I sit here writing this in my post-surgical medicated fog, but I wanted to try to write while the experience is still fresh in my mind.
We have been living in the UK for less than six months, but during this time, I have been unfortunate enough to experience both sides of the UK Healthcare system.
In August/September, I experienced what I thought was a scratch on my cornea after removing contact lenses. This had happened several times in the past year and usually resolved itself. But, since I was in the process of registering for the NHS, I mentioned this to the doctor and was told to get an eye exam because I may have an ulcer. So, I headed to the local Vision Express (like Visionworks or Pearle Vision in the US). The optician found not one but 9 corneal ulcers at various stages (some scars others active) spread over both eyes.
I was sent to the eye hospital at John Radcliffe Hospital in Oxford early on a Sunday morning for an emergency eye clinic. The hospital was pretty modern, unlike other hospitals I had visited in other countries. I filled out a one page form with my name, address, birthdate and was asked to sit down. I did not have my NHS card yet, but they did not seem to care. I was seen within 10 minutes as I was the only one there on a Sunday. I went home on antibiotic drops and ointment and was basically told that my contact lens days were over.
I had to go to eye clinics every week for a month to make sure the ulcers healed. Every week I received a text message from the NHS with a reminder about my appointment as well as a letter reminder. Every time I went, I took my appointment letter and put it in an acrylic file slot and waited for my letter to be pulled. The eye clinics were packed, but I waited a max of about 30 minutes, usually less. I think I spent more time trying to find parking than waiting to be seen. The care itself was good. Each exam was thorough. After 4 weeks, I was discharged from the clinic. I never received anything else from the NHS regarding my visits. I did not pay a penny for any visit.
In October, I was referred to an orthopedic surgeon at the the private Nuffield Manor Hospital in Oxford. This is where I began to see the differences between the two systems within the NHS. The way things work here is that if your general practitioner (GP) (a PCP in the US) refers you to a private hospital, NHS will cover your treatment 100%. However, I was being referred by my private doctor through my employer so I did not receive NHS coverage for the consult or the subsequent surgery. If I had to go through the GP, I would have had to get on a waiting list for surgery. I was told to expect to wait up to a year or more to get the surgery scheduled. Going private expedited the process.
How do I know this? Because the NHS has this down to a science. The NHS website told me that if I went to my GP, it would take 24 weeks just to be seen by an orthopedic surgeon at John Radcliffe Hospital. The same process GP to Nuffield Manor Hospital would have been 17 weeks for an appointment. By going private, I got an appointment in 3 weeks and got to pick when I wanted to have surgery.
The only annoying part of the process was communicating with the surgeon's office. In the US, you can generally get a hold of a secretary. Not here. I tried to get in touch with the office by phone and there was no voicemail to leave a message. I was told that I was going to be getting a booklet emailed to me with information about the surgery. Nothing. I called and emailed and got nowhere. If it had not been for my doctor's office who kept trying to get in touch with them, I would have never been able to schedule the surgery. This was in keeping with the reviews on the NHS website - great care, but poor communication.
I received the invoice for the October consult in late November. 200 GBP about 300 USD. I don't know what it is about Europeans, but they have a very lackadaisical way about them when it comes to getting paid for their services. The surgeons office only accepted cash payment. The invoice said to contact the office for bank information since Europe runs on bank transfers. Again, phone, email and no response. Finally, while we were on vacation in Scotland in mid December, I finally received an email with the bank info so I could transfer the funds.
I took that opportunity to ask about pre-surgical appointments in my response since we were now about a month away from the surgery date. No response. Finally, 2 weeks before surgery, after not hearing anything from the office, I contacted the hospital directly and received an immediate response cc-ing the surgeon's office. That got the ball rolling and by the end of the day, I had my pre-surgery consult scheduled and an invoice with fees for the surgery.
Believe it or not, it was wonderful to receive an invoice with fees for the hospital stay and for each doctor broken down as line items. Hospitalization in the US is a crap shoot when it comes to fees. Doctors and surgeons rarely provide you with the cost of services and hospitals may have a chargemaster, but that book is rarely available to patients. It was so nice to see that the anesthesiologist charged 425 GBP about 600 USD for his services. Do you know that when I had my first child, I only had a spinal anesthetic and I received a post insurance invoice for 1500 USD in 2002? More than double what this anesthesiologist charged me for a general, regional and local anesthetic in 2016. And the surgeon? 850 GBP/about 1200 USD for his surgical services. It would have been twice as much in the US.
I reviewed my US insurance benefits and was able to determine that I would have had to pay about 1500 USD overall if it were an outpatient procedure and only $350 if I was inpatient. Where is the logic in that? Since I was an inpatient and I have an added medical benefit at work, I ended up paying nothing.
The hospital care was excellent. I had a private room and the nurses were much more attentive than in previous hospitalizations in the US. If I pressed the call button, they were in the room in about 15 seconds. My mother felt comfortable leaving me there overnight on my own because she saw how attentive they were. They didn't freak out that I went to the bathroom on my own, for example, and other than taking my vitals every couple of hours, they mostly let me be. Despite having surgery, I had no IV put in unlike the US when that is one of the first things they do. A physiotherapist met with me to go over some home exercises and explained that physical therapy was part of the package. If I had physical therapy at the hospital, it would be free of charge. Sweet! That would never happen in the US where they nickel and dime you for everything and insurance limits the amount of visits you are entitled to.
In the US, you are usually kept on a morphine drip and after you are weaned off of this, you are given a 10 day prescription of Percocet to manage pain. Not here. I did not get heavy duty pain meds. I was given a cocktail of Paracemetol (Tylenol), Naproxen and mini Codeine pills. That is it. They also gave me the actual medications before I left the hospital instead of a prescription to collect meds at the local chemist.
When people discuss socialized medicine in the US, they are thinking in terms of the worse case scenario. I have heard stories of places where families have to bring in their own supplies when they go into the hospitals. In Poland, this was the case. It was bare bones medical care consistent with a second world country. Not so in first world Western countries. I had linens on my bed, vitals checked on a Dinamap vital signs monitor, wound dressings provided by and medicines dispensed by the actual hospital. This is the kind of care you would receive in a US hospital. Only it is generally free. Do people complain? Sure. It is human nature to complain. Does it sometimes take longer to get treatment? Yes, but there are options and even the cost of private pay is cheaper than in the US.
Take medication. My son takes a medication for migraines that is not available in the US. Because I got a prescription from a private doctor, I paid about 65 GBP (about 100 USD) for a 6 month supply of this medication. That is about 16 USD per month for these meds. No different than if I got something similar in the US through a co-payment. I prefer going private because its an American doctor I am seeing, it is convenient for me to go that route and I can afford that. But if that option was not available, I could go to the GP and the medication would be free. The GP via NHS is like an HMO that manages your healthcare while going private is like going to a preferred provider.
I think the biggest problem with the Affordable Care Act is its name. It is not affordable unless you are poor and get your premiums subsidized. It is not affordable when you have a high deductible you must meet before your care is considered paid for. And the costs will continue to rise since the young people they planned on enrolling to support the sick are opting for the cheaper penalty.
Rather than issue tax penalties to all those who refuse to join, they should have funded this as a payroll tax just like Medicare and cut out the insurance companies that only care about their profit margin. That would have provided true universal coverage that everyone could access. Would it be perfect? No, but at least no one would go into debt because they can't afford healthcare.
Maybe people like me are an anomaly because we have been able to experience the other side and realize that it is not the scary monster that it is made out to be.
Now back to my nap...
