
An American doctor experiences an NHS emergency room - VBprogrammer
http://drjengunter.wordpress.com/2014/08/12/an-american-doctor-experiences-an-nhs-emergency-room/
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patio11
I actually have directly relevant experience to the question of "What happens
if you get something in your eye in the US and need to see a doctor urgently?"
Don't read the following if you're squeamish.

About a year and a half ago, I dropped my iPad while on a flight from Japan to
the US. The screen cracked in the top corner. I tentatively touched the
screen, to see if the crack was dangerous. I did not cut my finger, but did
succeed in transferring a very small piece of glass to my finger.

People touch their eyes frequently, often unconsciously.

Six hours later, after attempting self-irrigation on the plane and at the
airport, I was at a hospital in Chicago seeing an eye doctor. Time from
arrival at proper floor to being taken to room: three minutes ("glass in eye"
cuts down on paperwork quite a bit). Time to arrival of doctor: approximately
four minutes after that.

They successfully treated me for, possible misquote, "non-traumatic
introduction of a foreign body to the eye." (The attending physician's first
words, after reading the chart, were "How in God's name does an iPad screen
end up in your eye?")

Treatment was approximately 15 minutes of a resident's time and 5 minutes of
the attending physician's time plus one cotton swap and some iodine.

Total cost: approximately $300, plus twenty minutes of dealing with the
billing clerk (after approximately 30 minutes of waiting for the billing clerk
to be ready).

Most of the time with the billing clerk was a result of the clerk getting the
run-around from a Japanese commercial travel insurance company. I customarily
travel with private insurance which, among other things, covers me for medical
emergencies while traveling. (Normally I'm covered by Japanese national
insurance, which doesn't normally cover treatment of Americans in America for
all the obvious reasons.) The insurance company denied reimbursement for
elective medical treatment. Direct quote: You could have elected to leave it
in your eye.

~~~
jff
$300 ain't bad to save the sight in your eye.

~~~
throwaway283719
It is, however, more than $0 (and presumably somewhat galling when you are
already paying for health insurance.)

~~~
sp332
Is it more than nothing, where nothing == taxes? I'm guessing that the amount
of your annual taxes that goes toward health care is > ($300 * chance of you
incurring $300 in health care costs).

~~~
throwaway283719
Why guess, when you could get some data?

In the UK, the per-capita spend on healthcare is $3480, of which $2919 is paid
by the government (and so raised via taxes) and $561 is private (via health
insurance or direct payment).

In the US, the per-capita spend is $8362, of which $4437 is paid by the
government (via taxes) and $3925 is private (via health insurance).

This is only a cursory glance, but it does look a bit like nationalized
healthcare results in lower private spending _and_ lower government spending
(the extra spend in the US presumably goes into the pockets of doctors,
pharmaceutical companies and insurance companies).

Data sourced from the World Health Organization, via The Guardian[0]

[0]
[http://www.theguardian.com/news/datablog/2012/jun/30/healthc...](http://www.theguardian.com/news/datablog/2012/jun/30/healthcare-
spending-world-country)

~~~
sp332
I wasn't really defending the US system in general, but I don't think
nationalizing healthcare in the USA will lower taxes. The inefficiencies
aren't inherent in privatized health care, they are a result of a corrupt
system. The corruption isn't going to change if we give the government more
control over the system.

~~~
dragonwriter
> The inefficiencies aren't inherent in privatized health care

No, but lots of them _are_ inherent in having a nest of overlapping private
and public health insurers (regular, workers compensation, and others) each of
whom spend considerable resources making sure that they don't pay for
something a _different_ insurer (public or private) could instead be compelled
to pay for.

> they are a result of a corrupt system.

Believing that the excess costs in the US system are a result of "corruption"
rather than the structural inefficiencies of the architecture of the system
requires believing that Americans are unusually, among citizens of developed
countries, corrupt. This is not utterly implausible, but it is a claim that
requires some support.

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PeterWhittaker
As a Canadian, this doesn't surprise too much: People complain about wait
times all the time, but the only wait times I've ever seen are for relatively
stable situations that do not put the person at increased risk, e.g.,
corrective surgeries for non-threatening conditions, etc. (We can - and should
- debate whether surgeries to correct intense chronic pain should be delayed
as much as they often are, but current medico-political thinking appears to be
that pain ain't so bad, contrary to current psychological thinking).

I've had a couple of exposures to emergency rooms and clinics over the last
few years. The most telling was when I sliced open the back of my hand with an
industrial fan. We cleaned and bandaged it, then applied ice, and I sat until
the pain subsided and felt good enough to go the nearest clinic.

By the time I arrived, the pain and nausea had returned, but no biggie. I
presented my healthcard and described the situation, which caused the three
people behind the counter to pause and eye me as one asked "But you didn't
break the skin, right?"

I did not get a chance to complete my reply, which started with "Yes, of
course...". "Drop your card, come with me now".

The waiting room was more than half full, but I was priority number 1 for the
next 15 minutes. A nurse carefully, delicately removed the dressing, then used
a thin metal instrument to ever so carefully widen the cut and examine the
tissue underneath. When satisfied, she sent me back to the waiting room where
I sat for an hour and half.

I learned the full story when I returned for an x-ray the next day (I hurt
myself on a Sunday, the basement x-ray lab was closed): Had I severed - or
even cut - any of the tendons leading to my fingers, I would have rushed to
the hospital to save my hand before the tendons shrank and dried into
uselessness.

I didn't mind the 1.5 hour wait on the Sunday, or the combined 1.5 hours on
the Monday, because when it came to what really mattered, there was no wait at
all.

They only took my healthcard once the initial careful inspection was over.
Billing and bean counting were irrelevant.

Note: I expect that billing for treatment of visiting foreign nationals will
vary widely by province (anyone in the know care to chime in?), but that the
overall triage process will be similar.

~~~
sp332
The strangest thing to me when I (an American) visited a Canadian hospital was
that my "room" was just a curtain around a bed in the hallway. All the usual
hospital room connections came out of holes in the wall, just like in a room,
but it was in the hall. The curtain was just big enough to fit around the bed,
so the doctor had to lean on my bed every time she entered.

~~~
cms07
This is the way most regional hospitals in the US are.

~~~
sp332
My mother was an RN in the US, she said she'd never heard of anything like it.

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Nux
Well, he got into one of the better hospitals by the looks of it, I am sure
there are many. I'm surprised he was not billed, from what I read on wall
posters in hospitals non-residents (or non-EU?) are charged for medical
services.

Unfortunately had my share of landings in E&A and I was less than impressed.
Generally bad/old looking buildings and rooms, not the most skilled staff -
some of them were struggling to speak English, long waiting times (my record
is 5h).

On the other hand many of the people working in the NHS are literally life
saving heroes, so they deserve our respect. Any country on this planet that
does not have a similar system can't call itself civilised. Luckily most of
Europe has this in some form or another.

This is not to say that things can't be improved.

NHS could probably run 2 times better on half the money it currently spends; I
think efficiency is FAR from being their strong point. At this size it takes a
special kind of management to do stuff without huge waste - perhaps Toyota can
lend a hand here.[1] :-)

[1] - [http://www.businessweek.com/articles/2013-09-26/work-
efficie...](http://www.businessweek.com/articles/2013-09-26/work-efficiency-
lessons-from-toyotas-productivity-guru) etc

~~~
_benedict
The NHS is regularly found to be one of the most efficient health services in
the world (not to say it is anything like perfectly efficient, but it is about
as efficient as humanity has managed in the healthcare arena to date). The
idea it could be run at 4x efficiency is absurdly hyperbolic.

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baddox
> It makes you wonder exactly what frightens Americans about the NHS?

I'm less frightened of the NHS than of a hypothetical American version of the
NHS, which would be run by the US government and have (mostly) Americans using
it.

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omh
I've seen posters up in the local A&E that say something like "If you're a
foreigner please be aware that we'll send you an invoice". And there's
certainly been statements recently from politicians talking about doing this
for the dreaded "immigrants".

I suspect that the total income from this would be tiny though, and perhaps
not even enough to justify the administration costs. And my impression from
staff at NHS hospitals is that they're just interested in helping you and
really don't care if you didn't pay.

~~~
mortov
While management like to put these posters up, a friend who is a consultant in
the NHS was quite clear when I asked him about it - he's a doctor, not a
billing clerk and he doesn't care how obvious it is that someone is outside
NHS cover, it's not his issue.

He's involved in things like kidney transplants where abuse is apparently rife
- patients [outside NHS eligibility] often come from Xstan countries in renal
failure and are critically ill (i.e. ambulance from the airport tarmac). Some
of these people go to the top of the transplant list - which is why they got
on the plane to England to begin with (plane ticket < cost of unlikely kidney
transplant in home country). As far as he is concerned he treats the medical
condition based on _need_ and anything else is up to management and he will
not get involved in anything outside medical need.

Sounds like the registrar in the article has the same policy.

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junto
The NHS quality is dependent on where you are in the UK. For example my 92
year old grandmother cannot make an appointment in advance to see her GP
(general practioner). Instead she has to call the practice from 8:30am to get
put on a list for that day. If she is lucky enough to get through on the phone
she then has to be lucky enough to have been one of the first patients to get
through (it is normally engaged due to high demand). Once she is on the list
she has to go down to the practice and wait. That wait could be up to 3 hours.
She is blind and deaf.

I live in Germany on the other hand and I am privately insured. I can get to
see a doctor easily. However my health insurance has a strange caveat in that
I must see and be referred by my GP if I have to see a specialist doctor. My
health insurance recently refused to pay for a visit that I made to the ER for
a broken arm which was caused whilst playing football at 8pm (long after my GP
had hone home). I was expected to wait until the next day in agony to complete
their beaucratic hoop jumping.

That being said I like the UK system because it is free (excluding taxes),
whilst in general the German quality of service is exemplary (although non
private patients have a much poorer QoS). If I was seriously I'll with cancer
or something that requires a expidited process between diagnosis and operation
then I'd chose Germany every time.

~~~
Nexxxeh
Where I am, if you want a doctors appointment it's either a normal appointment
or an "emergency". If it's not urgent, you ring up whenever and make an
appointment, but it'll be a few days at least. I once waited a fortnight for
something non-urgent.

But if it couldn't wait that long, you rang at surgery opening (8:00 iirc) and
they give you a time for you to turn up. You turn up and then you wait to be
seen. They fit you in as quickly as possible, average wait for me is usually
about 45 minutes I guess?

Is it emergency appointments your nan is trying to get?

There's definitely an element of what we call "Postcode lottery", the quality
and provisioning of medical care can vary based on where you live. But
generally, while we British bitch and moan about it, it's brilliant.

Edit: which -> while we British

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pcrh
The reason they didn't bill is that it would cost far more to set up a billing
system than the revenue it would generate.

~~~
Nexxxeh
I guess that would depend on if we billed them at Yank rates ($1000 = ~£600)
and if they paid it. I'd imagine it'd be like trying to get the American
Embassy to pay the Congestion Charge (£8,775,965 owed and counting).

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nextw33k
Biggest problem I see with the NHS is their major issue of dealing with
randomness. Wait times are totally dependent on who and how many people walk
through the door at any given moment. However managers have to post staff
rosters 6 weeks in advance. The cost of calling in staff for extra cover is
likely to double.

As a manager what do you do?

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gambiting
Most doctors in the UK would be offended if you asked them how much do you
have to pay while you are in a hospital. Some even would take it as you
offering them some kind of a bribe.

