Friday, November 13, 2009

U.S. healthcare reform

Medicare brandImage via Wikipedia

I'm very interested in the current debate in the U.S. on Obama's proposed health care reform.
I decided to look up the subject on Wikipedia.
To my surprise there's no mention of Australia. Why Australia? Because we've had what Obama is proposing for the U.S. for over thirty years.

Want a first hand opinion of what it's going to be like? Ask me.

We in Australia certainly had a fierce debate on the issue before the reforms were introduced.
The only issue now is whether it should all be dismantled or not.

Our system is called Medicare (see Wikipedia system for details)

So here's my personal experience of Medicare.

The GP
I have a choice when going to the doctor. I can opt for a practitioner that 'bulk bills" or not. Bulk billing means my doctors fee is partially subsidized by the government. I pay a fixed amount while the doctor claims the balance directly from the government.
If I visit a doctor that doesn't bulk bill, I can go to a medicare office and claim a fixed portion of the bill (not a percentage) back from the government.

The Hospital
We have public and private hospitals.
Public hospitals are funded by the government and there is no cost charged to the patient.
Private hospitals charge whatever they like.
Public hospitals have emergency wards that are always full of patients waiting for treatment. Most of these patients are people who cannot afford or are not willing to attend a bulk billing clinic. Therefore a triage system operates. This means that if a patient is categorized as non-emergency case, they might wait for days to get treatment by a doctor.
The emergency ward system is also complicated by the shortage of available beds in hospitals.Even if you are seen as an emergency case, treatment still awaits the availability of a bed in that hospital.

Surgery is also subject to the triage system. It is also subject to a value based assessment process. That is, if you are young, working and supporting a family, you go to the top of the waiting list for surgery. Old people are placed at the bottom of the waiting list. It's not uncommon for older patients to wait years before they receive surgery.

The government being concerned by the negative news of long waiting lists in hospitals, imposes performance targets which are rewarded with financial bonuses if met by the hospitals. Recently the news headlines were full of stories of hospitals that had made "mistakes" in the administration of these statistics. Many hospitals were involved, all claimed ignorance and innocence of these "mistakes". Waiting list statistics no doubt have been fudged.

Health Insurance
For those who choose to pay for health insurance, the choices for treatment are much better.
Patients can opt to go to a private hospital or a public (Medicare) hospital.
The problem is that public hospitals depend to a large extent on the revenue of patients who have health insurance. This means that these patients are able to bypass the triage process and get access to a hospital bed that is available for private patients. The system works like this, public hospitals have allocated beds for private patients and public patients. Even when the public patient beds are all occupied, even when there are people on waiting lists waiting for a bed, there are empty beds in hospitals waiting for private patients to occupy them.
You might ask yourself, why don't private patients attend private hospitals instead of taking up beds in public hospitals? Cost!
The health insurance system is structured so that nobody ever gets 100% coverage of medical/hospital costs. There is what is known as the gap. The gap is what a patient with private health insurance must pay after the insurance covers most of the cost but never entirely all the cost of medical treatment. Given the option of which hospital to attend, even though a patient has private health insurance, they will opt for the cheaper option.

Reblog this post [with Zemanta]


Jeannie said...

Canada doesn't want to get into a multi-tiered system. It does look complicated but something has to be done to improve things here too. Our system worked best say 20 years ago. Everyone paid government health care premiums (this became an employment perk - which the whiners thought should be 100% the employers responsibility but then let businesses with low payroll and self-employed people off the hook which was stupid because then half the people were no longer paying)- it was affordable - doctors billed the government and got paid.

nanc said...

I had the benefit of having a little "disagreement" with a MOVEON protestor yesterday at a healthcare rally - everything he screamed was "I'm willing to pay more taxes so EVERYONE gets FREE healthcare!" He went on to state that he had worked for the insurance industry and is now a lawyer - BWAH!

Basically, everthing he iterated was communistic in nature.

For instance, last year his wife had to go to the hospital for something and the bill was $12,000 and because they had no insurance, the hospital reduced the fee to $5,000 - I asked, "Your point?"

We've had to pay a couple of those reduced fees so I know firsthand what this is like - it's like NOT having to pay $7,000 in insurance fees!

Oh, I could go on, but have alot of work to do.

Anonymous said...

And still, knowing this, Obama persues the "public option".

O and his pals should be the first to take the public option and stand in triage when they need medical attention.

As if.

Anonymous said...

Mind the gap!

Lexcen said...

Triage nurses and doctors are now protected by security guards. Just an indication of the anger and frustration the system imposes on those seeking emergency medical assistance.

Travel Italy said...

I find the problems you are experiencing in Australia interesting. 20 years in Italy and while the system is not perfect and leaves room for improvement generally health care is significantly better than here in the US.

I think I understood that Australia is using the form suggested here in the US. That is where the government is in the insurance business (payer) and not in the health care business (running hospitals, clinics, etc). Continental Europe uses the latter.

Italy has both public and private options. Private is almost a resort experience and public can make you wait for non essential or optional procedures but those who are sick get care.

I used both. When I was young, 4 kids and no money the public service was a god send. As I was more comfortable I used mostly private structures.

I paid gladly even when I no longer used the system because it allowed my family to grow up strong and not suffer financial ruin when we had very little.

Perhaps I was fortunate and never got caught up in the bad side of things.

Lexcen said...

Hello David.
I'm not sure if I made it clear but Australia had government run hospitals long before Medicare was established. These form the core of the Medicare system.The private hospitals do offer a better class of care to patients if you can afford it.
The public hospital system (government owned hospitals) are managed by both State and Federal governments. The complexity just gets more and more mind boggling as you look further into the system. I don't know what the nature of the "crisis" in healthcare in the U.S.A. is but in Australia the crisis has been ongoing for over thirty years. Not enough surgeons, not enough hospitals, not enough nurses, not enough hospital beds and no matter how much money is thrown at the problem by the government, it seems to be swallowed up by hospital administration costs. Inside informants have said that hospital administrators have no qualms about feathering their beds with funds that are allocated for patient care. One wonders how much money is squandered this way and contributes to the never ending demise of the healthcare system.

Travel Italy said...

Corruption is always a problem whenever government is involved. I look at it as a trade-off between the 40% ROI required by both the insurance side and the care giver side. Just one hand dipping into the till seems to be a better deal.

In Italy and France, I do not know about other European countries, by no means have a shortage of doctors, nurses etc. Since these are governmet jobs they are the most secure. In fact in 2003 there was alot of talk about how the underperforming regions of Italy (Southern) were producing an excess of medical professionals.

The difference in the success of the programs may be due to other societial factors since Australia seems to have mirrored the "Cowboy Capitalism" initiated by Nixon (in the 60s) and pushed ahead by Reagan.

I am not sure of how to get things right but the US system is worse than a third world country. The WHO list the US at 240th among nations for health care.