Health Care in the UK

Over at Managed Care Matters,  Joe Paduda posted this letter from a “very good friend.” Does every patient in London get such good care? Probably not. But I have heard    similar stores—and the UK does not have the best care abroad. (The NHS is still under-funded, though each year they’re putting more money into it.) France, Germany, Sweden, Denmark any Switzerland all boast better care.

Finally, see the American doctor’s reaction at the end. I wonder if he has ever been in a hospital in London?

Five hours into an 11-hour flight to London last month I had a heart-related medical "incident" that caused me to faint, hitting my head on a trolley on the way down giving myself a concussion in addition to whatever else was ailing me. Although I (stupidly) refused the wheelchair and ambulance the airline had waiting for me at Heathrow, upon arrival at my hotel I was sent to the emergency room at St. Mary's Hospital in London where I spent the next 24 hours.

I have to say that I received the BEST medical attention I have ever had or witnessed anywhere in the U.S. Upon arrival in the emergency room I was immediately seen by an administrator who did the necessary paperwork with a sense of urgency I've never seen in the U.S. I never even had a moment to take a seat. I was then admitted to the treatment area where for the next 3 hours I received a steady stream of nurses and – not one – but THREE doctors in rapid succession as checks and balances against each other. (At one point the three doctors convened and argued about my diagnosis just like the doctors on television who only have one patient to care about – and actually care.)

In addition to a battery of blood tests, temperature-takings and blood-pressure checks, I had THREE ECGs, TWO X-rays and a CAT-scan before being admitted for an overnight on a heart monitoring machine. After repeated attempts and many delays, they were finally able to get my cardiologist in L.A. on the phone to consult my records and get his opinion. The next day I continued a battery of tests all day long and was told they wanted to keep me for 3-4 days for monitoring and more tests. I refused and demanded to be released as I had to get to the business meetings I was there for – but promised to follow-up with my cardiologist when I returned to L.A. For the next ten days, I received phone calls every couple of days from one of the doctors who had seen me (not a nurse, a real DOCTOR) to make sure everything was alright and that I wasn't experiencing symptoms.

The hospital was the cleanest I've ever seen, was stocked with the latest technology and the most attentive and empathetic staff I've ever seen. Had I been an EU resident, all of this treatment would have been free. As an American, I was allowed to walk out without a bill, but was later mailed a bill for — get this — $600. That's right – six hundred dollars! ONE NIGHT in Cedars Sinai Hospital in Los Angeles – without any tests – starts at $15,000. The last time I paid for a CAT-scan it was about $1,800.

I am no stranger to hospitals in the U.S. I've had more than my share of emergencies and have been rushed twice by ambulance with life-threatening conditions only to be kept waiting on a gurney in a hallway for up to five hours. One unforgettable incident was being kept waiting five hours at St. Joseph's Hospital in Santa Monica while my organs were in shut-down mode. The doctor later told me I was hours from death. Another time I was rushed unconscious while tumors had caused blockages of my large and small intestines. They wrongly thought I might have a ruptured appendix. While waiting five hours to be admitted, I was given an enema to try to clear the blockage. Had I had the ruptured appendix they suspected, this would have killed me.

I can only hope that the American health care system will become like the UK's. Even the hospital food was good!

Oh – and by the way – when I got home and saw my cardiologist, he completely ridiculed and belittled the Brits for "over-reacting" and "throwing mud at the wall". He explained that the reason they reacted as they did was because "they didn't know what they were doing". He offered the tests they recommended, but I'd have to wait 6-8 weeks to get on the docket at an outpatient facility and it was going to cost many thousands of dollars and he doubted my insurance would cover it. No thanks! I'm planning on getting the tests when I return to London next month

9 thoughts on “Health Care in the UK

  1. While I’ve offered my share of anecdotes in comments on various healthcare blogs, I don’t give them a lot of credibility as indicative of overall healthcare system quality. I’m sure lots of people can offer examples of both wonderful and terrible experiences from every healthcare system. From reading I’ve done and talking with people I’ve met over the years from other countries, my impression is that the European and Canadian systems are generally quite good at primary care and pretty good at emergency care. For care that requires access to specialists, diagnostic imaging, elective surgeries, etc., there can be lots of waiting. In Japan, where people can go to any primary care doctor they want, according to the recent program on Frontline, patients who want to go to the more popular doctors typically spend three hours in the waiting room for a visit that lasts 3-5 minutes. While there is no doubt that there is plenty of waste in our system and we need to cover the currently uninsured, every country’s healthcare system rations care one way or another and in some quite significant ways. I don’t have a problem with it personally, though I think the best way to do it is through sensible payment reform backed up by comparative effectiveness and cost effectiveness data as opposed to artificial supply restrictions or ability to pay. By payment reform, I mean tiering of services, tests, and procedures and differential co-pays based on clinical effectiveness. We are already doing this for prescription drugs. I’m also in the doctors’ camp regarding the need for tort reform as it relates to suits based on a failure to diagnose. If they were confident that they couldn’t be sued for a failure to diagnose as long as national evidence based standards were followed, I think there would be a lot less defensive medicine.
    What really struck me about the post on Joe Paduda’s blog was the reference to Cedars Sinai in Los Angeles charging $15K for a night without testing. I’ve been saying repeatedly that it’s the hospitals that are killing us financially. By contrast, I had a surgical procedure that required a four day hospital stay way back in 1976 at Cabrini Hospital in NYC. The per day charge for a regular semi-private room at that time: $150! Don’t ask me why but I seem to have a very good memory for such trivia. If we index that for the increase in the Consumer Price Index over the ensuing 33 years, the equivalent cost today would be about $700-$750. In late 2005, a NYC academic medical center billed over $31K for an overnight stay following the insertion of a cardiac stent. The doctor billed an additional $5K while insurance paid about 60% of the list price. My local community hospital billed $2,609 for a colonoscopy two months ago, a procedure that took less than 30 minutes. Insurance paid $1,051. Their list price approximately doubled since 2000. There is no way that their costs have anywhere near doubled in that time. I think this is pretty typical of what is happening throughout the hospital sector, 85% (by beds) of which is non-profit.

  2. Barry–
    Good to hear from you.
    You write:
    “From reading I’ve done and talking with people I’ve met over the years from other countries, my impression is that the European and Canadian systems are generally quite good at primary care and pretty good at emergency care. For care that requires access to specialists, diagnostic imaging, elective surgeries, etc., there can be lots of waiting.”
    That pretty much squares with waht I have heard and read.
    But longer waits for elective surgery can be a very good thing. Resarch shows that when people have more time to think about–and learn about– the possible side-effects and risks of elective surgery,often they decide against it (and this is often better for their health.)
    As Americans, we are impatient. (I’m certaintly impatient.) But feeling that we need elective surgery “next week” is probably not in our best interest. (The reaason they call it “elective” is because it’s not necessary; it’s a choice that patinets need to make, weighing risks and benefits.)
    We also know that excess capacity of specialists and dianostic imaging in the U.S. leads to overtreatment that can hurt patients who are exposed to risk with no benefit . . .
    So the supposed downside to care in other countries is complicated; often it’s an upside. (And this helps explain why their outcomes often are better.)
    That said, I agree that anecdotal evidence is just that– hardly a huge controlled clinical trial.
    On the other hand, most of what Americans hear about healthcare in other countires is anecdotal–often from people who don’t know anyone who has received medical care in other countries.
    I know Joe Paduda well enough (not personally, but through reading him and e-mail) to believe that an account from a very good friend of his is credible.
    That’s why I thought that what his friend had to say was wrthh corss-posting–even though it’s only one man’s opinion, it may help to counter too many very subjective and not well-informed accounts of what care is like in other countires.

  3. I totally agree that primary care and E.R care are quite efficient in U.K. My parents lived there for 20 yrs and it is hard to miss screening tests and annual stuff as they get reminders to get mammo etc, have nurse visits who completes vaccination cards, B.P checks at home etc. They have private GP (primary docs) for those who wish private care. I always compare it to public and private school system. Their cardiac stent use is much lesser than U.S. I was surprised that their grocery carts are much smaller than ours.

  4. “(The reason they call it “elective” is because it’s not necessary; it’s a choice that patients need to make, weighing risks and benefits.)”
    From my perspective, “elective” surgery means it’s not immediately life threatening so it can be scheduled in advance and there is time for both the doctor and the patient to review the risks and benefits as well as other potential treatment options.
    In the case of hip replacement, for example, for patients who have put the procedure off for as long as possible but reached the point where it is difficult for them to function, it’s nice to be able to get the procedure done within a few weeks or a month of making the decision to go ahead rather than having to live in pain for, say, three to six months or even more. For people with abnormal blood tests that could be indicative of cancer as well as less serious conditions, it’s very stressful to have to wait months to see a specialist or for an MRI that would either detect or rule out cancer. The stress associated with that waiting doesn’t show up on life expectancy statistics for the population overall but it’s certainly real for the individual patient.
    As I think you know, I’m all for shared decision making, especially for expensive surgical procedures, cancer treatment strategy, etc. If the shared decision is to go ahead with the surgery, my own preference is to get it over with as soon as possible, not to have to wait additional months to get on the schedule.

  5. Ray & Barry -Thanks for the comments.
    Ray- Interesting.I realize
    your parents’ story, like the post, is anecdotal.
    But when you hear enough stories like this from credible sources (and I know quite a few people who live abroad) it becomes apparent how propaganda has distorted our view of healthcare in other countries.
    You write “From my perspective ‘elective’ means it’s not immeidately life-threatening . . .
    I’m afraid that the definition of medical terms is not something that each of us gets to decide from our own perspective:
    Here’s what a medical dictionary says: “open to choice; optional; not required: an elective subject in college; elective surgery.”
    What’s interesting is that, like many Americans, you assume that anything a doctor suggests should be done. “Elective” just means you can wait a while before you do it . . ..
    But in fact, a forthright doctor would tell you, surgeries like hip replacements or treatments for early-stage prostate surgery or angioplasty (in the vast majority of cases) really are Optional.
    It’s up to the patient because there is no “right answer.” We undergo way too many elective treatments and tests.
    Research show that when people wait a few months, often they change their mind and decide not to do it. (The waiting period gives them more time to reflect, to hear what other patients who did it have to say, to try something else–like a combination of medication and physical therapy.
    We tend to want “instant gratificatin” and often this is not in our best interest.

  6. Maggie – thanks for the explicit trust. I can assure you the friend did undergo this experience, and only wants his name withheld in case he has to apply for medical insurance here in the US and would be rejected due to this ‘pre-existing’ condition.
    Just another reason to hope for reform…

  7. Joe–
    Thanks for your reply.
    I do read your blog (“Manged Care Matters”) regularly and so have a sense of who you are. That’s what made me know I could trust your post.
    And thanks for running the post.
    Americans need more
    “direct from patinet” information about healthare in other countries.
    Best, Maggie

  8. Several years ago, while traveling in New Brunswick, Canada my son developed abdominal pain that would not go away. We reluctantly took him to a Canadian physician who immediately had him admitted to the local hospital.
    Within two hours of the admission my son had had 2 CT scans, several blood tests, and physical examinations by several doctors. He was admitted to the hospital and stayed 3 days. During the time he was there, I felt his care was exemplary. The hospital staff was caring, committed, and knowledgable. At the end of three days he was released after the condition was resolved.
    I realized much of the venom hurled by Americans at “socialist medicine” was ridiculous. The care people get in Canada is quite good in most respects. Their facilities may not be the newest in the world, but they are pretty good.
    The total bill for my son’s visit was about $2,300 American dollars. I think the moral of the story is that all healthcare system have their pluses and minuses. We Americans need to stop assuming ours is the “best in the world”. It often is not.