U.K. Vs Elsewhere...

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Hi everyone

I have to say it's really interesting (if not a bit confusing) hearing all your experiences. One thing that strikes me is how different our treatment and access to it is?

Here in the UK it certainly seems to me that we put up with longer waits and we have to have exhausted every option before a drug is changed. I've been left for extended periods on nothing at all because the hospital is struggling to see everyone, and my GP doesn't want to interfere or cause a problem. However it's all completely free at the point of use!

Meanwhile in America it seems that you guys are seen as and when you need it, and action is taken quite quickly but with eye watering amounts of money on insurance. I can't work out if the NHS is very cautious (as well as underfunded), or if American GI's are much more willing to try a more severe treatment if it means you suffer for less time and don't go unchecked.

Is there anyone here who has experienced both sides? I would imagine there are many differences and I would be really interested to hear how it works in other areas of the world too :)
 
Hi,

I'm only really qualified to talk about UK but over the years I've had a bit of experience of the NHS and the only thing that I can say is to not devote too much time and effort to thinking about the internal machinations. :ybiggrin:

I think the NHS is a monument to 'best practice' which means that treatment, by necessity, will be by the book so that they cover themselves against any accusations of malpractice. Treatment by numbers.

I think there is a huge variation in access to treatment across the UK even within the NHS. If I had an issue that I felt required attention, I would get in contact with my IBD nurse who is fantastic - but alot of people don't seem to have access to one.
 
Haven't had both just US
I can say there is a wide variation in the US
Whether or not you have insurance
If it's govt funded or private insurance
And your level of employment

We have very good insurance it's considered part of the salary and benefits package
So while we pay a premium it comes out of our paycheck prior to taxes and the company pays a large portion of it
So the individual cost to us is low
And what it covers is a lot

As far as drugs
Most insurance companies vs(nhs there )
Are the ones who determine if you can be approved for a higher level drug
Most still you go from the bottom up and prove you failed the less expensively drugs

You do get seen sooner if it's urgent within a day to a week depending on the level but this is after your an established patient otherwise you wait

Testing same way depending on test
Scopes they can admit you and scope next day or routine wait a week to 8 weeks
MRI have the longest wait of 1-2 months unless urgent

So overall we pay very little extra out of pocket even on humira and mostly elemental formula
Insurances covers it all

But just like nhs varies from place to place on funding and wait time etc

Insurance in the us on what is covered and how much you pay out of pocket can vary big time

And most GI and other specialists still have to fight insurance companies to get approval for tests and drugs to prove they are medically necessary
Even then insurance companies sometimes still say no

There is no good system since someone always loses out
 
I agree it seems to be very variable! Although 8 weeks routine wait for a scope is amazing! I waited 9 months for one and another 6 months after that for a follow up appointment.

At this stage though I was still misdiagnosed. Once they thought something else was responsible I had further scopes and an MRI all within 2 months (referred as urgent.)

I was lucky to be diagnosed though in all fairness, my symptoms were not typical so not complaining at all :)
 
I think it depends also on your consultant in the UK. I am lucky in that my team are very proactive. If I need an urgent scope it is usually within a few days. Less urgent I wait a few weeks. I know others have to wait forever for appts/tests/drugs.

The NHS is grossly underfunded and though most people in the UK would like a quicker service, they don't want to pay for it via their taxes.
 
I think it depends also on your consultant in the UK. I am lucky in that my team are very proactive. If I need an urgent scope it is usually within a few days. Less urgent I wait a few weeks. I know others have to wait forever for appts/tests/drugs.



The NHS is grossly underfunded and though most people in the UK would like a quicker service, they don't want to pay for it via their taxes.



I was having that discussion in a facebook group the other day. The proposal was everyone contributes an additional 1% solely for the NHS. I would be more than happy to do that if it meant things improve.

Sadly though (I was guilty of it too) when you're healthy you don't see the problem and aren't seeing how hard it is for people who are chronically ill and need support quicker than they can get it [emoji53]
 
The NHS seems to be in permanent catch up. It's like at some point in the past they got 3 months behind, and even though it's coping with the current demand the backlog is still there.

IMO the free at the point of use ideal gets in the way and is half the problem, and we should be having a good look at our neighbours seemingly much better healthcare systems and adopt some kind of partial payment / compulsory insurance / state top up system.

But this is interesting:

https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/health-care-spending-compared

You see we spend about 9% of GDP on healthcare, whereas France, Germany, Sweden, Switzerland and The Netherlands spend more like 11% and achieve better results. So maybe the answer really is as simple as we need to pay more, and the easiest way to do that would be some kind of compulsory insurance deducted from every pay slip. Every employer is being forced to enroll employees in a pension scheme, so it's hardly a stretch to do the same for healthcare.

But you also see spending in the US is almost double, so surely everybody in the US has great affordable healthcare? Obviously not, and that shows why you need strict regulation. Presumably a large part of that ends up in the pockets of insurance and drug companies and lawyers.
 
Doctors in the UK call it 'free at the point of abuse' because much of the problem is people abusing the system - lack of self care, refusing to buy over the counter or see pharmacist, unwilling to self care for minor illness, not attending appts etc. , misusing ED and GP services etc
But those who do this won't change so those that do need the service suffer. A co-payment etc would help reduce waste and unnecessary overuse.

And Demberton, yes we have the lowest bed numbers and spend per person than most of the developed world.
 
I had multiple horrendous doctors and 1 GI that wasnt fit for purpose. Then i changed area (15miles away) and elected to change hospital and have had a much much better time. Not perfect, but better. Both hospitals are in black alert but atleast i dont get ignored now. I still have problems with not getting hold of anyone for appointments but when i see them, they are quite good. I know way too many people treated badly or ignored. They just cannot cope with how much work needs to be done.
 
I was reading something yesterday about people calling ambulances for strange lumps they've noticed and sprains. A lot of paramedics say people think they will be seen faster if they come in via an ambulance but you are triaged the same as anyone else would be walking into A & E. It's bonkers that people tie up the service like this when GP's are calling 999 when they have patients with serious heart irregularities sitting in their office, and are being told they aren't a priority as they are already with a healthcare professional. GP's aren't qualified or equipped to deal with this, and I've seen some have even driven the patient to hospital themselves!

That said I think (and others agree and have had the same experience) that 111 are just as bad for dispatching ambulances unnecessarily. If you hit one trigger on the computer system they just send it out and won't let you say no and that needs fixing. They sent one out to me for a really nasty facial rash when all I wanted was an out of hours GP appointment because it was a bank holiday weekend!
 
I'm located in Massachusetts, and have great hospitals and doctors. I'm also fortunate in having great insurance coverage. Even so, when I went to the ER a few years ago because I couldn't eat or drink anything and was in severe pain, my insurance company didn't want me to be admitted. I ended up being in for a week--until I could tolerate clear liquids; I had a severe partial obstruction. The on call GI had to go through hoops to get coverage for me. Location and insurance are key to getting good coverage, and that leaves far too many people without the ability to get good care.
 
I'm located in Massachusetts, and have great hospitals and doctors. I'm also fortunate in having great insurance coverage. Even so, when I went to the ER a few years ago because I couldn't eat or drink anything and was in severe pain, my insurance company didn't want me to be admitted. I ended up being in for a week--until I could tolerate clear liquids; I had a severe partial obstruction. The on call GI had to go through hoops to get coverage for me. Location and insurance are key to getting good coverage, and that leaves far too many people without the ability to get good care.



Wow, that's not good! The impression I had from this forum was that the standard in the US was better because you are paying for it! I suppose like all insurances though they will try to get out of paying, but you quite clearly needed treatment!
 
The US has a mixture of health insurance options that range from outstanding to nonexistent. Most people, including me, get their health insurance through a group plan offered by their employers. Often employees can choose between a Preferred Provider Organization (PPO) option and a Health Maintenance Organization (HMO) option.

In a PPO the patient can choose their own doctor and can go straight to a specialist if they so choose. But they are strongly and financially encouraged to choose doctors and hospitals that are “In plan.” Which is to say they have signed a contract with the insurance company to provide services at a discounted price. If you choose a doctor or hospital that is “out of plan” then the percentage of bill the insurance company will cover is sharply reduced. So there is strong financial incentive to stay “in plan.” I live in San Diego and the quality of the medical care available here is quite high. I have a PPO that offers many In-plan choices, and I am generally happy with it.

In an HMO there is less freedom of choice for the patient. You cannot go straight to a specialist but must first work your way through a series of triage nurses, GPs, and other screeners. Same for drugs. The HMO may have rules requiring the doc to first prescribe older, cheaper drugs before moving up to the fancy and costly new ones. HMO insurance is significantly cheaper for the patient than PPO, but you pay for it with more limited choices and greater bureaucratic headaches. For expensive non-emergency procedures (an MRE or CT scan for a Crohn’s patient for example) both HMOs and PPOs will often require a pre-authorization process in which the doc justifies the need for the expense.

For very poor people there is government provided insurance called Medicaid. It’s a sort of government run HMO. The waits to see doctors are often long and choices very limited. This is because the government reimbursement rates to the healthcare providers are so low that most doctors can afford to accept only a very limited number of Medicaid patients. Many accept none at all.

For the millions of people who are employed by small companies that cannot afford to offer group insurance plans there are the options of either buying a private insurance policy or going without any insurance. Traditionally, a private policy was very expensive, so most people who fell into this category simply went without insurance and relied on Emergency Department care for the times when they got really sick. This however is very inefficient since ER medical care is the most expensive medical care there is. This is the gap that the ACA (ObamaCare) sought to fil by providing both the carrot of financial subsidies and the stick of penalties to induce people without insurance to get one of these policies. This has been a success but an uneven one. Twenty million more people have insurance now than had it before ObamaCare, and that’s good. But the program is faltering as some insurance companies have bailed out of the program and others have raised rates, and that’s bad. Plus the law is unpopular because many Americans resent being told by the government that they must purchase something, even when it may be in their interest to have it.

It will be interesting to see what happens under the new administration. Mr. Trump has promised to repeal the ACA law and replace it with something better, but no details are forthcoming on what the replacement will consist of and how it will be funded.

By contrast in the UK the system is much simpler. They have NHS – which is basically one big HMO for the entire country. And it has all the same advantages and drawbacks that most US HMOs have but on a much larger scale, and with a dose of government bureaucracy and political pressure thrown in.

There is no one best answer. Healthcare funding is a kind of a zero-sum game. Any money spent on one function or service is taken away from somewhere else. So it all depends on the priorities and choices any given society makes. The UK system provides decent but not great care for everyone. The US system provides the latest and very best care in the world to those who have the money or good insurance to pay for it and somewhat less for those who don’t - ranging down stepwise to those who have no health insurance at all.
 
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Wow Scipio thank you, that makes everything much clearer. I've asked about how insurance works before and just ended up more confused! [emoji854]

You're right, the whole time I was reading your comment I was thinking that the NHS is basically a national insurance funded HMO. It used to be a lot better I have to say, but our current health secretary has previously written about why it should be privatised, and a large number of MP's have financial interests in private healthcare.

Sadly in the 6 years they've been in power the NHS deficit has suddenly become unsustainable with austerity etc.
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Call me a cynic but I hardly believe that's a coincidence! I love the NHS and there's no way I could afford to pay for my own treatment, and I fear premiums would be very high for me if they were to even agree cover pre-existing conditions with insurance. It's a crying shame what's happening here and my parents actually wanted to pay for me to go private for a second opinion they were so unhappy with my lack of improvement at one point. Thankfully now I've exhausted all the cheaper meds and I'm on the good stuff I'm much better than I was, but still a way to go. This rings very true....
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You guys gotta thank god you're not born an Egyptian with Crohn's.

I had to spend 2 years to be diagnosed; one year on Imuran, although it wasn't showing any kind of improvements in the very first couple of months, but I "had" to continue taking it and then I had to pay myself to get methotrexate which wasn't of help either and now I'm unable to get Remicade or Humira because they are too expensive and such disease is not covered by almost any health insurance.
 
You guys gotta thank god you're not born an Egyptian with Crohn's.



I had to spend 2 years to be diagnosed; one year on Imuran, although it wasn't showing any kind of improvements in the very first couple of months, but I "had" to continue taking it and then I had to pay myself to get methotrexate which wasn't of help either and now I'm unable to get Remicade or Humira because they are too expensive and such disease is not covered by almost any health insurance.



You poor thing. I follow an Egyptian charity based in Cairo on Facebook, which often references the healthcare leaving a lot to be desired. So it's insurance based there too?
 
You poor thing. I follow an Egyptian charity based in Cairo on Facebook, which often references the healthcare leaving a lot to be desired. So it's insurance based there too?

Well, it is insurance based, unless you have something serious. At first I thought what I had was IBS, so I didn't bother spending money to get a private doctor look at it, until it got really horrible and I had to seek a private -somewhat expensive- doctor.

I don't know anyone else with Crohn's here, but all I know that people who take Remicade or Humira either have a very decent insurance level or are super wealthy.

Actually my sister is an anesthesiologist and the stories she tells me about the governmental insured hospitals sound far-fetched, but too bad it's true.
 
Sophabulous…totally agree that there is an underlying devious plan of defund and then the MPs in all the parties who have fingers in private healthcare will coin it in.

There are already many areas under private owners such as Virgin but they just take the lucrative contracts and leave the difficult expensive services to the NHS who get more in debt.

Did you know the Health secretary Jeremy *unt wrote a book on how to privatise the health service!
 
Sophabulous…totally agree that there is an underlying devious plan of defund and then the MPs in all the parties who have fingers in private healthcare will coin it in.



There are already many areas under private owners such as Virgin but they just take the lucrative contracts and leave the difficult expensive services to the NHS who get more in debt.



Did you know the Health secretary Jeremy *unt wrote a book on how to privatise the health service!



lol I did indeed and I think I mentioned it in my above post! If not I meant to but got sidetracked with my rant [emoji12]

He's an odious little man. I was gutted Theresa May didn't give him his marching orders like the rest of Cameron's cabinet!
 
I don't agree; I don't think the NHS has been worse in the last few years than the last 20 years. If anything there's some signs of improvement; for example my GP's surgery now send text message reminders, something they could have been doing for years.

I'm sure the politicians see as much as anyone the flaws in the whole system, but then they're politicians; they mostly care about being elected and appearing to criticise the NHS is political suicide.

I also was thinking about simply paying to go private whilst waiting diagnoses (my parents also offered to pay for me). In the end it turned out my employer's health insurance didn't exclude pre-existing conditions and therefore did pay for my surgery, but it was done by the same surgeon in the same NHS hospital to the same schedule. Only difference was I got a private room, but of course that's only possible because NHS hopsitals are built with private rooms to rent out to private patients. So the lines are very blurred.

They sent me for a blood transfusion the week before, and for that I went to a nice private hospital in Oxford. That was quite an eye opener; for starters the car park was free. Then having got to reception the first thing they asked is how I was paying, which is a very odd experience when you've only ever experienced free healthcare. And finally having shown me to my nice private room they brought round the lunch menu. I had no idea and had already scoffed a sandwich in the car, but I did have a very nice lasagne in the evening. Needless to say the food in the NHS hospital (even in my private room) was pretty horrible.

But the insurance doesn't cover chronic conditions, so all my follow up care has been back with the NHS.

Yesterday I happened to notice the appointment card I'd been given for my next NHS consultant appointment says on it "if you have health insurance and would like to pay, please ask on arrival". Which is very odd: make the appointment via the NHS but you can pay if you want.
 
I dread to think what the costs would be for diagnosis, your insurance must be worth its weight in gold! There's talk of us getting it through our jobs soon but I doubt it will cover pre-existing conditions.

The problem would be as everywhere, those who can't afford the insurance, or the costs of treatment either. We would need our own version of Obamacare/Medicaid which would all take time to implement. I would personally rather pay a little more NI and keep it all free at the point of use, on the understanding that the NHS will be given the funding to provide better care. At the moment they are stretched beyond belief and couldn't even provide a single paediatric emergency bed the other week.

We're getting close to the brink and either people will come up in support of the NHS or it will be gone [emoji53]
 
I don't have health insurance any more. I have had it a couple of times with different jobs, but they always excluded pre-existing conditions which makes it a bit of a waste of time for anyone with a chronic condition. I assumed I wasn't covered in this case too, but it was only when I told my boss I might be needing 6 weeks off that she told me this.

I can tell you the BIK (that's what it's valued as for tax purposes) was £1400 per year; I don't know if that's what it really cost but it must be in that ballpark. One of my colleagues had cancer a few years back (he's fine), so I imagine he made quite a big claim on the insurance.

The other thing I'd say is that I still ended up paying for some of it. The surgeon wasn't on their approved list and charged £80 more than they'd pay, so I thought fair enough I'll pay £80. But he discovered a fistula and fixed it whilst he was there (as you'd expect), and as the insurance hadn't approved that part of the operation they wouldn't pay. And that was another £300. Apparently they're meant to wake you up in the middle of surgery so you can call your insurer.:lol2:

I think there's a tendency for people to think it's either the NHS or the US style system, but lots of other countries make compulsory insurance mixed with state funding work one way or another. It would be a lot more honest if there was a specific deduction from payslips for the NHS; NI is not for the NHS it goes on wars, and Brexit, and nuclear power stations and everything else the government does.
 
The NHS may have improved as far as technology and treatments available goes, but this means a lot of rationing is now happening. In some places (even in non rural areas where it can be much further) people have to travel 50 + miles to see a GP as so many practices have closed due to funding issues.

Also in some areas male (vasectomy) and female sterilisation is not funded on the NHS unless exceptional circumstances, no varicose vein surgery unless complications, no food on prescription for coeliacs except bread, no antihistamines on prescription for hay fever and many more.

Some of these things I agree with, but many are very short sighted.

ED waits are increasing, there are huge rota gaps in junior doctor rotas, worse since the junior doctors contract was imposed as so many have let medicine or gone abroad.

GP practice in northern ireland is mostly going private in 2017 unless the powers to be do something drastic as it is impossible to run a service. The majority of GP's there have written resignation letters. Rural practices in scotland and becoming are as hens teeth.

I could go on. People are unaware as the government spins it or puts reporting restrictions on it. But there is a crisis. I think it may well end up with some sort of co-pay type service.
 
Also in some areas male (vasectomy) and female sterilisation is not funded on the NHS unless exceptional circumstances, no varicose vein surgery unless complications, no food on prescription for coeliacs except bread, no antihistamines on prescription for hay fever and many more.

I always wondered about vasectomies. Not that I want one.

My step-mother had big problems with varicose veins that the NHS wouldn't do anything about. But now they live in France so it was dealt with quickly, with apparently some disgust for British healthcare. And because they're retired it was still paid for by the NHS. It did occur to me when I was ill and waiting diagnoses that I could move to my Dad's house in France, wave my EHIC card around and probably get much better treatment without having to pay.

Today I paid my £8.40 for 56 Azathioprine tablets, which according to the NICE website costs the NHS £3.13. I think people are deluding themselves if they think we don't already have co-pay, and did I mention the car parks?
 
The NHS isn't perfect by any means but I'm glad I live in the U.K. where it takes care of my medical needs.
We had private medical cover for many years, till my husband retired. I can honestly say the only problems I've had since throwing myself at the mercy of the NHS have been very, very minor.
No system is perfect but give me the NHS anytime.
 
In the US chronically ill and disabled can qualify for Medicaid and social security which is govt run .
But who decides what conditions are on that list and what the govt Medicaid (medical insurance) is willing to pay limits which doctors and hospitals will accept it
So that isn't the answer either
 
I am not surprised at all that the Red Cross have had to step in these last few days. It's absolutely appalling that in the 5th largest economy people are lying on trolleys to die in corridors for 30 plus hours after strokes and heart attacks.

The system needs a complete overhaul and if the tories do back down and give an emergency cash injection it will cost SO much more than just funding social care etc adequately in the first place would have done. This austerity is absolutely crazy.

Same story with David Cameron and the flooding, after he cut all the budgets for flood defences then had to give millions for repairs instead! It's like they're on another planet.
 

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