Health care differences across the globe

[Barfalamule]

---

Members do not see this ad.

I was just reading the following article:
http://news.yahoo.com/s/ap/20090204/ap_on_re_as/as_japan_medical_care_denied

And it reminded me of the 60 minutes piece that contrasted health care in Japan, Germany, UK, Taiwan & the US.
Correct me if I'm wrong but the United States does not have the option of rejecting admission of an emergency patient.
I was hoping to see what others have heard about the major downsides to the health care in other countries of comparable quality of life to the US. Also, in Germany, Japan & Taiwan, is the competition tough for getting into medical school? From that 60 minutes piece, it looked like the doctors were paid very low salaries and treated disrespectfully by the government. Do you think respect and salary have a strong correlation?

 

[ChandutheMagici]

I was just reading the following article:
http://news.yahoo.com/s/ap/20090204/ap_on_re_as/as_japan_medical_care_denied

Man, that's just sad.

Correct me if I'm wrong but the United States does not have the option of rejecting admission of an emergency patient.

Many E.R.'s are funded with public dollars. I have yet to hear of one turning a patient away. Even the woman who died in Kings County wasn't turned away. Then again, she wasn't given the best care either.

I was hoping to see what others have heard about the major downsides to the health care in other countries of comparable quality of life to the US.

From my understanding it's the wait that'll kill you in other countries. I've often heard of people waiting months and months for MRI's, CTs, etc. All the while their disease is progressing and they don't even know they have it. 👎

To give you an example, last year I was on vacation in the Caribbean with my wife and we happened to do a tour around an island with a Canadian Nurse. So her and I got to talking about "Free" healthcare and what she thought of it. Well as it would turn out she needed an MRI for something and she said she got it really fast (being that she worked in the hospital and was in the know). I said, "Well that's good, how fast?"

Her reply: "A month." 😱 If that's fast and this person WORKS in the hospital....I'll take the failings of the U.S. healthcare system anyday.

The impression that I get is that if you're a relatively healthy person, Universal Healthcare isn't that bad (although you're going to pay a lot). However, if you're a person with numerous complicated medical issues..you'd rather be in the States.

it looked like the doctors were paid very low salaries and treated disrespectfully by the government.

Ah, the joy of being a government employee. Yeah, I don't really like the implications of having only one consumer to the services that I provide.

Do you think respect and salary have a strong correlation?

Only to people who put an emphasis on money. Then you have to ask yourself, "Do I really want that person's respect anyway?"

 

[Barfalamule]

I wonder if lawsuits can resort from the waiting problems in Canada and in Europe. For instance, can a woman sue if a lump was detected but it took a month before the screening could be done to confirm cancer, by then the cancer has metastasized and a minor problem becomes major. Does she have a financial recourse?

I just learned this week that in China you have no say as to what kind of doctor you're going to be and where you do your residency. You are assigned by the government out of medical school.

As to the money and respect correlation, I should have been more precise Chandu. I meant it in more of a macro sense. In the US, doctors make more money and have more power in terms of purchasing power and lobbying when compared to countries like Germany and Japan and every other country for that matter. Because the government has cut the monetary value of a doctor in the said countries and can in effect push them around more, do they lose respect in the eyes of their fellow citizens? A negative cycle that oppresses the doctor and starts with the $.

 

[dragonfly99]

I wonder if lawsuits can resort from the waiting problems in Canada and in Europe. For instance, can a woman sue if a lump was detected but it took a month before the screening could be done to confirm cancer, by then the cancer has metastasized and a minor problem becomes major. Does she have a financial recourse?

I just learned this week that in China you have no say as to what kind of doctor you're going to be and where you do your residency. You are assigned by the government out of medical school.

As to the money and respect correlation, I should have been more precise Chandu. I meant it in more of a macro sense. In the US, doctors make more money and have more power in terms of purchasing power and lobbying when compared to countries like Germany and Japan and every other country for that matter. Because the government has cut the monetary value of a doctor in the said countries and can in effect push them around more, do they lose respect in the eyes of their fellow citizens? A negative cycle that oppresses the doctor and starts with the $.

You can't really sue the gov't in socialized medicine countries. This is like US military health care...you can't really sue if something goes wrong.

I don't think it's really correct that US doctors make more money than docs in all other countries...we do do better as attendings than in most other countries, but primary care docs in some other countries may do better (especially than US pediatricians and some fps). UK general practitioners make about $150k US equivalent I think, plus a productivity bonus...that's better than some US primary care docs. I know that residents in Australia also get paid overtime, which definitely does not happen here. I think that being a physician is a less desired occupation in some countries (like China) because of the lack of respect and $. Apparently engineering is what many top student pursue in China.

 

[Barfalamule]

Direct from the PRHO website, here are some numbers on salaries in the UK. Interesting stuff, but I should clarify that although the average US attending makes more, this does not reflect cost of education, intern and residency costs and $ spent on doctors against the total $ spent on health care.

Pre-Registration House Officer (PRHO) in hospital (1 year).
Starting Salary: £19,703
Total earnings include a banding supplement to reflect out of hours work and intensity; a new doctor in a typical high intensity post would receive a minimum of £35,465 and be offered free hospital accommodation in their first year.
Senior House Officer (SHO) working directly with patients in hospital as part of a team led by a Consultant Doctor (2-4 years*).
Basic Salary Range: £24,587 - £34,477
Total earnings include a banding supplement to reflect out of hours work and intensity; after three years in this grade a doctor in a typical high intensity post would be earning £50,191.
Specialist Registrar (SpR) working in a chosen area of special knowledge and expertise which could include a period of medical research (4-6 years, or longer*).
Basic Salary Range: £27,483 - £41,733
Total earnings include a banding supplement to reflect out of hours work and intensity; after three years in this grade a doctor in a typical high intensity post would be earning £60,007.
Qualified Professionals
Career Grade Doctor working directly with patients in hospital as part of a team led by a Consultant Doctor.
Basic Salary Range: 29,845 - 72,882
Consultant , leader of a medical team and responsible for the treatment of patients seen by that team.
Basic salary: £67,133 - £90,838
Consultants may also receive out-of-hours supplements and also Clinical Excellence Awards that are worth up to £69,000 on top of their basic salary.

To dragonfly99's post:
If you can't sue in these systems, wouldn't law firms have a vested interest in keeping a single-payer system or socialized medicine out because it could substantially reduce the flow of cash? Do you think it is possible to change the US health care system and keep the laws of malpractice intact?

I point to Germany again where I found this interesting paper:
http://civil.udg.es/EUROCENTRE/Projects/Med-malpractice/malpractice.htm

German salaries were cut way way back, but now it seems that malpractice law is coming into play to drive prices up.

 

[ChandutheMagici]

As to the money and respect correlation, I should have been more precise Chandu. I meant it in more of a macro sense. In the US, doctors make more money and have more power in terms of purchasing power and lobbying when compared to countries like Germany and Japan and every other country for that matter.

I see what you're getting at here. But man, that's a really hard question to answer. I fear I would sound like a gigantic ******* if I even tried. So yeah, I'm useless on this topic 😀

 

[NonTradMed]

I just learned this week that in China you have no say as to what kind of doctor you're going to be and where you do your residency. You are assigned by the government out of medical school.

I think you misheard. I have two cousins in China who went through med school recently and neither were assigned to be a certain type of doctor by the government. The government doesn't tell you what kind of doctor you want to be, it all depends on your test scores and where which med school you apply to. It's kind of like the match in the US, only it starts before med school, not after.

Med school is an undergraduate degree program, but it also has a masters and PhD level. My cousin was internal medicine at the undergrad level but got into a dermatology masters medical program so after her two years, she will be a dermatologist. This was all based on her own application and academic record. There was no government directive.

There is also NO official residency in China. Whoever told you that was incorrect. You get a year of clinical rotations after basic clinicals and then you graduate and look for a job (or go onto masters/doctorate in medicine).

Hospitals who hire newbies show you the ropes in an unofficial apprenticeship until they feel you can work by yourself. Government involvement in dictating medical fields stopped years ago, so your information may be out of date.

I think that being a physician is a less desired occupation in some countries (like China) because of the lack of respect and $. Apparently engineering is what many top student pursue in China.

I think that information is a bit out of date. Engineering used to be the top student choice in the 70's, 80's when my parents were in school. But biology and business were the top majors by the time my parents' friends children went to college in the late 90's. Biology because you can more easily get a visa to study in graduate school in America, and business because foreign companies paid the most in China and they were hiring people with business skills.

I know that mechanical and electrical engineering had fallen out favor recently because government factories were shutting down and demand for engineers fell accordingly. Also, the appeal of working in factories diminished with the new generation of kids born during China's economic boom.

Computer science/engineering, biology and business majors are all very popular in China. Medicine is about as popular right now as nursing or physician assistant. It's considered a "girl's" field and it's relatively low reimbursement means guys tend to avoid the field. However, given recent economic upheavals, health care is not as unpopular as it once was.

Remember that while US doctors are paid more, we also have higher liability and take more of the risks. We pay for our own malpractice and can be sued more easily, and we pay for our own education, incurring higher debts.

Many countries where doctors are paid lower do not have these burdens and lead less stressful lives. I don't think doctors are looked up or down more because of this. People have high respect for the field as long as doctors continue to care for patients.

 

[Ded2Med010101]

Man, that's just sad.



Many E.R.'s are funded with public dollars. I have yet to hear of one turning a patient away. Even the woman who died in Kings County wasn't turned away. Then again, she wasn't given the best care either.



From my understanding it's the wait that'll kill you in other countries. I've often heard of people waiting months and months for MRI's, CTs, etc. All the while their disease is progressing and they don't even know they have it. 👎

To give you an example, last year I was on vacation in the Caribbean with my wife and we happened to do a tour around an island with a Canadian Nurse. So her and I got to talking about "Free" healthcare and what she thought of it. Well as it would turn out she needed an MRI for something and she said she got it really fast (being that she worked in the hospital and was in the know). I said, "Well that's good, how fast?"

Her reply: "A month." 😱 If that's fast and this person WORKS in the hospital....I'll take the failings of the U.S. healthcare system anyday.

The impression that I get is that if you're a relatively healthy person, Universal Healthcare isn't that bad (although you're going to pay a lot). However, if you're a person with numerous complicated medical issues..you'd rather be in the States.



Ah, the joy of being a government employee. Yeah, I don't really like the implications of having only one consumer to the services that I provide.



Only to people who put an emphasis on money. Then you have to ask yourself, "Do I really want that person's respect anyway?"

Interesting. I actually disagree here. If you have a "complicated medical issue" you do NOT want to be in the US.

Those people typically do not qualify for insurance, and if they do, they will at one point not be able to afford the rising premiums and co-pays for the care that DOES get "approved". Or they will be denied coverage entirely from that point on. Managed care by Big Insurance is never good when you're staring death in the face. I can't imagine being forced to drive an extra 20 miles to a specific hospital because your insurance is only accepted there. I can walk into any Canadian hospital and get "free" (well, tax funded) care by just showing my health card.

Unfortunately, Americans have been brainwashed about national healthcare. If used properly, it works. In theory, it's great and sustainable for preventative medicine, trauma care, and for those unfortunate patients with non-preventable chronic and acute disease. But society must do their part as well. Sure we (Canadians) complain, but that's because we're spoiled idiots who live like kings. If I'm in a car accident in Toronto for example, I will be rushed to a world class research hospital, and will get immediate care and walk/limp out without a $420,000 bill.

The same people who complain about wait times go to the local ER for an cold. The same people who complain about doctor shortages refuse to see the certain doctors that ARE accepting patients. The same people who complain that they need more expensive testing for their "poor health" are the same people who refuse to follow their doctor's advice and are overweight, smoking, and eating MacDs like there is no tomorrow. Preventable chronic diseases are a HUGE drain on healthcare resources. The same person who complains about getting rehab "only" 3x per week is the same person who didn't want to wear a helmet while riding their bike. While all patients deserve equal care, the point is that society and people in general must take responsibility for their own health and well-being (and use common sense) first and foremost.

As for the Canadian nurse, it sounds like her MRI was not considered "urgent". Perhaps it was more of an extra precaution elective test. Anyone with any urgent or malignant health issue DOES get the required testing ASAP.

My 2 cents.

 

[niranjan162]

Remember that while US doctors are paid more, we also have higher liability and take more of the risks. We pay for our own malpractice and can be sued more easily, and we pay for our own education, incurring higher debts.

Many countries where doctors are paid lower do not have these burdens and lead less stressful lives. I don't think doctors are looked up or down more because of this. People have high respect for the field as long as doctors continue to care for patients.

These are the differences and they are huge. Also I think life is less of a rat race in the other industrialized countries, the US is all about makin money, other places are about living life. Although this is changing and now you have a generation who thinks they are entitled to everything and want to make tons of dough, not a good combo for the future.

I think in the US money is related to respect. Mostly because of the lifestyle that people associate with money. Look at rappers for instance. Theyre all about flashing their money around. Its a qualifier for respect because it gives you access to things that not many people have. If everyone had a ferrari, they wouldnt be as special.