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Medical Systems Abroad

Posted by on December 5, 2012

 

Hospitals around the world

royal-london-hospital Hospital Costa Rica

In the United States there seems to be a perpetuated myth that other countries have free health care. Somewhere, some people have it better than us. We want something for nothing too. If they can have it, then why can’t we? The problem with this myth is that it is just that, a myth. Somebody has to pay the medical providers. Doctors and nurses do not work for free. Better doctors want more money. The nerve! Living in other countries, we got to experience “free” medical first hand. So, we have our opinions about the health care of those countries compared to ours in the United States.

Day one in England, we needed to go to a hospital emergency room. The recruitment firm that secured me a job teaching in England put us up for three nights in a quaint bed and breakfast in the village that would become our new home for a while. The place was absolutely marvelous and we were very impressed with our new surroundings. The one small problem was that the doorways in the old house were approximately a foot shorter than what we were used to in America. Apparently the Brits of yore were a little shorter than today. I turned to go through a door way only to ram my thick American head into an even thicker old British timber door frame. I hit it hard! Britain 1, American 0.

My wife, who heard the collision and my verbal reaction (I think I accidently insulted several generations of British carpenters), came running. “Are you OK?” she asked. “No!” I snapped, as I Iaid on the ground with little British buses driving circles around my head and Big Ben ringing in my ears. The problem, other than me having a concussion, was that my wife could not drive our new British automobile nor navigate to the nearest hospital. So, while she was trying to figure out this dilemma, our hostess called a friend who offered to take the poor (stupid) American to the local hospital.

Actually, I wanted to test the British National Health System (NHS) at least that is my excuse today. The NHS has a policy where you must be seen by a medical person within 20 minutes of checking in. Wonderful! So, someone comes, looks at you to verify that you are really there, and then disappears for two hours. But, they did validate my existence within the 20 minutes. Luckily, I survived to fight British craftsmanship (my Land Rover) another day and write about it in this post.

The system is stretched too thin. After arriving in England, you are obligated to visit your local health care provider center for an initial consultation. The facility and doctor are selected for you. You must get some base line data entered into the NHS computer system. Without that, no medical people will touch you, except in the case of door frame hit and run type accidents. Ironically, most doctors are not even from England. You will most likely be seen by a medical professional from India, the Middle East, or Asia. Since NHS sets the doctor’s pay scale, many of the best British trained doctors leave for more financially lucrative areas (i.e. The U.S.). The U.S., however, does not recognize the British medical license. British trained doctors need to be re-certified by the AMA.

Our oldest son, Aaron, decided to also test the British NHS just to get a second opinion. He broke his arm falling off my pull-up bar. We experienced the same level of service. The NHS uses a controversial system called quality-adjusted life years (QALY) as a means to quantify medical intervention priority. Basically, the closer you are to dying, the more likely you are to being treated. QUALY applies to the ER, specialists, regular appointments, medications, and every other medical practice. Therefore, preventive medicine is practically unheard of in England. If you are persistent, like my wife, a woman can get a mammogram every other year after age 45. Consequently, England leads Europe in breast cancer deaths. Many Brits go to other European countries for health needs or about 1/3 pay for expensive private care.

The system is not free. Although there is no specific tax for the NHS, tax there is and plenty of it. I paid on a salary of 31,000 pounds (about 50,000 U.S. dollars then) a 32% tax rate. Anyone lucky enough to earn 150,000 pounds or more pays 50% in taxes. This does not include value added tax (VAT) on goods and services, council tax on your domicile (rented or owned), and other tax sources. So, we like to call the NHS “free” health care “pre-paid” health care.

The German system was better. Our oldest son, Aaron, was the guinea pig this time. Shortly after arriving in Frankfurt, he developed appendicitis. I receive a frantic call from my wife while at school telling me that Aaron was on the living room floor double-overed in pain crying. A very nice Scottish lady took me home, where I found my wife distraught, my son as previously described, and three emergency medical people standing over our son talking in German. Luckily, my taxi driver spoke German. I was very impressed that the Germans send an actual doctor out on the ambulance. She decided that he needed to go to the nearest hospital.  Seeing you first born taken away in a foreign country by strangers speaking a different language is an extremely unnerving experience. I recommend avoiding it if possible.

The German hospital was very well equipped and staffed. Even though the staff did not speak English, they did everything they could to make us feel comfortable and explain about the condition of our son. Overall, we were impressed. Aaron was indifferent to the whole experience. He was so medicated that we are not sure if he even remembers it. Like England, the tax rate is high, 24% for our income range. The quality, however, was far superior. We were amazed that even small town clinics had the latest high-tech x-ray and ultrasound equipment.

Costa Rica, on the other hand, was a very different experience. First, the U.S. State Department highly recommends that American avoid using the public medical facilities expect in “life or death decision emergencies.” Ouch! We drove by the main hospital in San Jose and concur. Fortunately, we had private medical insurance through my school so we were privileged to use one of the three private hospitals that cater to ex-patriots. And talk about privileged! The private hospital in Escazu is of the same quality and modernization as any in the United States. We got to test this one too.

My wife, Mish, started to have breathing problems. She suffers from scleroderma, which affected her lungs. The hospital ER did a full pulmonary exam and EKG for only $1,500.00! No wonder why many Americans take “medical vacations” to Costa Rica.

Aaron, Elijah, and I went to the same private hospital for a case of cholera. I will spare you the details, but let me say, it was no vacation. Abbot and Constello were my ambulance drivers. Aside from not speaking English, they didn’t seem to know any medical either. As I had excrement violently erupting from both orifices of my body, they had me walk to their vehicle. Luckily, the doctors were used to seeing numerous cases of intestinal parasites, so they knew exactly what treatment was needed (thank God). The hospital visit was less than 12 hours, but the recovery at home took days.

All in all, we prefer the American medical system. However, we fully acknowledge that we are the minority in the U.S. with adequate care. Our careers have afforded our family the best medical insurance and so the best medical care. Tragically, most Americans do not have our level of coverage. That is the problem. I do not have an answer. I like our medical care, but do not like that it is exclusive.

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