From the USA to Israel: Myths and Truth about Medicine in Developed Countries
If you ask residents of quite prosperous countries whether they are satisfied with their medicine, there can be unexpectedly many negative answers. Foreigners were tortured by formalities, long queues and high cost of insurance: for example, in the United States, patients are treated “without a soul,” and in Israel one has to wait for an operation for years.
America: almost paradise and insurance "on trial"
The model of providing the population with medical services in the USA works like this. The United States spends on health annually 16% of GDP - the most in the world. But there is still no equal access for Americans to its benefits. So, in 2018, 15% of Americans were not insured at all: the policy is too expensive, it is impossible to get an insurance subsidy. And without insurance, you can only use the services of non-profit medical institutions and emergency rooms. The latter are obliged to assess the patient’s condition and stabilize it, but not to heal further, writes Today.
Insurance programs, however, are also imperfect: they will write out too much, they will not prescribe what they need, they do not always cover the treatment of chronic diseases. A third of the population receives medical assistance for insurance programs at the expense of taxpayers. Medicare, for example, is the national insurance program for people older than 65 years and the poor. But enough of those who are not poor enough to claim it, and are not able to buy insurance. These can only rely on help in treating children up to 19 years.
In order to enroll in the medical university in the US, we need recommendations, scientific work and publications, says the Ukrainian otolaryngologist, Ivanka Nebor, who recently completed an internship at the Weill Cornell Medical Center (New York) and received a research position in Cincinnati.
“The competition for popular medical professions (residency) is very high. There are usually ten times more candidates for a narrow surgical specialty than positions, ”she says.
The medical profession in the United States is considered top-notch. “It's hard to get in, it's hard to study, it's hard to work," Ivanka lists.
To communicate with patients, everyone has an office and a secretary: he can check with the doctor and give recommendations on the protocol. Here is a clear division of labor. The doctor can answer questions only about what he is doing, the rest (documentation, for example) does not penetrate. The doctor’s personal number is taboo. The patient, however, also has every right to secrecy. All healthcare providers in the US undergo HIPPA training and know that patient data is not placed in a prominent place. Dispose of - strictly according to the rules, throw it in the trash - a violation of the rules and punishment.
In America, parents accompany children to the operating table.
“They take the emotional state of the patient and loved ones very seriously,” says Ivanka.
At the same time, relations with patients to a resident of a post-Soviet country would have seemed too businesslike. Admission to the clinic lasts no more than 10 — 15 minutes: during this time, the doctor manages to collect anamnesis, conduct an examination and give an appointment. No extraneous remarks, jokes, everything is strictly according to the regulations.
“No one is trying to establish close contact,” she says. “The system tries to neutralize unnecessary emotions and attitudes.”
We would say: without a soul to people.
“The explanations are short. If surgery is recommended, the patient receives printouts. Reads and asks questions on the next visit, ”says Ivanka.
The doctor's time is expensive: you can spend it on explanations, and the patient will think it over and go to another.
Before surgery, the doctor gives a document for signature.
“It describes the essence of the intervention, notes that the patient had the opportunity to ask questions and he agreed with everything,” says Ivanka.
Legal proceedings with clinics are not uncommon.
“According to doctors, every health worker has special insurance that covers lawsuits,” says Dr. Nebor.
“Our people manage to be treated clandestinely by immigrant doctors in Brighton Beach,” says Ivanka.
Insurance is not cheap. The employer officially buys the policy to those who work, but the program may be minimal and the dentist will never cover it.
“You have to pay extra for it yourself. And out of 5000 dollars of salary, 2000 dollars can go to the policy, ”says the Ukrainian.
Call a doctor to the house can only very wealthy people. In outpatient clinics, they are consulted by phone or asked to go to them (almost everyone has a car).
“An ambulance is also called only as a last resort - it is really very expensive. Most medications are prescription drugs: antibiotics, hormones, antidepressants. Consultation first, then recipe, ”she says.
The doctor's office personally contacts the pharmacy and gives instructions, and they pick up the “registered” antibiotics according to the passport. The label will have an individual dosage regimen.
“Without a prescription - antihistamines, sprays, antispasmodics. They are sold in special departments of supermarkets, ”says ENT.
Vaccination is required, and the list of vaccinations is wider than ours.
Poland: the diagnosis sometimes takes a year and a half
“It’s not a problem to call a doctor at home, and at a time convenient for the patient,” says Emilia Verbitska, a nurse-cosmetologist from Krakow.
The National Health Fund (NHF) covers all expenses if the insurance company cooperates with it.
“The doctors are qualified, the level of training is better than ours,” says Verbitskaya.
The cheapest policy is only 100 euros (112 dollars). Without it, a doctor's consultation - 150 zł (35 euro or 39 dollars) - for the average Pole, according to Emilia, it is quite affordable. But for a survey and analysis runs up already a decent amount. In Poland, they also raise funds for the treatment of children with cancer, their photos with a call for help can be seen even on transport.
“If state medical institutions cannot help, then in private ones it is very expensive,” says the Ukrainian.
The National Health Fund is funded from the pockets of working citizens and is expensive: the deductions increased the tax burden of interest on 13. An ambulance in Poland only leaves when there is a direct threat to life or an emergency (sudden chest pain, heart rhythm disturbance, bleeding, serious injuries). In such cases, medical care is free. But for an unreasonable call, the police fined PLN 500 — 1500 (115 — 350 euros or 130-390 dollars). With high fever and food poisoning, the Poles themselves go to the SOR (emergency medical service).
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Polish NGO “We are Patients” has compiled a list of absurdities in medicine from the patient's point of view. So, the amount of funding makes the doctor to minimize the diagnosis. In Poland, there is a protocol stepwise system for prescribing tests, which, according to patients' complaints, kills a lot of time. Has passed the initial tests - make an appointment with a doctor. He sends for additional examination or to a narrow specialist, and he, in turn, prescribes his tests and examinations. All these are queues and a long wait for the next visits. By the way, there is a limit on them too. Therefore, in case of ailments with especially difficult diagnostics (chronic, allergic), the diagnosis may take a year, or even two! But the problem is often solved by hospitalization for 2-4 days, during which the patient is quickly examined.
In institutions controlled by the NFZ, it is difficult to make an appointment with a doctor: they often ignore calls, and there is no online recording. Signed up - you can not cancel the visit or transfer directly to the clinic, only through the NFZ. There are no clear requirements for the technical equipment of the clinic, where the patient is sent automatically. If the drug is prescribed from the list of difficult to reach, the patient simply does not know where to get it. A patient card, even for the attending physician, is sealed: if it is necessary to correct the appointment, only through a request made by the patient. But inopportune correction therapy may cost life.
Turkey: queues and “just ask”
Private medicine is available here and is very popular. But the insurance services of private owners are covered in part, and state clinics - by 100%.
“An ultrasound scan for a pregnant woman without insurance costs 150 lira ($ 25), for insurance - 50 ($ 8),” says Yulia Najar from Didim.
The state clinics are clean, beautiful, dignified, but with lines, so it’s difficult without dating. Even knock out a ticket for the queue at times unrealistic (the doctor takes a certain number of patients per day).
“And you can run into“ there is no doctor, when he will be, I don’t know, and there is no other either, ”says Yulia. - But there is a service that monitors the quality of service. And if you scare her, it helps. ”
Medicines are free with insurance or with 40 — 70% discount. There are no informal boards:
“After giving birth, I ran after the doctor with a bag of whiskey, sweets and dollars,” recalls the Ukrainian. “He drank the whiskey with her husband, and returned the rest.”
Every hospital has an emergency department (Acil). If you need urgent help, go there, the ambulance will come except for an attack or loss of consciousness. Pediatricians do not go home: there is not enough doctors at one site, and the reception is a conveyor. Looked, appreciated, recorded, put off.
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“If the doctor is good, that's not bad,” says Yulia. - A doctor friend says that according to the standard, each patient should be given 25 minutes. But in practice, only 7-8: the line props. "
And in this queue there are a lot of those who came without a number at random (suddenly someone does not come), and who want to “just ask”.
But even if the treatment requires a lot of money, there is a way out.
“My husband's brother needed a complicated operation in Ankara. The insurance covered 50%, there was still another 20 lira (about $ 000) to pay, ”says Yulia. - We turned to the ministry with certificates and extracts, they say, it is necessary to operate, but the income does not allow. And after 3300 days the state transferred 7 to the hospital's account. ”
But, according to Yulia’s observations, Turkish doctors sometimes do operations when they don’t. Caesarean section, for example. It is profitable for them: according to the system of payment for each operation they are charged extra sums.
“They will scare my mother with the possible consequences, she is shocked and ready for anything,” she says.
But, of course, it is impossible to prove this.
Israel: patient endures to the last
Israeli medicine does not need advertising. The best technologies, equipment and doctors are here. But citizens are accustomed to using it according to rules that many “ours” would not like.
For example, in Israel, no one runs to the clinic just like that, check out and discuss well-being. At first, the symptoms are checked against the Internet and endured to the last.
“So, at a temperature of 38 ° C, children go to kindergartens and schools - this is not considered a problem, let the body fight,” says repatriate Victoria Shilo. - There is no prevention (in our understanding) as such. It is not possible to get checked “just in case” at the expense of the health insurance fund - only if there are symptoms ”.
But the patient from the risk group will be invited to be examined. For example, a woman older than 45 - for a mammogram, or after 50-ti to check the level of cholesterol in the blood. Every year, be sure to invite for vaccination against influenza.
Here, everything is controlled by the sickness funds. Choose one, make monthly installments (about 30 dollars with a minimum salary of 1400 dollars) and adhere to the existing rules in it. A family doctor can be changed only once a quarter, if you do not like it, and you can get to some specialists only in his direction.
“Ambulance (ambulance) is called in an emergency. But if you are not hospitalized, you pay for the call yourself (about $ 200), says Victoria. “Many, when it’s bad, take a taxi themselves and go to the emergency room.”
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And in general, doctors do not get bored without extreme need. After all, the hospital bills, and the health insurance fund closes it, considering the appeal justified. And if you do not see a real threat to the patient's health, pay for it yourself. Or if the problem is not within the purview of the box office (like many dental services). Their patients pay themselves - too expensive. But the cash desk (if the insurance package is advanced) will cover the cost of a nutritionist, IVF and pay for the treatment of cancer patients for years. You participate only in the purchase of drugs at 20 — 30% of their value (the rest is covered, their drugstores are covered at the cash desks).
If you need emergency help, they save you conscientiously. But if you need a planned operation - then in order for the cashier to pay for it, you must stand in a queue and wait. The severity of the situation is taken into account, but waiting for 4-6 months is the norm. If you want faster - pay yourself.
“I somehow got a seal,” says Victoria. - Gave the direction, I stood in line for removal. The turn came a year later. And the lump had resolved by that time. "
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