Before I start this post, let me just say that my goal here is not to be politically divisive. I do think that many Americans have misconceptions about socialized systems like the UK’s National Health Services (NHS), and many Brits are confused by the American private-sector system. Both of these might be dispelled by comparing my experiences.
As a backdrop, let me explain my health situation. (Don’t worry, nothing gross or weird!) I have only been to the emergency room once, after a car accident in 2006, and my sole reoccurring issue is that I get chronic sinus infections, sometimes as often as every other month. Other than that, I’m a healthy young woman. One other note, while in the US, I had really good employer-provided health insurance, so my experience is not that of the 48 million uninsured Americans.
Quality of Care
US: The quality of my care has been incredibly varied from neat rural clinics staffed by elderly family doctors to an over crowded ‘inner-city’ clinic staffed by medical students that had no record of my visit or prescriptions from the week before. My trip to the emergency ‘room’ in 2006 was especially scarring. I say ‘room’ lightly because the place was so packed that I had to lay on a stretcher with a neck-brace in the hallway covered in blood and glass. My incredible nurse did her best to comfort me, but had to keep leaving when police and doctors ran around shouting things like, ‘where is the baby?’ and ‘was it a gun wound?’. When my sister and friend Rob arrived, they were the ones who had to wipe the blood off my face. There was not even an available bathroom, so the nurse and my sister held up a sheet in the corner while I shook the glass out of my clothes.
For my sinuses, American doctors have prescribed it all to me: antibiotics, sinus washes, nose sprays, and decongestants. Over the past four years, several told me that the infections must be allergy-related and started to suggest more medications like Claritin. I believed them, until the last three months when I started to track my ailment. I realized that the infections were not seasonal and occurred with equal regularity in Nebraska, Colorado, Minnesota, Uganda, and the UK – incredibly different ecosystems and living conditions for a persistent allergy.
UK: Clearly my experience here in the UK is much more limited (3 months vs. 28 years), and I have never been to a NHS emergency room. Still, I cannot imagine a scenario (outside of Africa) much worse than my American ER visit.
For my sinuses, my British GP was especially helpful. During my appointment the two of us had a long talk about my health history and all of the different solutions I had tried. He printed me some information about sinusitis and told me that since both my mother and father are similarly plagued, I most likely have a hereditary condition. He prescribed one of the nose sprays that I had used before (and that my father uses) and suggested that I use it daily to prevent infection. I left feeling like someone had finally listened to me and given me a more thoughtful answer than the easy-out of ‘allergies.’ We’ll see how it works.
Access to Care
US: Anytime I had a sinus infection in the US, it was easy to get into a clinic within 24 hours. I would just call and fairly easily make an appointment for that day. Yearly check-ups and planned examinations were scheduled either over the phone or online, and could normally happen that same week. For other daily questions my insurance company had a nurse hotline to answer all of my questions, and my calls would get through in less than 5 minutes.
UK: An unexpected sinus infection here means that I am promised access to a GP (general practitioner aka doctor) within 48 hours at my local Surgery (clinic) where I am registered. There is also a local walk-in centre farther away where I can wait for more immediate care. Planned examinations are scheduled either over the phone or online, but the first opening will probably be available in a week or two. There is a nurse hotline, but the only time I tried calling it, the answering service told me that only emergency calls were being accepted and the wait would be up to half an hour. (Since that number was not the emergency line, I’m not sure what type of ’emergency’ caller would use that number in the first place and be able to wait half an hour on hold.)
Bureaucracy of Care
US: For my State Department candidacy last September, I had $800 of medical tests and exams done at a clinic run by a huge corporate healthcare provider. (Yes, I was uninsured at the time, and yes State will reimburse me.) The appointment itself was relatively straightforward, but tracking down my test results was not. The clinic filled out the required State paperwork incompletely twice. I would call the clinic but never be put through to the PA who had seen me, and was later told that she did not even regularly work there. Moreover, the clinic had a policy of not emailing patients, so my only option was voicemail. Finally, after I wrote a letter detailing my rights to my medical records, the clinic sent me the completed appropriate paperwork.
UK: Accessing my health records here seems no less bureaucratic. According to NHS information, I will need to make my request ‘in writing to the Practice Manager’ and pay an administrative charge of £10-£50. Doesn’t sound like a quick process either. On they other hand, they do promise that calls can be made directly to my doctor if I have concerns.
So there you have it, a few personal anecdotes of two very different healthcare systems for your consideration. Of course there is much more to say, but for now, I’ll leave you with these three issues.