Healthcare in the UK
Posted by: Justin on 14 July 2004
Folks,
I read and hear from prepubescent medical students in the US who are scared shitless of universal heathcare that countries that have such a system are in shambles. One person said that she had to wait years to have her tonsils removed.
I tend not to believe a word of it, given that you all seem a happy lot and, in any event, your enjoyment of healtcare seems every bit as technologically advanced and proficient as that in the US.
But I want the truth. For those who live in the UK (and Canada), what has been your experience?
By way of comparison (in case you don't know), in the US a typical course of treatment for chronic tonselitus would look something like this for a person with private insurance:
January 1: Call to make an appointment with primary care physician for sore throat. Because it is an accute condition with possible bacterial infection, appointment would be scheduled for same day or next day. Say 2:00pm next day.
January 2: Arrive at 2:00pm and wait for 45 minutes to be called back into examination room. Wait additional 15 minutes in exam room. Doctor comes in, looks at throat, ears, etc. declares tonselitus and infection. Prescribed antibiotics. Then looks in chart and notices this is 7th time in two years for the same complaint. Suggests tonselectomy and writes referal to see ENT.
On checkout patient presents his insurance card, pays "co-pay" (average about $25 for an office visit). Insurance company will be charged $90 for the visit. They will "write it down" to $67, subtract the $25 patient just paid as the "co-pay" and pay the doc $42.
The patient goes to the drug store (pharmacy), waits 20 minutes for the scrip to be filled and pays about $10 for the anti-biotics (because it is generic and/or common).
Patients calls ENT's office and schedules earliest consultation for 45 days out.
Feb. 17: Patient arrives at ENT's office at scheduled time and waits 45 minutes to be called back to exam room. ENT prescribes tonselectomy and schedules it three weeks out at the local outpatient surgery center. Patient pays $25 copay.
March 6: Have surgery. Outpatient surgery center bills private insurance $1400 for use of the surgical suite, nursing staff and recovery supplies. Insurance "writes it down" to $650. ENT bills seperately for the surgery and bills insurance company $900 for the procedure. Insurance company "writes it down" to $450. As is typical, the patient has an "80/20" plan with a $250 deductible. Hence, the insurance company pays (in total) ($650 + 450 - $250)x.80 = $680. The surgery center (or ENT) charges the patient the addition $250 "deductible" and the 20%.
After all is said and done, it took about 2 months (give or take) to have her tonsils removed and cost her about $470.
Walk me through how this might go in the UK.
judd
Posted on: 14 July 2004 by Bruce Woodhouse
This is a short and rather provocative reply but I'm a bit busy.
1) Ring with sore throat.
3) Speak to nurse practitioner, who is entirely capable of dealing with this.
2) Be informed that the vast majority of sore throats are viral, even bacterial throat infections frequently resolve with symptomatic treatment, although it may be speedier with antibiotic treatment. Be informed that antibiotics are useless in viral infection and overuse may be leading to increased bacterial resistance. Make informed choice with prescriber about antibiotic treatment, perhaps a deferred prescription.
3) Discuss recurrences with own GP. Discuss the indications for surgery, the balance of harm vs benefit of tonsillectomy in adults. Have an opportunistic health check including blood pressure. discuss GP's recent exotic holiday and golf handicap/mountain bike accident.
4) Throat resolves.
5) Patient feels empowered and may alter health-seeking behaviour in future.
6) ENT surgeon starves to death due to lack of private practice.
7) Healthcare system saved unnecessary treatment costs. Decisions based on altruism not personal gain for physicians.
The US system may appear 'better' (and of course it is undeniably so in a number of scenarios) but remember access to 'more medicine' may not always be better.
Bruce
Back to my paperwork now!
[This message was edited by Bruce Woodhouse on Thu 15 July 2004 at 7:46.]
[This message was edited by Bruce Woodhouse on Thu 15 July 2004 at 7:46.]
Posted on: 15 July 2004 by Bosh
"ENT surgeon starves to death due to lack of private practice"
That'll be the day!!!
Ours are rolling in it, doubling their NHS salaries by running "waiting initiative clinics" to meet the 13 week target whilst cancelling routine clinics to undertake "clinical audit" meetings
They are also getting triple NHS salaries from producing noise induced hearing loss reports for greedy Solicitors, whilst the hearing disabled claimants dont get enough compensation to buy them a basic in-the-ear hearing aid
Putting the patient first? Think not
Posted on: 15 July 2004 by domfjbrown
quote:
Originally posted by Bosh:
They are also getting triple NHS salaries from producing noise induced hearing loss reports for greedy Solicitors, whilst the hearing disabled claimants dont get enough compensation to buy them a basic in-the-ear hearing aid
They drag their heels for disabled people as well - I've been waiting 2 months for prescription contact lenses; mine are waaaaay past their best, and I'm having even more problems than normal seeing. No good excuse given as yet.
If I went private I'd not be able to eat for 6 months, since my lenses are +13 prescription (so no disposables either then)
BTW - disposable lenses = lenses for people who don't need to wear them (due to low prescriptions) IMHO.
Of course, if you don't want to pay in the US for expensive care, jump on the first plane here and blag it for free, like everyone else in the world does.
__________________________
Don't wanna be cremated or buried in a grave
Just dump me in a plastic bag and leave me on the pavement
A tribute to your modern world, your great society
I'm just another victim of your highrise fantasy!
Posted on: 15 July 2004 by Justin
quote:
Originally posted by Bruce Woodhouse:
This is a short and rather provocative reply but I'm a bit busy.
1) Ring with sore throat.
3) Speak to nurse practitioner, who is entirely capable of dealing with this.
2) Be informed that the vast majority of sore throats are viral, even bacterial throat infections frequently resolve with symptomatic treatment, although it may be speedier with antibiotic treatment. Be informed that antibiotics are useless in viral infection and overuse may be leading to increased bacterial resistance. Make informed choice with prescriber about antibiotic treatment, perhaps a deferred prescription.
3) Discuss recurrences with own GP. Discuss the indications for surgery, the balance of harm vs benefit of tonsillectomy in adults. Have an opportunistic health check including blood pressure. discuss GP's recent exotic holiday and golf handicap/mountain bike accident.
4) Throat resolves.
5) Patient feels empowered and may alter health-seeking behaviour in future.
6) ENT surgeon starves to death due to lack of private practice.
7) Healthcare system saved unnecessary treatment costs. Decisions based on altruism not personal gain for physicians.
The US system may appear 'better' (and of course it is undeniably so in a number of scenarios) but remember access to 'more medicine' may not always be better.
Bruce
Back to my paperwork now!
[This message was edited by Bruce Woodhouse on Thu 15 July 2004 at 7:46.]
[This message was edited by Bruce Woodhouse on Thu 15 July 2004 at 7:46.]
Bruce,
Perhaps you've missed the thrust of my post. I want to know how long it would take to have your tonsels out in the UK (appointment times, etc.) not whether the UK system is capable of a better diagnosis. I have no idea whether my example ACTUALLY warrants a tonselectomy. I just made an assumption for the sake of discussion. Whether yhe causes of sore throats are viral or bacterial is not material here. Just wanted to get an idea of how things might go IF a tonselectomy was going to be the end result.
Moreover, I don't think I ever said that the US system "appear[ed]" better to me. Not sure why you made that assumption. I said that it was my impression the UK probably worked fine -but i wanted to know more.
Judd
Posted on: 15 July 2004 by Justin
quote:
Originally posted by Bosh:
"ENT surgeon starves to death due to lack of private practice"
That'll be the day!!!
Ours are rolling in it, doubling their NHS salaries by running "waiting initiative clinics" to meet the 13 week target whilst cancelling routine clinics to undertake "clinical audit" meetings
They are also getting triple NHS salaries from producing noise induced hearing loss reports for greedy Solicitors, whilst the hearing disabled claimants dont get enough compensation to buy them a basic in-the-ear hearing aid
Putting the patient first? Think not
Can you explain what these terms mean. How does one actually doubel or triple saalries under your system? What is a "waiting initiave clinic"? Somebody will have to explain to me how the system actually works.
Judd
Posted on: 15 July 2004 by Justin
quote:
Originally posted by domfjbrown:
Of course, if you don't want to pay in the US for expensive care, jump on the first plane here and blag it for free, like everyone else in the world does.
I thought this was interesting. In the US we have a law called EMTLA, which requires all emergency rooms and urgent care centers to treat all patients who walk throught the door regardless of ability to pay. The result has been that we have, for all intents and purposes, a government mandated (but not funded) universal healthcare system that treats both American poor for free as well as legal and illegal poor residents absolutely free. For Americans, we also have Medicaid (welfare) and Medicare (elderly only). Some states extend certain Medicaid benefits (as far as I know) to illegal residents as well.
From my experience "shadowing" in our local ER, and from reading what EM residents and attendings have to say on the subject, fully 75% of ER patients are there for "primary care" (ie., for sore throats, ear infections, a headache they've had off and on for 3 months, but decided that 3:00 am was the best time to have it looked at by a hospital emergency room). Why? Because these patients have no access to private health insurance because they simply cannot afford it. This means they have no access to community private primary cre physicians. They must avail themselves, then, of whatever "universal" heathcare system the US has to offer, which, as they are well aware, means they may receive treatment in any ER or urgent care center they find themselves in at any hour.
It also means that a $65 office visit for $10 worth of antibiotics for a common infection is morphed into a $900 ER visit with $110 worth of antibiotics. Because this bill is not paid, it is eated by the hospital (and ER doc) and reflected in charges to patients who CAN pay.
The reality, then, is that a lack of "universal" coverage in the US leads to MASSIVE overconsumption of medical care in two main ways. The first, as I have said, is the use of expensive and inefficient ER care in place of good, cheap primary care in the community. The second is the innevitable escalation of otherwise treatable conditions due to the inability to have them examined and treated early for wont of physician access.
The system over here is screwed up, believe me. What I wanted is some sense of how it works in the UK. I am very much leaning towards joining our various "universal healtcare" advocacy groups - but i want a sense of how things go in countries that already have it.
Judd
Posted on: 15 July 2004 by Tim Jones
Justin -
The British NHS has always been extremely good at very serious conditions and emergencies. It has lost the plot over the past few decades because of underinvestment and endless messing around with structures when what was needed was more fundamental reorganisation of service types to match provision to demand (cf Bruce's example).
In terms of sub-specialisation and 'medical advance' I think we're every bit as good, if not better than elsewhere - although our sub-specialisation tends to be driven more directly by need.
For all the talk about 'NHS bureaucracy' we actually have lower transaction costs than equivalent foreign healthcare systems (I spent two years trying to figure this out at the Department of Health). However, partly because of media and political pressure we also have a monitoring, reporting and governance system of epic proportions. Bits of it ( eg clinical audit) do important things. Other bits of it don't.
Bosh has a point about arcane medical working practices and perverse incentives. Every Secretary of State for Health we have has tried to 'take on the consultants' and end their grip on the NHS. The one I worked for (boo hiss Alan Milburn) actually got them to agree to a new form of contract that has many faults but will at least require consultants to agree job plans and have specified sessions (ie working hours).
The issue of "foreigners sponging off the NHS" (sorry dom - Daily Mail paraphrase) is much less of a problem than people think. The big London acute site I work on, in an area of high refugee population, has perhaps £10k of missing income from foreign patients - and in proportion to our budget this is a fraction of a percentage. It may be that this is a bigger issue for GPs than is generally thought.
Tim
Posted on: 15 July 2004 by Bruce Woodhouse
Justin
I guess I was pre-empting people posting about the delays in the NHS and trying to suggest that faster access and on-demand care is not always better.
The NHS is a single organisation in name only and despite its principles of equity I suspect that the experiences of similar patients to your scenario will vary widely. The variations are at least regional more than due to ability to pay or wether you have insurance.
Where I work I'd say;
Initial same-day appointment/Rx no problem (except on New Years Day-you must be joking!)
Referral to ENT same day if needed.
ENT appointment 6-8 weeks
Surgery within 6-9/12 at the moment
This varies with seasonal purges (and all the perverse incentives mentioned by Bosh). Typical scenario-hospital wait list starts to rise. Govt offers funds to Trusts to get cases performed as soon as possible. Only space is in private sector. Same consultants do operation, get private fee for doing it. Patient gets op in nice private ward, NHS waiting target reached, Govt re-elected. NHS system 'loses' money to private system. NHS consultants effectively rewarded for maintaining NHS wait list.
This is simplistic in the extreme but an example of how short-term targets may create all sorts of tensions and effects. There are plenty of wierd and wonderful dodges (in both primary and secondary care).
Bruce
Posted on: 15 July 2004 by Tim Jones
Bruce's paperwork has just fallen on top of him....
Posted on: 15 July 2004 by Bosh
Justin
Most National Health Service Consultants are on part time contracts earning c. £65k, the rest of their time is spent in the private serctor
Private practice should double this figure and legal asssesments, in the case of ENT Consultants in our area , bring in upto a further 3 times this figure totalling c.£300,000
"Waiting initiative clinics" - premium rates are paid to medical consultants to reduce waiting times to meet the governments latest 13 weeks maximum wait target(we have an election coming)
"Clinical audit" - a justification for cancelling clinics to examine waiting times thus ensuring the 13 week targets are not met and hence premium rates can be paid for additional clinics
Posted on: 15 July 2004 by Steve G
quote:
Originally posted by domfjbrown:
BTW - disposable lenses = lenses for people who don't need to wear them (due to low prescriptions) IMHO.
Possibly true. I have disposable lenses but only wear them for sports use (mountain biking etc) and wear glasses most of the time. I've wrecked too many pairs of glasses in the past playing sports so lenses are much, much better.
Posted on: 15 July 2004 by Tim Jones
quote:
"Waiting initiative clinics" - premium rates are paid to medical consultants to reduce waiting times to meet the governments latest 13 weeks maximum wait target(we have an election coming)
"Clinical audit" - a justification for cancelling clinics to examine waiting times thus ensuring the 13 week targets are not met and hence premium rates can be paid for additional clinics
Bosh - this is partly, uh, bosh. Fair enough the service has often forked out massively unreasonable amounts of money to reduce times and there have been 'all sorts of dodges and wheezes'. Reasonable to point out though that doing it within the service's own capacity would have meant waiting until the extra docs were trained - seven years.
There are lots of things wrong about how times and lists have been reduced, but the fact is long lists and vast waiting times were eroding public confidence in the NHS, causing more middle class people to go private and creating a vicious circle which would have ended with the NHS as a safety net service of pisspoor quality (which we've come pretty close to).
Are you really saying that clinical audit is a waste of time? Tell that to the Bristol parents, Ledward's victims, Ayling's victims and thousands of others who suffered or even died unnecessaily because we had no objective way of looking at clinical outcomes.
Tim
Posted on: 15 July 2004 by Justin
quote:
Originally posted by Bosh:
Justin
Most National Health Service Consultants are on part time contracts earning c. £65k, the rest of their time is spent in the private serctor
Private practice should double this figure and legal asssesments, in the case of ENT Consultants in our area , bring in upto a further 3 times this figure totalling c.£300,000
These are stunning figures to me. First, is it fair to say that there exists in the UK a
robust private healthcare system? It would seem so if, as you say, most physicians in the NHS are part-time (meaning they spend the other time in private practice). I am surprised that an ENT can pull 300k pounds a year (about $500,000).
It seems, then, however that what Tim jones has said is essentially true - that with parallel systems (one private and one public) as more and more people move into the private system, the public system starts to resemble more of a "backstop" for the poor.
How is medical malpractice handled in the NHS versus private? Are the standards different? What of the middle and upper class who purchase private insurance (and consume private medicine) but continue to pay for the NHS through taxes?
Judd
Posted on: 15 July 2004 by Justin
BTW,
what do you figure a primary care physician (not a specialist, but the sort of doc like a pediatrician) makes on a yearly basis if she too does a sort of part-time NHS, part-time private practice?
judd
Posted on: 15 July 2004 by matthewr
Justin,
I know little about the NHS from a doctor's (like Bruce) or Civil Servant's (like Tim) perspective. What I can tell you from my experiences as a recently diagnosed diabetic is that I get world class diabetic care for life for free and Americans don't. Exactly what service US diabetics get varies with exactly how much insurance you can afford but fundementally, from talking to US diabetics, you get inferior treatment and it costs more money. I also I know many American diabetics who actively compromise their long term health becuase it's cheaper to not have as many check ups or blood tests, reuse needles, do less blood testing, etc.
I also -- via my employer who does not allow me to opt out -- a very expensive private medical insurance. This provides no cover for my diabetes beyond the initial diagnosis. When I first got sick I did actually try to use their service but it was incompetant, unfriendly and basically useless. The NHS alternative was far superior.
Personally I think priviate healthcare is a rip off (for all sorts of reasons) and basically comes down to paying to jump queues and have a nice room with a colour telly becuase you can afford to.
Matthew
Posted on: 15 July 2004 by Justin
quote:
Originally posted by Matthew Robinson:
Justin,
I know little about the NHS from a doctor's (like Bruce) or Civil Servant's (like Tim) perspective. What I can tell you from my experiences as a recently diagnosed diabetic is that I get world class diabetic care for life for free and Americans don't. Exactly what service US diabetics get varies with exactly how much insurance you can afford but fundementally, from talking to US diabetics, you get inferior treatment and it costs more money. I also I know many American diabetics who actively compromise their long term health becuase it's cheaper to not have as many check ups or blood tests, reuse needles, do less blood testing, etc.
I also -- via my employer who does not allow me to opt out -- a very expensive private medical insurance. This provides no cover for my diabetes beyond the initial diagnosis. When I first got sick I did actually try to use their service but it was incompetant, unfriendly and basically useless. The NHS alternative was far superior.
Personally I think priviate healthcare is a rip off (for all sorts of reasons) and basically comes down to paying to jump queues and have a nice room with a colour telly becuase you can afford to.
Matthew
Are you insulin dependant? As it happens, in the US Medicare, which insured people over 65, also covers people of all ages with diabetes. Not sure why this is the case. In the case of diabetics, I think in the US they DO get care for free for life (though, I think it requires a sort of opt-in requirement before the age of 65, which is a hassle for people who otherwise have private coverage - I could be wrong about that). But, in any event, I'm convinced that the US does a horrible job with the provision of medical services for poeple with chronic conditions such as diabetes and hypertension. It does a MUCH better job with acute conditions and emergenies (as does the UK, as Tim suggested) In any event, my understanding of diabetes care is restricted to glucose monitoring (which is done almost 100% in the US by self-testing machines with test strips) and, if needed, insulin injections - again, almost always self-administered. What else is involved? (seriously, I don't know - I don't have diabetes - my father has type 2, but that probably doesn't count).
Judd
Posted on: 15 July 2004 by Joe Petrik
Judd,
quote:
For those who live in the UK (and Canada), what has been your experience?
Just a quick anecdote:
Last year my mother, who lives in Canada, underwent surgery to remove a rather large pituitary macroadenoma, a type of brain tumor. Although the growth itself is benign, macroadenomas grow slowly and, over time, cause blindness, brain damage and, eventually, death by crowding out and destroying nearby regions of the brain.
Less than a month elapsed from the moment her doctor suspected she had a problem (basically headaches and vision disturbances) to the point that she underwent lengthy brain surgery to remove the tumor. (In between, of course, she had several diagnostic tests -- CAT scans, MRI scans, etc. -- to determine the size, shape and position of the tumor.)
The cost of the tests, operation and convalescence at hospital were easily in the many thousands of dollars, but she was not personally billed a cent. Health care in Canada is paid for through taxes, although recently some provinces have begun tacking on an additional premium to help offset rising health care costs.
Health care in Canada is not perfect by any means -- stories about long waits and delayed surgeries are not all propaganda -- but, by and large, the system works and everyone, regardless of age, income or employment, is covered. In fact, I assume that, overall, the Canadian system is better than the American one as Canada's longevity is greater and the infant mortality rate is lower. And when you factor in the difference in cost -- that the U.S. health care system is the world's most expensive per capita despite some 44 million uninsured people -- it's hard to maintain that capitalism is offering a better and cheaper solution than that which most developed countries pay for through taxes.
Just as an aside: I don't know why conservatives in the U.S. rail so loudly against
socialized medicine. If paying for services with public funds is such an evil, then why don't they also rail against
socialized roads, police forces, fire departments, parks, coast guards, armies,...
Joe
P.S. My only experience with the American health care system is Suzanne's pregnancy check-ups, labour and delivery, and recent hospital readmission because of a nasty postpartum infection and high fever -- 104.7 F.
It's really been hit and miss. Some doctors, residents and nurses were wonderful, other much less so. Overall, the standard of care was good and likely equal to what we'd get in Canada through the public health care system. But we work at a big university and Suzanne is a prof in epidemiology, so I suspect she got better and more attentive care than the average university employee, let alone the legions of under- and uninsured.
Posted on: 15 July 2004 by Bob McC
Tim said
'The British NHS has always been extremely good at very serious conditions and emergencies'
Sadly this myth is continually regurgitated by the British press. Have you seen our cancer survival rates compared to The US or Europe? We have a third world health service with third world funding.
I was told that there was nothing more that could be done for my daughter and that she would die in 3 months. I refused to accept that and took her to the US for surgery. She is alive and well 8 years later.
Youe system with all its faults does not fool itself that it is 'the finest in the world' as ours continually does.
Bob
Posted on: 15 July 2004 by Martin Clark
quote:
my understanding of diabetes care is restricted to glucose monitoring (which is done almost 100% in the US by self-testing machines with test strips) and, if needed, insulin injections - again, almost always self-administered. What else is involved?
Slight digression offtopic FYI. In principle, yes that's it and not a lot more; but it's the details that make or break the entire quality of life, and the potential length of it also.
I can fill you in on Type 1 diabetes; my father's now in his
38th year as an insulin-dependant. That requires the glocuse monitoring on a 3-4 time a day regime, and multiple daily 'jabs'. Better than that, it requires a certain pedantry in watching his own diet meal to meal, which has become natural to him. All this has been revolutionised in the last handful of years with the coming of affordable, compact electronic testers, pen-type insulin dispensers and the result of much-enhanced freedom of choice in the interaction between requirements of daily life, diet and management of insulin vs. blood-sugar level. As a child, the kitchen fridge was always better-stocked with insulin and lucozade than milk, and you had to watch him like a hawk at weekends.
This, in Dads case, has been backed up with
excellent care and monitoring , diet review etc. managed between his own doctor (NHS) and the local hospital; and first-rate back-up on the (rare!) occasion where a 'hypo' has required medical intervention. The result is that at nearly 65 he is recently retired, in better health and more active than I can ever remember, has better eyesight than me, has no trace of nerve or capillary damage, and expects to be able to drive until he expires - at 96, according to his last estimate.
Posted on: 15 July 2004 by Tim Jones
Judd -
I don't think we ever actually got to the vicious circle I described. We came pretty close in the winter of 99/00, after which our nice Prime Minister threw a shedload of cash at the NHS, tripling its budget in real terms over five years.
We then spent a great deal of time and effort trying to prove that the money was being spent wisely...
Matthew's comment about private healthcare in the UK - that you're just paying for nicer meals and a colour telly - is exactly where the NHS needs to be. As waiting times for electives fall (slowly...) there will be less incentive for people to go private.
The interesting thing is that five years ago the media was full of horror stories about long waits ('My three year ingrowing toenail horror'). Now those stories are almost unheard of, so we're moving into a debate where the NHS is attacked more on the basis of the environment (eg cleanliness) and 'hotel services'. This has been a quiet but important shift and shows that at least some policy over the past five years has been right.
It has been a very bumpy ride - at least over the past two decades - but I think socialised medicine is one of the best things we ever did in this country.
Tim
Posted on: 15 July 2004 by matthewr
"Are you insulin dependant?"
Yes.
"diabetes care is restricted to glucose monitoring (which is done almost 100% in the US by self-testing machines with test strips) and, if needed, insulin injections - again, almost always self-administered"
All of which costs money -- the strips are about $30 for 50 and you need (roughly, it varies) 4 or 5 a day. I get as many as I want for free. Americans I know either get some (say 50 a month), lots, or none -- depending on their insurance. People in the US who are paying for them often skimp on the testing (which is bad).
Similarly with insulin, everyone in the UK uses a modern pen and cartridge system which is hugely more convenient and straightforward. I know many people in the US who still use bottles of insulin and syringes becuase they are paying and its cheaper this way (you can buy in bulk, cartirdes are slightly wasteful). I change my needle for every injection, people in the US frequently don't, and so on.
"What else is involved?"
I have blood (proper lab tests not glucose tests) and urine tests every six months. I can see a specialist dietician and nurse whenever I want. I see a Diabetic consultant every six months for a clinicial review. Once a year I have a battery of tests designed to trap the various complications early (eye tests, kidney tests, neuropathy, etc.). I also get all my NHS prescription charges waived.
"I'm convinced that the US does a horrible job with the provision of medical services for poeple with chronic conditions such as diabetes"
Private health care and insurance in general struggles with such conditions. With Diabetes it seems that it's prohibitively expensive to buy enough insurance to get the level of service we get in civilised
countries.
Martin said "it requires a certain pedantry in watching his own diet meal to meal"
Is he on Lantus or something similar? AFAICT it basically means you can eat what you want and, short of drinking pints of coke, I do exactly that and still have excellent numbers.
Matthew
Matthew
Posted on: 15 July 2004 by Steve G
A colleague at work was diagnosed with diabetes a year or two back and since then he's found that he seems to get a sort of fasttrack access to pretty much all NHS services.
Posted on: 15 July 2004 by Tim Jones
Steve -
It should be thus. As Matthew says, diabetes is an important risk factor in all sorts of things, especially vascular, ophthalmological (retinal capillaries), nephrology, etc.
Tim
Posted on: 15 July 2004 by Justin
quote:
Originally posted by bob mccluckie:
Youe system with all its faults does not fool itself that it is 'the finest in the world' as ours continually does.
Bob
surely you joke!! Our system DOES tout itself as the "finest in the world" and by some margin, I might add. It is one of our bigger whoppers. But data suggests otherwise. That said, it is difficult to judge the quality of a health system with references to life spans and infant mortality rates, as the first has quite a bit more to do with America's decedant lifestyle and the latter with the 40 million uninsured who don't get
basic medical care in the inner cities.
The reality is that in this case America is not in any way monolitic when it comes to medical technology and distribution. If you are upper middle class or wealthy (or have "good" private insurance) you will received the most technologically advanced medicine in the world. However, for a HUGE underclass, there is not even basic medical care available on a regular basis. It's a problem of distribution.
judd
Posted on: 15 July 2004 by Martin Clark
Matthew -
quote:
AFAICT it basically means you can eat what you want and, short of drinking pints of coke, I do exactly that and still have excellent numbers.
No Lantus, its just an old habit of Dad's to stay keep a strict grams-of-carbohydrate budget - its the accountant's approach
He does indeed have the freedoms you describe, but old habits die hard; the recommended regimes for diabetes have changed a
lot in nearly 40years. However this approach seems to have served him
very well in terms of overall control, stability and most-obviously, long term health.
Best regards,
Martin
