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Author Topic: Your national healthcare system  (Read 8392 times)

McTraveller

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Re: Your national healthcare system
« Reply #75 on: December 09, 2016, 03:48:16 pm »

So yeah, Reelya I think you're in my camp that thinks it's all about supply and demand issues:

The demand for medical services is by individual, but the capability to pay for medical services is aggregate.  So you get aggregate prices; essentially prices are "total available money divided by actual number of people using the service" instead of "prices that each person using the service is willing to pay."
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Starver

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Re: Your national healthcare system
« Reply #76 on: December 09, 2016, 03:51:10 pm »

So what are the checks and balances in various countries to help keep health care low? Is it just legal mandate, or is there actual balance of supply and demand in the countries?
May not directly answer your question, but the details in http://www.bbc.co.uk/news/health-38183672 and http://www.bbc.co.uk/news/business-38233852 might reveal the kind of tussles that get made public. (Extraordinary cases as they are, to become newsworthy, one assumes.)
« Last Edit: December 09, 2016, 03:53:25 pm by Starver »
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Reelya

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Re: Your national healthcare system
« Reply #77 on: December 09, 2016, 04:01:41 pm »

It appalled me than in that article about an anti-HIV drug that prevents infection, some people were opposed to the drug because it might encourage a "hedonistic lifestyle'. Oh great, we can't cure disease because some people might enjoy themselves if we did that.

Why not flagellate ourselves too while we're at it? I guess not, someone might enjoy that too.

ChairmanPoo

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Re: Your national healthcare system
« Reply #78 on: December 09, 2016, 09:01:56 pm »

I dont know the details, but it's more likely that they worry about "risk compensation".

Now, I don't buy it because PrEP is pretty fucking effective, likely offsetting an increase in risky behavior. But I can understand where they are coming from.
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Starver

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Re: Your national healthcare system
« Reply #79 on: December 09, 2016, 10:55:34 pm »

PrEP is pretty fucking effective,
It's probably also ugly fucking effective, and "meh, but there's no-one else who seems to be interested in me tonight..." fucking effective.  ;)

(Tangential to this...  :P)
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Jimmy

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Re: Your national healthcare system
« Reply #80 on: December 10, 2016, 08:17:37 pm »

Since nobody has given a detailed response for my country's system, and I work in healthcare, I'll do my best to summarise.

Australia

System: Universal public healthcare for all citizens and residents with private healthcare optional but encouraged

GDP Cost: 9.8% ($154B AU) 2013-2014

Tax Cost: 1.5% personal income tax levy (+1% for high income earners without private insurance)

Summary

If you're poor, you can get free healthcare, eventually. Any Emergency Room visit will be fully paid for at a public hospital. Private hospitals or mixed public/private hospitals exist that are funded by private health insurance. Elective or non-urgent surgical procedures can be accessed through public healthcare but will typically incur a waiting time running months or years depending on the type of procedure.

For non-emergency healthcare, you visit a general practitioner, a doctor who caters to simple or chronic diseases in a local business area. These are typically first point of call for general illnesses, small injuries, or prescribing of medication. A GP can either choose to accept the standard rate paid for by public health care for your visit, meaning you pay nothing, or can charge an additional cost, meaning you pay the difference between the public rate and the doctor's fee. Some GPs will also be fully private cost, meaning you pay the full amount, though these are fairly rare.

For more complex healthcare, your GP will refer you to a specialist, a doctor who focuses on one type of disease management. Examples include psychiatrists, cardiologists or endocrinologists. Not all specialist treatments are publicly funded. For example, dental treatments are typically fully private cost treatments unless delivered from a public hospital (and waiting times are usually extreme for these types of treatments). Additionally, specialists are commonly known to charge a premium on top of the standard public rate, unlike many GPs.

Finally, there's the cost of medications. The Pharmaceutical Benefits Scheme offers subsidised access to a large list of medication treatments for subsidised costs. The cost to the patient is typically capped at about $40 AU per month for each medication, with those on disability or low income receiving theirs for a little over $5 per month per medication. The remainder of the cost of the medication is paid by the Pharmaceutical Benefits Scheme. There are of course exclusions and limitations, but overall this allows equitable access to affordable medications for the majority of patients.

Those playing at home may note that the cost of all this public healthcare is far more than the amount charged in tax to fund it. Sustainability is a constant talking point and various policies get tried every election cycle to try to reduce this expenditure, but overall it's unlikely to change significantly aside from gradual erosion of benefits by exclusion.
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Reelya

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Re: Your national healthcare system
« Reply #81 on: December 10, 2016, 11:55:42 pm »

Americans often cite waiting times as the killer in UK, Australia or Canada. But they rarely cite any actual comparative data. The lack of pro-American heath articles that point out that data is sort of a giveaway: if stats backed up their claim that USA was better then they would publish both stats back-to-back rather than just NHS fear mongering.
http://www.healthpolicyjrnl.com/article/S0168-8510(13)00175-9/fulltext
^ Elective surgery waiting times are slightly lower in Australia than England

https://www.theguardian.com/society/2015/aug/25/gp-appointment-waiting-times-in-us-worse-than-nhs
^ Long waiting times are normal in the USA. You have to book a GP visit 66 days in advance in Boston!!! I've never waited more than 2-3 hours to see a GP in Australia, and that's when I was unexpectedly sick. In Australia, you just take for granted that you can go to see a local doctor any time you need, and wait for an hour or two in the waiting room to see them. And it's free. Apparently that's not how it works in America I guess.

https://web.archive.org/web/20100401115216/http://getbetterhealth.com/wait-times-for-medical-care-how-the-us-actually-measures-up/2010.02.02
Quote
* The United States had the largest percentage of persons (61%) who said that getting care on nights, weekends, or holidays, without going to the emergency room, was “very” or “somewhat” difficult. In Canada, it was 54%, and in the U.K, 38%. Germany did the best, with only 22% saying that it was difficult to get after-hours care.

So, America does poorly for regular access to healthcare compared to NHS-style countries, e.g. going to see a GP etc. On elective surgery waits, America does pretty good however, but the #1 system by far for efficiency is Germany's national health system, beating everyone on every measure.

Lower wait times for non-important surgery seems to be the only category whee America comes out ahead compared to most universal health systems. But that would be because those NHS-style systems prioritize much lower waiting times for primary healthcare and access to regular doctors, at the expense of less resources for non-critical surgery.
« Last Edit: December 11, 2016, 12:09:40 am by Reelya »
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ChairmanPoo

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Re: Your national healthcare system
« Reply #82 on: December 11, 2016, 03:39:03 am »

Untrue. There is more to the matter than that.  Nationalized healthcare systems (eg Scandinavia) are more cost-effective than single-payer insurance (like Germany).  Both are better than private insurance ones though
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Starver

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Re: Your national healthcare system
« Reply #83 on: December 11, 2016, 03:54:47 am »

Germany isn't actually single-payer. Taiwan and Canada alone, apparently, are single-payer.  (UK is in part disqualified by being multiple devolved regional NHS bodies.)
 
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Neonivek

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Re: Your national healthcare system
« Reply #84 on: December 11, 2016, 04:00:10 am »

That is because people who cannot afford proper healthcare in the USA deserve to die. *Actual American Politics*

Actually it seems more like, to me at least, that the American system for some reason encourages lower quality work for greater pay. Though I have no idea what is the mechanism for that... Could it be lack of competition, low regulation, and an expectancy for high pay?

As for life expectancy. A lot of it isn't healthcare related. American Diet and exercise does a lot of it.
« Last Edit: December 11, 2016, 04:03:48 am by Neonivek »
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martinuzz

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Re: Your national healthcare system
« Reply #85 on: December 11, 2016, 05:26:42 am »

That is because people who cannot afford proper healthcare in the USA deserve to die. *Actual American Politics*
If you are ever in a position that you need life saving treatment, but are denied it because of financial reasons, I fully endorse you robbing a bank or blowing up a cash machine. If you go to court, they can't charge you with criminal intent. Your motive will be self-preservation, not criminal intent. Self preservation is a basic human right.
If I were a judge I'd convict you of robbing a bank, but deal no punishment because of 'circumstances beyond a person's control due to psychological distress.' (that would be the legal term around here. It was used here a few years ago when a pregnant teenage girl stabbed her brother to death after he kept bullying her and stomping her in the stomach. The judge convicted her of manslaughter, but no punishment was given.
« Last Edit: December 11, 2016, 05:31:17 am by martinuzz »
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Reelya

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Re: Your national healthcare system
« Reply #86 on: December 11, 2016, 05:38:25 am »

To be honest, in America you shouldn't do that. You should commit some fairly minor crime for which they can jail you, then do a plea deal for a set amount of jail time. In prison, they're constitutionally obligated to provide you with the health care you couldn't afford.

This is actually more common than you'd think. There's also a bonus. If you have a medical condition that cannot be treated in a federal prison, they hold you in a hospital ward instead.
« Last Edit: December 11, 2016, 05:41:07 am by Reelya »
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martinuzz

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Re: Your national healthcare system
« Reply #87 on: December 11, 2016, 05:39:58 am »

That's horrible! Punish the sick by sending them to jail?
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Reelya

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Re: Your national healthcare system
« Reply #88 on: December 11, 2016, 05:52:38 am »

Well yeah. There's a current case of a felon in America who stole $1 from a bank - the first offense in his life - and was sent to prison. He admits he did in on purpose because he was crippled and couldn't get medical care. Now the doctor treating him is angry that he's getting free treatment.
https://www.theguardian.com/world/2011/jun/21/verone-one-dollar-robbery-healthcare

Although in this case, he didn't commit a bad enough crime, so they charged him with larceny rather than bank robbery. He needed to pretend to at least be trying to commit the crime.
« Last Edit: December 11, 2016, 05:56:42 am by Reelya »
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ChairmanPoo

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Re: Your national healthcare system
« Reply #89 on: December 11, 2016, 06:19:49 am »



Actually it seems more like, to me at least, that the American system for some reason encourages lower quality work for greater pay.
Yeah, because it's totally the doctor's fault  ::)
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