Healthcare in your area 10 replies

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#1 2 weeks ago

So, some know that recently I've had to use the NHS healthcare system here in the UK quite extensively due to developing dysautonomia, which is ruining my life in many ways.

However I've struggled a lot with the pressure the NHS is under, with many experiences of uncaring or dismissive doctors, poor waiting times, in and out consultations where you feel nobody has helped you and a sense of nobody listening.

In terms of mental health, I have only just got my first appointment for the 14th of this month after a five month wait.

I did get some consultations and tests privately and that was night and day, very short wait times, decent consultation etc. but very, very expensive, and has cost me about £600 for just one consultation and an echocardiogram.

So I am wondering how do you people find their own health systems? Do they work well and what do they cost.


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#2 2 weeks ago

Likewise, NHS over here.


My most recent experience with it was when I was trying to come off some medication against the advice of the person I was seeing at the time. Who was seeing me for the first time at that meeting. That wasn't super-fantastic. Fortunately, I'd read the guidelines concerning coming off that medication beforehand, and there was no way they were going have a good argument for removing my liberties. So... I didn't take their advice too seriously.

Things got better afterwards. That medication was really doing a number on my ability to think clearly.

There's someone out there who honestly trusts doctors though, and that person is still on that medication. Alternate-Nem probably did not do well.


It's a system that really needs a proper review. Like, the whole NHS trusts and internal market and... that's a mess. Maybe it needs more funding, maybe it needs better management. I don't - and to some extent can't - know where the problem lies. 

I know that their front line staff seem run off their feet all the time. That doesn't seem desirable, regardless of the cause. How good a job would any of us do advising someone on serious issues if we saw them for a ten minute window in their entire life and were constantly stressed and sleep deprived? 

If I knew that I was going to see someone for ten minutes, and maybe that was all the support they'd get, maybe I'd recommend they stay on the same medication too. - If you don't have the time to get to know the person in front of you on any level, all you can do is play the odds.




Zipacna VIP Member

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#3 2 weeks ago

The German system can be annoying or "satisfying", if that is the word, depending on the situation.

Everyone has to have health insurance, but if you want, you can buy private health care insurance instead of the public version. Private insurance usually covers more, but most if not all private health insurance services require you to pay the doctor and, after receiving the bill, will pay you back whatever amount they are contractually obligated to.

If you're in the public system, most insurance providers (there isn't just one) offer roughly the same coverage. Some are specialised for certain occupations. There is usually a legal price cap for specific medical procedures. Generally, if you're sick, even public health insurance will cover all the costs of the doctor's visit and "simple" treatments. If you require drugs from the pharmacy, you have to pay part of the cost, but the most I ever had to pay for any drug was 15€. Usually, it moves around the 5-10€ range.

Now, for more complex things: If a procedure is absolutely necessary and doesn't come with a longer hospital visit, it will generally be paid for by public health insurance in full. Procedures that you get done because you yourself suspect something to be wrong can include you having to pay part of the procedure. You can directly go to a specialist, but if you go to your usual doctor who has all your medical records on hand ("Hausarzt"), he'll usually be able to refer you to a specialist and with a doctor's referral, you usually get a higher priority. In Germany, radiologists are notorious for having the longest waiting periods of usually up to two months. Your "Hausarzt" is a specialist in general medicine (i.e. basically GP) who has his own practice. You can generally go to him / her every weekday and usually, they'll see you that day without an appointment. Usually, you'll wait between half an hour and, in the extreme, two hours if without one.

If a procedure is done as per your wish as opposed to a doctor's order, as I said, it most likely brings in costs for you. I looked up the price cap for an echocardiogram and, including the consultation, that should run at about an average of 70 to 80€ if done on your wish. Now, this isn't necessarily saying that the German system is cheaper; I don't actually know, how much do people pay for the NHS (I believe it's done in taxes)?

In Germany, with my current public health care provider, you have to pay just over 190€ per month as minimum (and directly to the health care provider, not as tax), but that's for people who earn really low wages. Earning above, I think, 850€ per month (possibly a bit higher) is the point where your monthly fees start rising as well.


I'd say the German system works okay, although some people in the public as opposed to the private health care system can get several weeks of waiting period with seeing specialists relying on machinery if their conditions aren't immediately life-threatening. For really "hardcore" stuff, i.e. things that require lots of immediate care, I cannot give an accurate opinion, since neither I nor anyone in my immediate surroundings had to go through that since I was maybe 12. The worst thing was my sister's godmother who needed heart replacement surgery. That went well, quickly, and she was able to retire early without significant losses to her retirement payouts due to the health care system.

Now, talking about retirement money in general in Germany is something that would be fit to be discussed in forum sections without certain barriers on language because the entire system is busted and my sister's godmother is lucky in that respect alone, especially with literal millions of people draining money from the country in recent years, but that's another discussion.


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MrFancypants Forum Admin

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#4 2 weeks ago

In Germany private insurance isn't really an option for most of the population as it is too expensive. If you earn well, are single and young its fine, but costs increase quite a bit when you get older and have kids (who then also need to be privately insured). Finally, once in the private system it can be difficult to switch back to the public one. Funnily enough, public servants get generous subsidies to private healthcare. That's right, the guys making the laws made sure they don't have to go through the same sucky healthcare they came up with (they are also largely exempt from other types of indirect taxes, making public servant salaries competitive with many high-paying jobs in the industry).


The public system works more or less. It is reasonably affordable but works like a progressive tax; so middle and upper class end up paying the party. 


The quality of the system is so-so. If you get unlucky you end up with people who are overworked and underqualified, then have to waste a lot of time getting second opinions. It can take a while to get an appointment with a specialist, but general healthcare is quite good (lacking a bit the experience to compare it well with other countries).

If you look at studies that compare the quality of healthcare systems Germany is better than the US but worse than most other European systems (in terms of amendable deaths).






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#5 1 week ago
Posted by MrFancypants

public servants get generous subsidies to private healthcare. That's right, the guys making the laws made sure they don't have to go through the same sucky healthcare they came up with

Well, to be fair, the main beneficiaries of that rule are "Beamte" (a type of government employee that cannot be fired except in extreme cases and enjoys several other advantages) like financial office bureaucrats, local government section heads, that sort of person. My dad was one until his retirement because he was a postal service official and all of them were folded into the Deutsche Post or Telekom. They have been dramatically decreasing the number of "Beamte" over the last 25 years, but most people benefitting from the rule you mentioned are still people who have been working for the town-owned waterworks and are now the local head of the water supply or who have some bureaucratic government position overseeing a handful of people because they went to university, not just members of the Federal Diet.


Posted by MrFancypants

If you look at studies that compare the quality of healthcare systems Germany is better than the US but worse than most other European systems (in terms of amendable deaths).

Do you have a reference for that (not trying to discredit you or anything, would like to see the studies)?


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#6 1 week ago
Posted by Zipacna
Posted by MrFancypants

public servants get generous subsidies to private healthcare. That's right, the guys making the laws made sure they don't have to go through the same sucky healthcare they came up with

Well, to be fair, the main beneficiaries of that rule are "Beamte" (a type of government employee that cannot be fired except in extreme cases and enjoys several other advantages) like financial office bureaucrats, local government section heads, that sort of person. My dad was one until his retirement because he was a postal service official and all of them were folded into the Deutsche Post or Telekom. They have been dramatically decreasing the number of "Beamte" over the last 25 years, but most people benefitting from the rule you mentioned are still people who have been working for the town-owned waterworks and are now the local head of the water supply or who have some bureaucratic government position overseeing a handful of people because they went to university, not just members of the Federal Diet.


Posted by MrFancypants

If you look at studies that compare the quality of healthcare systems Germany is better than the US but worse than most other European systems (in terms of amendable deaths).

Do you have a reference for that (not trying to discredit you or anything, would like to see the studies)?

Don't remember where I read about it originally, but I found one of the links I was a looking at back then which has some nice statistics:

https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/



As for the "Beamte", I wouldn't say that this status is limited to the higher echelons of public service. I think there are approximately two million tenured public servants in Germany. It is getting more difficult to get on the tenure track nowadays, but that's still a significant number. And besides healthcare and indirect taxes they also get excellent pension schemes.

If I get tired of my current job I will really consider applying for such a job; the ratio between workload and compensation is amazing.





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#7 1 week ago
Posted by MrFancypants

As for the "Beamte", I wouldn't say that this status is limited to the higher echelons of public service. I think there are approximately two million tenured public servants in Germany. It is getting more difficult to get on the tenure track nowadays, but that's still a significant number. And besides healthcare and indirect taxes they also get excellent pension schemes.

If I get tired of my current job I will really consider applying for such a job; the ratio between workload and compensation is amazing.

Many of them are "older" people, they're trying to limit the number severely, especially to people who have already been working in their job for some while. But I think we're getting off track; point is, there are many more of them who get the health care benefits than 'them greedy, greedy lawmakers' either way.


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#8 1 week ago

I've always used the NHS so far in London and I've always found the staff to be caring, attentive and just brilliant. They are worked to the bone but that's not their fault, it's the way it is run. It needs stronger management and a lot more cutting in middle management to be able to ensure we get the funds to the frontline and new technology that is going to save peoples lives. 


I'm a massive fan of our NHS after having used it and my family too for various reasons, never had an issue so far and long may it continue with tweaks to make it even better.




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#9 1 week ago
Posted by Zipacna
Posted by MrFancypants

As for the "Beamte", I wouldn't say that this status is limited to the higher echelons of public service. I think there are approximately two million tenured public servants in Germany. It is getting more difficult to get on the tenure track nowadays, but that's still a significant number. And besides healthcare and indirect taxes they also get excellent pension schemes.

If I get tired of my current job I will really consider applying for such a job; the ratio between workload and compensation is amazing.

Many of them are "older" people, they're trying to limit the number severely, especially to people who have already been working in their job for some while. But I think we're getting off track; point is, there are many more of them who get the health care benefits than 'them greedy, greedy lawmakers' either way.

Which makes it worse, if you think about it. But I don't think lawmakers actually get the exact same conditions as tenured public servants.

As for the severe reduction in numbers; they have to limit the number of people they hire with the same conditions as the pension entitlements are starting to be a significant burden to their budgets. But the overall ratio of public spending to GDP is unlikely to "severly" change any time soon. So in the end you are just looking at money being distributed in a different away among public servants with younger generations having to settle for less, which creates another set of problems (like the shortage of teachers).





Zipacna VIP Member

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#10 1 week ago
Posted by MrFancypants
Posted by Zipacna

Many of them are "older" people, they're trying to limit the number severely, especially to people who have already been working in their job for some while. But I think we're getting off track; point is, there are many more of them who get the health care benefits than 'them greedy, greedy lawmakers' either way.

Which makes it worse, if you think about it. But I don't think lawmakers actually get the exact same conditions as tenured public servants.

As for the severe reduction in numbers; they have to limit the number of people they hire with the same conditions as the pension entitlements are starting to be a significant burden to their budgets. But the overall ratio of public spending to GDP is unlikely to "severly" change any time soon. So in the end you are just looking at money being distributed in a different away among public servants with younger generations having to settle for less, which creates another set of problems (like the shortage of teachers).

Again, getting far off of health care now, but the main reason it's getting to be a burden is because every level of government is being forced to save more and more money by law ("Schuldenbremse"... and if you read the news the last few days, apparently, "die fetten Jahre sind vorbei", as if any average worker had noticed we were, as it seems, living the high life since 2010). But here's a segway back to health care: Our oligarchs will require a whole lot of it in the near future if they continue along the course of making the semi-wealthy poor and the poor poorer, which has been going for 20 to 25 years now.


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