Thursday, December 24, 2009
Comparing US healthcare costs with Europe
By BBC Bureau:
With the passionate debate on US healthcare provision drawing to a close, BBC World Service spoke to people undergoing treatment for three different medical conditions, to compare experiences in the US with those in other countries.
HEART SURGERY IN INDIANA AND ITALY
"One day, back in 1992, I started feeling pain in my lower back, below the kidney and a gurgling feeling. I went to a local community hospital and the doctors examined me and indicated that I was having a heart attack.
"The doctors decided that if I were to survive I would need a heart transplant. I was then put on the top of a list for transplant recipients in the mid-west region. Within a couple of days, fortunately, I was able to get a heart and I had wonderful treatment at all three hospitals.
"After I went home I had some medical treatment and I was given a cocktail of medication to take every day.
"I do have Medicare but I also have a supplemental insurance plan. This supplemental plan covers my drugs. I pay 20% of the cost of each drug I take up until I reach a total expenditure of $1,000. Once this happens the insurance company pays the remainder of the total cost of my drugs for the rest of the year.
"Fortunately I belong to an insurance plan where my wife was employed. One month before I had my cardiac event, this firm transferred their insurance to another carrier. Had they not done that I would not be speaking to you today.
"The initial carrier considered - much as other carriers in 1992 - that heart transplant surgery was experimental and they would not pay for it. However, the second insurance which I was carrying at the time did approve that operation, and paid all the expenses associated with that operation."
An angiogram of the human heart showing an artificial valve inserted (generic image)
Pace-makers cost a lot and I got it free
"I had a heart valve replaced at a hospital in Paris nearly 30 years ago. Then, in 1998, I had a heart flutter and went to Milan for another heart operation. After the second operation they advised me to put in a pace-maker. And now I feel great.
"The pace-maker will last for about 10 years but the less I make it work, the longer it lasts. Since then I have had check-ups every six months. I work fast, swim and I feel pretty healthy. I had all my operations, even the one in Paris, completely free.
"Pace-makers cost a lot and I got it free as well as the medication to thin my blood and keep my blood pressure down. Because I am a long-term patient I get it all free.
"The only thing I pay for is for my private doctor. I pay him 200 euros every six months for my private check-ups and it was he who got me the operations at the hospital.
"Someone with contacts is useful in Italy. The rest of it is paid for by the state.
"The only difficulty with public health here is that if you need to do something urgently, you might have to wait two or three months. So if someone does not want to wait you need to go through a private doctor to get a public appointment in a hospital which has space.
"I think the public system is fine but when you go to the private hospital you get better surroundings, like the choice of food. But I have lots of friends who have gone through the state system and they have been fine too - the operations are the same.
"Our health insurance is taken automatically from our salaries and free healthcare is available to all. We pay about 8% of our salaries each month to healthcare. But the healthcare is the same for everyone."
BREAST CANCER IN CHICAGO AND THE UK
Angela Walker from Chicago discovered she had breast cancer at 34
Angela, Chicago, US:
"It started when I was getting ready for work as a pastry cook. While in the shower I found a lump in my armpit, so I called my aunt who is a physician's assistant and she told me to call my doctor.
"But at that time I had only been with my company for two months and so I was on a probationary period. This meant that I had to wait 90 days for my insurance to kick in. It was hellish - I went to work and I was a wreck.
"After I was diagnosed with breast cancer, treatment - and payment - started quickly. I went for a 20/80 insurance option which means that my insurers paid 80% of my bills and I paid 20%. So I was getting bills every week.
"The doctor's office had to ask my insurers for permission for some of the therapies I got. For example, I had to get a MUGA scan which checks to see if your heart is okay to stand the chemotherapy but my insurers had to give me permission to get the test.
"And I wondered why, when I was having all this insurance, why I had to ask permission for a certain test?
"Ultimately I filed chapter seven bankruptcy. The hospital was billed for $193,426 which was the 80%. The mind boggles. It's a lot of money. Can you imagine what that would be for people without the money?"
Briton Cathy Luton is in remission after treatment for cancer earlier this year
"It started in 2008 when I noticed a lot of irritation on my breast. The doctors told me three times not to worry, but by February this year I went back and asked them to check. After some tests they found I had an early form of cancer.
"Up to this point this was all free at the point of use under the National Health Service (NHS). I pay money in every month in my salary, as we all do in England, and then hospital visits and doctor's appointments are all covered.
"In May this year my breast was removed - which was very quick. I'm very happy since the operation that this was removed.
"Next year I go back for reconstruction of the nipple. Interestingly enough this could be seen as a cosmetic operation, but this is something I can have under the NHS.
"Goodness knows how much it would cost if it wasn't covered by the NHS.
"I do feel gratitude - some towards myself for making the doctors take me seriously - and now towards the NHS.
"But I do still have issues about the fact that I was initially turned away three times by doctors, only to find I had a disease which could have killed me."
PREGNANCY IN SEATTLE AND GERMANY
[My spouse] is currently uninsured, which is very worrying Alena Ciecko, Seattle
Alena Ciecko, Seattle, US:
"My pregnancy has been relatively easy. I'm tired, but very excited. I've had a lot of choices. I plan to have a natural birth out of hospital at a birth centre with a midwife.
"I also had a choice of what kind of doctors I wanted at the hospital. All these choices are within my insurance plan - I can't just pick anyone out of the phonebook.
"I have full coverage as an employee with Group Health - an insurance provider which provides everything internally.
"If you want to go outside of what they have approved or a doctor who doesn't work at one of their facilities, then you have to pay.
"I had three different ultra sounds. I had an option of doing pre-natal and genetic testing and so took advantage of that because it was covered.
"I didn't have a situation where I needed a doctor or an additional test that wasn't already offered.
"But a big problem is that my insurance does not cover my spouse without an additional monthly payment of over $500 per month - which we can't afford.
"So he is currently uninsured, which is very worrying.
"Once the baby comes, she will be a dependent and I can add her to my plan but that will cost over $150 per month which I will have to pay.
"I think this is because my employer cannot afford to cover extra people and the employer balance what benefits they can offer employees with what they can't.
"It seems that, over time, employers are covering less and less because the cost is so high.
"Under federal law, I'm allowed 12 weeks' unpaid maternity leave. In Washington [State] I'm allowed a little extra - 18 weeks - but more than half of this will be unpaid.
"There is no guaranteed paid time off generally for mothers."
Pia Valerio de la Cruz
Pia Valerio de la Cruz is 30 and lives in Berlin
"Since I found out I was pregnant, I have had a midwife and the care has been excellent. I see my doctor as well as my midwife and I can call her any time if I have problems.
"I like the hospital where I will give birth - I went and checked it myself and friends say it is good too. I pay 50% of the cost for this care and my company pays 50%.
"I don't know what it costs as I don't see any bills. The money comes straight out of my wages. When I go to the doctor, they contact my insurers directly. But there are always some additional optional checks and I pay for these myself. The insurers pay just for the basic checks.
"Since I wanted to make sure the baby was healthy, I did pay for more tests. Six weeks before the baby is due and eight weeks after, I get my full salary, and my company gets some money from the insurers too, but I don't know how much.
"After that I either go back to work or I have the opportunity to stay at home for one year and we get 67% of our salary. But this isn't paid from our insurers but from the government. I will do this.
"They changed this a few years ago to encourage women to have more babies."