Sadie, i'm sorry for your mothers loss. I work as a bedside RN so insurance isn't an issue for me-thank God. carring for the patient is. I've seen the system change, though, in the last 6 years. Doctors who would never turn away patients, i'm talking PCPs (GPs), have been known to turn away patients. I worked for a short time in a community hospital were we would call MD consults- and we had to know the insurance coverage which was a foreign concept to me- some consulted MDs would refuse the consult or agree and not show up for the consultation so you would page them all day and they would ignore your page.
It is my understanding that for those on public assistance (the dole) or if they make bellow a certain level, there exists on the federal level medicare A (which covers some portion of Rxs) and B (which covers lab tests, ect...). Theres medicaid and i don't know the distinction but the feds cover 90% of the costs and states 10%- I think this is for disabled individuals that are collecting disability. In CA we have medical which is a type of supplementary insurance, and i don't know how much you can contribute. But I'm no expert- luckily the case managers deal with this shit.
Now if you have assests (like a house and a job and don't meet the criteria it is
whole different story). The number #1 cause of bankruptcy, I heard somewhere were people that were hospitalized without insurance or with inadequate insurance that basically lost everything as a result.
Somebody made a comment, and forgive me for missparaphrasing but something to the effect that if your sick and don't have insurance you will be thrown in the streets. This is not the case. In CA (laws could be different in other states) if you present to the Emergency department-
they are required to teat you, and if hospitalization is indicated, the hospital is required to hospitalize you. This is straining the healthcare system because people are using the ED for routine GP visits or something that could be handled by urgent care, or a skilled nursing facillity, adding to the strain on the health care system. You 9the patient) are still stuck with the bill. it typically runs $500.00 (a doc told me once that sadly 1/2 of ED presentations are uninsured so the cost would typically have been $250.00.
Then, if an ED doc thinks hospitalization is waranted, the patient is admitted by an MD with hospital priveledges (typically a hospitalists.)
Now living in San Diego, you get alot of patients that are unisured that go to the ED that are illegal aliens (typically from Mexico, but also Cambodia, Central America, Russia, ect...) These patients are required to receive all required treatments, tests, and their plan of care has to conform to practice standards. From my standpoint I treat them the same than say a VIP that donated to the hospital (typically their nicer, less abusive, and less demanding than the VIP). The Hospial has to eat up the cost of the hospitalization. Now, because opportunist defrauded medicare and other budgetary contraints our public health system is strained and medicare doesn't pay for the stuff it used to. there is a new list of criteria- mistakes made by the hospital some due to flagrant negligence, some like UTIs, falls, skin tears, difficult to avoid stuff- the hospital would have to eat the price. So hospitals are closing or getting rid of ancillary workers further diminishing the quality of care. Obama tried to require healthcare for all Americans- a noble goal when you see the lives destroyed- but what happens when your self-employed and have to buy healthcare out of pocket- healthcare exchanges were proposed- but i think that is was all a ruse by the right and left, lobbyied heavily by the healthcare industry, which is where the capital has gone in part, to get more customers under the ruse of altruism.
However, underinsured, i've noticed get cheaper meds, less tests ordered, and there is a push to send them home faster. Having said that, they, in most cases I've seen got the appropriate care. The best insurance is from the government- its called tricare. This is for vets and I heard doc in the elevator marveling that they pay for everything- their is no test they will disapprove- and that makes sence- vets are owed something for the sacrafices they've made- but I wonder when their rules are gonna change- returing vets are getting less and less needed services- however underutilization, not lack of services is the biggest problem I hear (especially for combat related psych issues).
Now if I was to go to mexico- go to a hospiatal- and get injured severly- they would bring me to a hospital (which is disconcerting), and demand cash upfront. Eitherwise they will wheel you to the street or keep you until you come up with the money-usually the helicopter from the US comes and gets you. (I had one patient that had cancer, went to mex for an "alternative therapy" contracted MRSA as a complication. He was brought to a clinic by his daughter (they lived on the US east coast). They held him until she coughed up $10,000, then they crossed the border and came to the ED were he received a 10 day course of vancomycin at the hospiatals expense. The daughter wanted to get him home early so after 5 days, they were discharged for the flight home. Bassically, he had depleted his assets in mexico and was treated- the hospital ate the fee( I'm guessing probably $30,000 all in.)
I was wondering, if I went to the UK or another EU country, Norway, Switzerland- the more wealthy Euro countries- If I was critically ill, as a foreign citizen, would I be covered under the NHS in the UK or require travelers insurance. My family is from Greece, a whole different world. When myGreek-American cousin's wife got sick in the 90s and she was an MD (think hippocritic Oath (sic)), she almost bled to death. The medics would pull over and empty her bloody bedpan by the roadside. Finally, they had the luck that one of the foremost GI docs was vacationing in the area. The village, with the police descended upon him and basically forced him to come. He did an EGD and got the job done (without anaesthesia- fuckin bastard)
- her bleeding was stopped and she narrowly escaped death. While in the hospital, my cousin would have to bride the doctors and nurses so she got good care. He would have to play this game were the MDs would refuse money because she was a collegue and he would play the game forcing them to take it which they would "reluctantly accept at the last moment." This was the vacation from hell- she was saying her goodby's to her family and she's an ER doc so id familiar with the s/s of impending death.
But Greece isn't the UK and things might have changed. This year, I heard the Irish health ministry issue an announcement to new RN to consider looking for positions in other countries like NZ, Australia, and Canada.
I think the quality of medical care is prety good in the USA- even in Territories like Guam and the American Samoa (were they have the well funded LBJ medical center).
But now our country and its health care system is ready to implode- Universal Coverage is something they should have instituted in the 50s when we had the money. The US from 1790- the 1990s managed to accumulate a $3 trillion debt. Now our debt is an astounding close to$14 trillion. My conern is were is the money gonna come from- their is gonna be painful cuts. atleast they passed a law that you can't raise premiums on children with prexisting conditions (our state is almost bankrupt too.)
