some folk from UK who are on forums grumbling about having to wait, and rightly so. As I said earlier, there will be some geographical variation on how long folk are waiting. What I would honestly say though to those who are having issues waiting at the end of the day in the UK.....okay guys..know what? you really don't know how good you have it! .Do you want to come over here and pay through the nose for your surgery? Come on over and give it a shot!..see how much it costs yah!. Then I would stand back and hear the grumbling take on a whole new meaning!! Its the same all over the world and is human nature...for those in the UK who don't know any better because they have never experienced anything so absolutely outrageous as the costs incurred in the USA, then of course they are going to grumble and have a rant/moan every now and again. Truth be told though, there are very few people throughout the whole country who would be happy to live without their NHS support system, regardless of their grumping.
I completely concur that things are not perfect with NHS healthcare back home. One of the very factors however that always gives me GREAT pride and trust in the system is the very fact that it is genuinely patient centered and absolutely 100% committed to continuous improvement. There are clinicians who are now employed within the Scottish Parliament healthcare sector (Google Jacquie Lundie for anyone who is interested! who are tasked purely with redesigning services to better meet the needs of the population and advising the government what needs to be done. They, together with NHS Quality Improvement Scotland, travelled the whole country for months and months, holding conferences and seminars for the general public to attend. The purpose of those conferences were to get down to the nitty gritty with the service users themselves rather than basing improvements and redesign on what professionals thought were best. I was involved in facilitating one of those conferences and it was absolutely brilliant. The folk of Scotland were truelly given their say in what they want from their NHS, what the pitfalls are, and how they suggest it improves. A number of redesign strategy papers were then developed as a result and over the next few years, improvements will continue to be made.
I am going to post one more concept for you all to ponder in my next post...in the meantime however, I have returned home from work to find my "benefits" enrollment package for 2014 have arrived oh goody goody! I wonder what this years "Highlights" will entail! I'll take the next week or two to try and make sense of it all and lets see if I can understand it any better than I did last year! Can you not just take 13% out of my pay packet and be done with it???
In the NHS , the words "For profit" do not exist. There is this huge pot of public money that is to be effectively managed to meet the healthcare needs , from the cradle to the grave, for the population of the UK.
So it is the responsibility of those working and managing the healthcare services to ensure that this public money is being used wisely and in the most effective way possible. So let me address a common problem for both the UK and the USA and let me discuss total hip replacement surgery as an example, in the elderly population.
Hip fractures as a result of falls in the elderly population are one of the biggest cost burdens to healthcare providers ..this is fact. Costs incurred not only include the hospital costs for hip replacement surgery, but also includes the social /care burdens that that elderly person experiences as a result of lost function for weeks/months and possibly over the longer term as that elderly person no longer feels able to manage at home. I won't bore people with figures and percentages but this is a fact.
An elderly person falling is very traumatic and it is certainly not something you want your elderly mum or dad to go through right? In addition to the physical limitations it places on mum or dad, it also impacts on their confidence, and having to go into hospital for an elderly person is pretty god damn awful for all sorts of reasons, particularly those frail souls who also have cognitive deficits. It just throws them for six when taken out of their own environment. Not to mention all those hospital borne infections..yuk. Not great for your loved one.
UK NHS action plan to improve this situation = lets try and prevent these patients from falling in the first place. Makes sense right?? For years, there have been initiatives put in place to enhance falls prevention awareness in the community...too many to list...even down to employing Falls Project managers and teams who's role includes going into homes, sheltered housing environments (ALF US equivalent) and nursing homes to assess their environments with a view to providing education and training for all concerned...even down to replacing worn out ferrels on mobility aids (the rubber end bit)
As I sat in one of my very first committee meetings at work when I first arrived here, I began my fairly lengthy list of all that could be done to work in the community and raise awareness to prevent those wee souls from falling. As my speech came to an end and I was becoming ever more consious of eyes glazing over, can you imagine my surprise when I heard "that all sounds fabulous...great ideas indeed. However why on earth would we want to prevent the elderly from falling??? Do you know how much money we make from people who fall?" At which point I was thinking what on earth have I come to!!!!...REALLY??
And that is the main difference between Universal healthcare and the USA system. Its the "for the people" vs "for profit" cultural mindset difference. In the NHS, sure you are asked to meet savings targets..and sure you are asked to provide streamlined services in order to be more efficient blah blah blah ( I know..I managed a budget of $2.6million for the services I was responsible for). But here's the thing..the sole purpose of meeting savings targets and being cost efficient are not to line the pockets of the suits and to make even more money for the organisation. Nope. The purpose is simply to have more monies available to reallocate and improve the weaknesses in the system e.g waiting times. So in the NHS the money is frequently moving around WITHIN the system to provide ever improving healthcare for its people..not going towards funding the next ferrari for the suits.
As I sat in one of my very first committee meetings at work when I first arrived here, I began my fairly lengthy list of all that could be done to work in the community and raise awareness to prevent those wee souls from falling. As my speech came to an end and I was becoming ever more consious of eyes glazing over, can you imagine my surprise when I heard "that all sounds fabulous...great ideas indeed. However why on earth would we want to prevent the elderly from falling??? Do you know how much money we make from people who fall?"At which point I was thinking what on earth have I come to!!!!...REALLY??
Quite an indictment ....capitalism at its finest.
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And yep, our salaries here are better (however I'm ever conscious that the additional money we earn here can be wiped out in a flash the moment we become ill) 
The UK equivalent is called A&E....Accident and Emergency. We go there for minor injuries. I had never heard of walk in clinics etc and being a newbie to the USA, I learned a costly lesson! 
. But it's hard enough to take care of people who are legally in developed countries - especially older people - much less those who are illegal.
But in all genuine honesty, I would far rather pop a few more pain killers for a few months (which incidently are supplied at no cost...or a 3uk pounds cost flat rate for those that need to pay (ie age 16-65..for all prescription drugs btw...ALL of them...for whatever drug it may be!!) than lose my life time savings. Elective surgery waiting times are most certainly an area for improvement ,however your healthcare needs over the span of a lifetime are going to very likely exceed that of an elective surgery procedure!...so logically, waiting times for elective surgery being one of the main weaknesses of NHS care, I can live with.
Then I would stand back and hear the grumbling take on a whole new meaning!! 
Its the same all over the world and is human nature...for those in the UK who don't know any better because they have never experienced anything so absolutely outrageous as the costs incurred in the USA, then of course they are going to grumble and have a rant/moan every now and again. Truth be told though, there are very few people throughout the whole country who would be happy to live without their NHS support system, regardless of their grumping.
