Sunday, September 28, 2014

Healthcare and Hospitalization: US vs. UK

If you're American, you've probably heard either glowing, romanticized reviews about the NHS (National Healthcare System in the UK), or horror stories about someone waiting 10+ hours to receive an emergency operation. Or if you're from the UK, you've likely heard about people going bankrupt for appendectomies in the US. As someone who has experienced both systems extensively, I'm going to go over my experience being hospitalized and at the GP for you. 

The huge issue with comparing the two is that for one, you are comparing apples and oranges. You can get American-style private insurance in the UK, but the NHS is completely free (aside from some scripts that you'll pay a base fee of £8 for). But since Americans have no other options at present, I will have to compare the two.

General Doctor Disposition:
In both the US and the UK, I have found extremely caring doctors and doctors who seriously can't wait to shoo you out the door. Doctors in both places are overworked and deal with high volumes of patients. Some have incredible bedside manners and some think they are God. I don't think this has to do with the country the healthcare is in, but more about the overloaded healthcare systems in general. 

One thing I did find weird in the UK, however, is that GPs don't usually examine you. You will get an exam if you go to the emergency department or a specialist, but with a GP, you generally just discuss your systems whilst s/he sits at a computer clicking things. Sometimes, if they are particularly overloaded, s/he will also tell you that you can only discuss one symptom or issue at a time and need to make an appointment for any other symptoms you are experiencing. 

Wait Time: 
One of the bigger arguments about socialized healthcare is that wait times at Emergency Rooms will increase. The argument is basically invalid because you can pay for your own private insurance in most countries if you don't want to wait for things. However, I have found wait times in emergency services to be about the same in the US and UK. Sometimes you're in and out in 5 minutes if it isn't busy. Sometimes you're there for 5 hours.
Are wait times to see specialists increased on the NHS? Without a doubt, yes. In the US, depending on your healthcare plan, it is possible to see a different specialist if your first choice has a waiting list that is too long. In the UK, it isn't as easy, although you can make a request to see someone in another town if the wait is too long. 

How long are the waits? Well, for example, I was put in the hospital at the beginning of September. I am not due to see the specialist for the reason I was there until early November.

Choosing Your Doctor
In the UK, assuming you use the NHS, you are placed with a certain GP practice according to where you live. If you are unsatisfied with it, you can try to change, but it isn't always easy. I have been trying to change GPs for over a year and I haven't been successful. However, just because you are registered with a certain GP does mean you will see him/her every time you visit the practice. You are sometimes seen by whoever is available that day.
In the US, you can go "doctor shopping" and pick someone you feel you click with.

Blood Draws
With Lupus SLE, I have had a TON of blood draws. I am supposed to get them monthly, though sometimes I skip out and get told off. In the UK, if your GP orders bloods, you typically have to wait a week or so to have your blood drawn and make another appointment. If you go to emergency services or a specialist, blood is often taken there. Also oddly of note, in the UK they don't wipe where they are inserting the needle with a sterilized wipe. They simply stick it in. Doctors also seem to do bloods a lot less than in the US and I've met people in their early to late 20s who have never had their blood drawn, or if they have, only once or twice.

Tests and MRIs
In the United States, there seems to be more access to more state-of-the-art testing that doesn't require you to travel. Although, this may be different for people who live in states that don't offer a lot in general. In the UK, I find that a lot of people have to travel for tests, often down to London. However, in the US, they tell you up front that you'll be paying an arm and a leg to run machines if your insurance doesn't cover it.  You'll never see a bill for something like this in the UK. Often times in the UK, however, they won't run certain tests in the Emergency Room, if you're hospitalized, it can take a few days after a test is ordered to get it.

This one is a biggie. The differences in hospitalizations aren't huge, I would say, besides the fact that in the UK you pay nothing.  In the US, you typically have your own room in the hospital, although you may share with one or two people. When I was in the hospital in the UK, at first I shared a room with five other people, which is really annoying when you're trying to sleep as visitors are in and out and so are doctors. I was then moved to a section of the hospital where I had two roommates and then eventually spent two nights in my own room. Having your own room seems to be the luck of the draw in the UK, or whether or not they have certain concerns.

In the UK, you may wait a few days in the hospital, however, to see a specialist to come have a look at you. In the US she or he can see you in the emergency room on most occasions.

One other important point is that in the UK, you will likely be hospitalized for things that the US doesn't deem necessary, most likely because your insurance company doesn't want to pay for it.

In the UK, you will only pay for medicine, which is a max of £8 per script. If you are in the hospital, the medicine is free.

In the US, you or your insurance company is responsible for paying the bill, including medicine, tests, doctor visits and overnights in the hospital.

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  1. I love your posts comparing the US to the UK- I've never visited the US so they're really interesting! This I found a particularly good read because I'm a medical student training within the NHS so I was interested in finding out how different it really is from other formats of healthcare. Some of the things you've said are things I've never really thought about, such as GPs not examining you. I guess it depends what you go in for, but I'd just never expect a full examination- despite being taught to do them!

  2. Through being hospitalised many times in the UK, Spain and in Australia, i have found very little difference in the experiences of public hospitals- athough my boyfriend who has private healthcare in Australia (the done thing apparently) was in more of a state waiting in accident and emergency than me due to the waiting hours when we went-something i was totally used to. I really do think it is luck of the draw with who examines you and the time you go in. I've had close family memebers go into the French healhcare system which they were really impressed with- people checking on them (rather than having to alert them if something was wrong), a chef for each ward who makes you meals according to your preferences (amazing for people with food allergies- the NHS still struggles with me being vegetarian and gluten-free) and just generally felt the French system was amazing. It's interesting to read how you compare the UK and US :)

    Lizzy at Nomad Notebook

  3. Him & Me (But Mostly Me)September 29, 2014 at 12:12 AM

    This was very interesting. I've only ever known the US system and for the majority of my life I've had health care through an employer (my dad's until I was 25, then through my own employer). We've never had to pay anything other than our co-pay which has always been $5 to $10 per visit (unless it is a yearly physical which are free, and also for woman to have a pap smear it is free - these have always been free for me, but now they are free for everyone by the new health reform that President Obama has set in place). Our medicine has always been inexpensive, too $5 for a 3 month prescription.Sometimes you have to fight for it, just because the pharmacy will give you a 1 month prescription instead of 3, and the insurance pays either way, so it's better to be given 3 months worth of medicine obviously. We are lucky, though. The insurance we have is paid for completely by our employer and we even get some money back every month (which essentially covers the price of the co-pay's and prescriptions). But mine is just one of many different insurance methods (I have Kaiser Permanente fyi).

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