It seems like there wasn't enough said about health care yet, so let's start a discussion here. Mainly the Finnish system vs the American one. They are very different. In Finland we pay with our tax money so that (hopefully) everyone gets health care by public health care stations and hospitals. Everyone gets a government heath care insurance when they are Finnish. Besides the public options, there are private hospitals and dentists that you can use, and employers often offer work related health care. Terms for this vary a lot, but they are often provided by the private facilities.
Complaints: for public options there may be long lines for different operations. This depends very much on the place. Private options don't get covered by the government insurance (you can get a private one too but people rarely do) unless they're for treatment of a sickness, in which case the insurance covers a part of it. Medication gets partly covered by insurance but can still get fairly expensive.
American system: people get insurance through work, by buying it themselves or through government options (Medicaid for poor, Medicare for elderly, besides these there are options for low-income families' children like CHP+.) These vary very much depending on states. In some states employers give more insurance than in others. Small businesses might not do this. Students in general seem to be covered well by insurances but if they have wives or children the insurance gets fairly expensive.
Without insurance people can still get treatment in emergency rooms. Hospitals pay for this (not sure if the state gives them subsidies - anyone?)
Complaints: Many people still don't have insurance, which they seem to be fine about until they get sick. Having read loads of credit reports in my former job I know that medical bills are a major credit problem across the country. If people are fine with losing their financial credibility this might not be such a problem - nobody goes to prison for unpaid medical bills - but for those who want to pay their bills this will be a major issue, since they tend to be VERY high.
In some states and insurance companies pre-existing conditions might be a reason for not getting insurance. Pregnancy mostly counts as a pre-existing condition, so if you don't have insurance in the beginning you will not be able to give birth without some serious hospital bills, unless you're poor enough to qualify for Medicaid (you have to be poor indeed since I've never qualified.)
In BOTH systems there are always complaints about delays or bad care. I've had to wait for acute care during after-hours both in Finland and the US, and I've sometimes been cared for faster than I'd ever imagined in both countries. In Finland this seems to depend on where you are, and how unlucky with timing (for instance, falling on ice the same day that everyone else does the same...) Also, a friend of mine keeps telling me Tampere has about the worst birthing facilities in the whole country. Bad luck if you have to give birth there (this might have changed, or be changing). In the US it equally seems to depend on place and luck, but of course you might have more of a choice. Unless your insurance, like mine, only covers their own place.
Covered everything important? What do you think?
Jun 1, 2010
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About the lines, nowadays there's this thing called "hoitotakuu" which means that you're entitled to get treatment within 6 months of the time your doctor sends the referral. Meaning not urgent care.
ReplyDeleteAlso there's a limit to the costs of medication and hospital bills etc. which is 3000 euros/year and after you reach that it's all free.
It's especially convenient for infertility treatments, since you usually reach the limit after the first treatment and then (if the treatment doesn't work) all other treatments during that year are free. From what I've understood is that in US the insurances only cover for two attempts (weather there's a baby or not) and that's the reason they usually insert multiple embryos simultaneously which causes a lot of problems. In Finland they insert maximum of two embryos and they recommend just one.
The waiting issue: what people need to understand (but often don't) is that sometimes the waiting time has nothing at all to do with money. I'm talking about the emergency here, now. In every country in every public or private hospital the most critical patient always goes first. So if the ED get a critical patient (or sometimes more than one) it means that the other patients just will have to wait. But of course, everybody thinks that THEY'RE the most critical and urgent patient. I can't tell you how many times I've wanted to say that "usually the whiniest patient is the least critical". :)
About US, I was under the impression that all people do get treated wheather they have insurance or not, but an american friend of mine told me that's not exactly so. She said that her friend was in a car accident and was taken to a hospital and had a bad fracture in her ankle and they said she needs an emergency operation. Then they discovered that she doesn't have insurance and just put some bandage on her ankle and sent her home.
I don't remeber if she said wheather her friend's ankle ever got operated or not, but it did sound kind of brutal and that's when I decided that I'd never work in a hospital in US. I just could not work like that. I could not send home people that should stay in the hospital.
But you're right that in both systems there will be those who complain. You'll never be able to make everyone happy.
What also upsets me in Finland (don't know how it is the US) is that the private clinics exploit people's ignorance a lot. They often just take the money, but don't take x-rays or pathology tests or anything like that. More often they don't even have anyone who knows how to put on casts. If the patients problem requires more than 20 min of their time they usually just send a referral letter to a public hospital. And people don't complain because they don't realize that they just paid 60 euros for nothing. I see that almost every day at my work and it really upsets me. Sometimes I even do tell people that they've got fooled.
I think more and more people have health insurances in Finland too, especially for kids, and use more and more private clinics. I'm one of them. With just one child and a smaller public clinic closeby I went there with him twice due to ear infection. Got an appointment for the same day - the doctor was horrible though. They combined the smaller unit with a bigger unit and never since have been able to get an appointment for the same day though started phoning right at the time phonelines open -sure they say come here and wait and someone will see you at some point, but don't really want to go there with many kids for hours to get all infections other people waiting there have. Usually don't even try anymore but go straight to the private. Try getting an appointment to some pediatrist - you'll have to wait 2+ months usually, more if they don't think it important at all. Got one appointment for myself - sure wasn't the most urgent, no limbs broken, but heart issues - had to wait for 2 months and the only option available was the doctor I really have no confidence in.
ReplyDeleteOur youngest, at 6 months had (had for a while) horrible breathing sound and reasons I suspected milk allergy. Got an appointment (had to wait for some weeks again) and the general practioner says - well babies breath a bit funny sometimes when they have a flu... Went straight to a private one and the issue was resolved (sure making the absolute correct diagnoses took some time, but the matter was taken seriously) and the milkprotein allergy and very severe asthma (at the time) were diagnosed and formula and medication received.
I love the fact we have free public health care here. Just that with the kids I've noticed how it really doesn't work in this area. I use the private for the kids, unless it is something that really is not urgent at all.
There are good doctors in public sectors and bad doctors, as well as in the private sector - but with the private you can choose which one you go to (and ours have been some of the best in their special fields) and you can pretty much go when you have to go without waiting. I like that. And am happy to pay for it too.
Oh dear... What I have been suspecting is probably true then. The health care center in our area sucks. Last time I was there, just a few days ago, I was directed to a nurse, and she smelled like cigarettes and looked like a drunk and seemed like she even was a little. I had a really bad flu and my throat was hurting like crazy and I'm pregnant due any day. She checked my throat and ears (the nurse!!) and said I may have a little ear infection. In the end she decided to ask the doctor to come and see me after all (thank goodness!) and there was nothing wrong with my ears, but throat was so bad the doctor sent me to the lab to check that I didn't have a bacterial infection there and would have to go into labor with a bad infection... And don't get me wrong, I appreciate nurses very highly (Sirpa, don't go ballistic ;), I was just horrified of the fact that a nurse was diagnosing me and could EASILY have just sent me home, without even seeing a doctor. And feeling the way I did, feverish, achy, sore everywhere, dizzy, coughing my lungs out, not being able to swallow and pregnant, I think a doctor was indeed needed.
ReplyDeleteI never ever had problems like these, or like yours, mormoniäiti, in Töölö, so I think the area must make a big difference... Sigh. We don't have a private insurance, because you're not supposed to need it in Finland :( And until now, we've been satisfied. Can't wait for next winter and how it'll be with three kids. :/
I'm a bit upset about HUS anyways, so I can understand. Then again, I've had good doctors and treatment both in Kallio (and that's a big place!) and Kirkkonummi (for a workplace accident). In Kirkkonummi I had to wait for a doctor for a couple of hours since there were all these people who also had fallen on the ice... But at that point a great nurse had already glued up my face and I just had to see the doctor for insurance purposes since it was a workplace accident.
ReplyDeleteThe only time I've had trouble is in Marian sairaala, where they moved all the after-hours care. And with bad treatment I can understand you, mormoniäiti, and Sara too. I think HUS is doing some bad decisions based on money.
What will be more interesting to me is how the public reacts when governments lose the ability or inclination to guarantee health care for their citizens. People (in the US and elsewhere) have generally come to believe in health care as a right, something that society owes them regardless of their ability to pay for it.
ReplyDeleteFor the past few decades, government services in many nations have been funded by a series of speculative bubbles, phony growth, and paper assets. Those days are over, and if the various economic theories of statism, corporatism, or phony-lazziez-faire capitalism are capable of promoting and sustaining unlimited organic economic growth, they certainly haven't done it yet. Instead, they've generally concentrated wealth and power in the hands of a political and corporate elite, buying off the votes and acquiescence of voters with things like universal health care.
Fine and dandy (if you don't mind losing civil liberties), but what happens when a government's priorities (accumulating wealth for an oligarchy and power for a political elite) start preventing it from fulfilling ever-expanding voter expectations? We are hitting that now.
I think one of the problems in the US is that things don't go how you want to, you sue. No matter how the doctor said there is only a 60% chance of this procedure working, people just expect to always be in that 60%. Things happen!
ReplyDeleteI've noticed lately that they tend to go way overboard in their evaluation and tests. Before when I had a sore throat they'd look and go, Ok, sore throat. Let's do a culture. Now they do the culture, bloodwork, preferably a chest x-ray and what not. Some people see it as trying to get as much money out of the insurance companies but I can see it just as much as a 'covering their butts' for litigation.
Just read that malpractice litigation is up in Finland as well. Wonder how much of it is actual and how much is similar to here.
As far as hoitotakuu in Finland... as far as I know it's not working very well. No one really says anything about it publically. My brother recently had knee surgery and they said about 18 months wait if he wanted it done publicly. 3 weeks on the private side and they got about 2/3rds back.
You are fine in Finland in public health care as long as you're in your own area (hoito piiri) when you get sick. Last year my mom was in the Turku archipelago and had a gall stone attack. The coast guard picked her up and took her to Raahe (closest hospital to the island). This was about 2am. At 8am when she had gotten pain medication and started on IV, the hospital there called Jorvi and set up the transfer because she was out of region. She was transported by ambulance to Jorvi (took about 3 hrs I believe), Jorvi was well aware when she was leaving and when she was getting there. She still waited 8 hrs in the corridor before anyone even looked at her. At that point it was so bad that her gall bladder was inflamed severely and the infection spread to her pancreas. Took over a week before she could leave the hospital (no surgery yet) and every other day they did a test, then wait for the results for the next day, repeat etc. I have to say that in the US those tests would have all been done in a day or two and the person could have gone home faster. Great use of Finnish tax money... She was there for 9 days instead of maybe 3 when she was stable. Then when it came to set up the surgery to remove the gall bladder the doc said Oh it's at least 3 months out (she would have had to take meds the whole time) and then added, but in reality probably closer to 8 or 9.
Think what one wants about the future US health care plan but when someone comes up with that everyone will have but makes oneself exempt from such health care plan... makes me weary!
Sirpa:
ReplyDelete-'What also upsets me in Finland (don't know how it is the US) is that the private clinics exploit people's ignorance a lot. They often just take the money, but don't take x-rays or pathology tests or anything like that. More often they don't even have anyone who knows how to put on casts. If the patients problem requires more than 20 min of their time they usually just send a referral letter to a public hospital'-
I've used private clinics for several times. And there has been reason for that. As I visited public care doctor last year ( I met3 doctors) and was left empty handed. For some reason I got no help. My mother send me to private clinic, and they instantly reacted and gave me all the help I needed. I had two surgeries after that, and they asked direcly if I wanted to save money and use public hospital. I was very pleased that they gave me the option to choose. I desided to do it 50%/50%. everything worked out well. But as I met my own doctor in Espoo again later she was a bit lazy about my condition. And for that reason I'm willing to see private doctor next year, just to make sure that If something is wrong- someone reacts. Anyway, this was third time when I had to use private care system, and there the staff has beed very helpful and most of all very proffessional indeed. Maybe just bad luck, but yep ... catch up HUS! I think private hospitals do much more than take money.
If I catch a flue etc... seasonal virus , I always see doctor in my own healtcare center (public care). And I always get help. I like the idea that I do not need to worry about insurance policy if something happens. I have a child, and in general waiting lines haven't been too long.
In the United states I got help too. I actually broked my arm. It took awhile until all the paper work was done, and after that they took me to x-ray room. It was painful to wait as they tried to manage with my insurancecard. anyway they gave me good care, but it's just took a little more time (or maybe the pain did the time feel much longer than it was?!)
My baby sees doctor every now and then ( public care), everything works well. I'm very happy about our finnish 'neuvola' system for new borns and moms. It's amazing how well the system runs. It's not perfect but Í don't want to live without it anymore. How does it work in the USA? I have no clue about the system there. anyone?!
Finnish system is very expensive to maintain. still I see that Finns feel it's vital to have this system. Willingness to pay taxes for healthcare purpose makes sense to people and it's part of our society now days. I just hope that our tiny country would somehow make more money, that we could make the public care even better.
Niina: I wish public care was better on some areas too. Some are fine! Seems like the crappiest care in Finland you get around Espoo and Helsinki, at least looking at these comments, but even there it depends. But yes, I think taxes should be concentrated in the areas that really matter and that don't work very well without them: health, safety, basic income for people who can't do it, transportation, public lands, arts and culture... I might be forgetting something. Sometimes it feels like too much is going to just "running the system".
ReplyDeleteNeuvola: gift of the '70's or '80's? Still, quite an amazing system. Unless you're unlucky and get an annoying nurse. In America all of babie's and pregnant women't health care goes through the hospitals and stuff... if you're lucky (or rich) you can choose very much where you go, but if you're on Medicaid for instance, or live somewhere far from places the choice is more limited. Or if your insurance through work only works in one place.
I think individual experiences are difficult to compare in systems so different as in Finland and America...
Tuittu: Sara's and Mormoniäiti's experiences have nothing to do with HUS. It was their area health care clinic they're not happy with.
ReplyDeleteSara: no offence taken. I know you get all sorts of people in doctors and nurses. And probably there's people in every occupation that don't really know what they're supposed to do.
I knew this topic would get down to a lot of personal experiences and I agree that the good thing about private clinic is that you get to see the doctor sooner, but too often it's all you get. By working in ER we get patients sent to us from the private clinics ALL the time. The kind of patients that they should have taken care of themselves, but if it's anything they actually need to do something more about than just write a recipe they won't do it. Even if the patient is willing to pay for it. And it's not just a couple of seperate insidents. It's a rarety if they don't send someone to the public.
It happens even more with the kids (probably because they private clinics and health insurances are mainly used by the kids). Too often I've had a confused parent asked me: "why did they send us here. Why didn't they take all these tests in the private clinic. We have insurance." I've been tempting to tell that the reason is probably that they get better profit by sending you to be somebody else's problem rathet than doing the time consuming tests there.
We stopped paying for the insurances after I saw how it all works and we never needed the insurances anyway. For us the public has been working just fine. I suppose it also helps to work in a hospital so if all you need is a recipe, you can just go to work to get it :)
It is a problem that thus far in the public clinics you haven't been able to choose your doctor, but that's atually about to change. You can even choose the clinic you want to use so Sara, in the future you can still use the health care clinic in Töölö.