As I have read the many tales here of dealing with AF in the past 7 months, I've grown more curious about what's it's like to get treatment in our different health care systems. I'm aware of the US, UK, and Australia being represented here, though I imagine that people from other countries participate at the forum, too.
With the current political climate around health care in the US (as in, will some of our politicians really succeed in their desire to take health care away from millions of us?), I'm grateful for every bit of health care I'm able to get...even if the docs sometimes drive me crazy!! 😂
The cost and availability of an ablation can vary within the US, depending on what kind of insurance you have. Here are some things I'm curious about -
In the UK, do you pay anything out of pocket when you have an ablation?
Do most people use only the NHS or can you purchase private insurance, too?
How about in Australia? I know nothing about your health care system.
Do you have much choice about the doctors you see?
My first ablation 6 years ago happened just before the new law went into effect that prohibits insurers from refusing to cover care based on pre-existing condition (thank you, President Obama!) So the insurer refused to pay $147,000 in bills. I fought them and eventually won, but it was quite something.
The $104,000 bill for my ablation has written at the bottom: "Please pay in full at your earliest convenience." 🤣
For my second ablation, I ended up paying only around $250 after wrangling for 4 months with insurance and hospital billing about mistakes on the bills.
When I'm making decisions about care, especially about an ablation, the financial aspect is at the top of my list of concerns. I've learned enough about the system to know how to slog through the mistakes and keep them accountable, but still, it's quite time consuming.
I'm wondering if these types of concerns come up at all in other countries. I'm curious if my assumption that you don't have these kinds of financial headaches with health care in other countries are true.
NHS puts health care free at point of service so if they will do any operation or procedure it is free. When is an entirely different matter!!! Waiting lists vary from six months to a year or more and in some parts of UK I believe that some operations and procedures are not covered.
Yes you can take out private health care policies to hopefully short cut the system and many managerial jobs do include this in the pay/reward package. Some even include it for spouse and close relatives.
So if you have a private policy, can you basically jump closer to the front of the line for a procedure?
Even if someone had really intense AF and was badly in need of an ablation, would they still need to wait that long?
Can you look in different cities for a doctor or a shorter wait time? Or are you restricted to your local area?
What a tremendous amount of hassle it would save everyone involved for patients to not have to pay anything for a service. No system's going to be perfect, but taking out the billing nightmare has got to be a vast improvement. So then I'm guessing that you don't even see a bill.
Nella, the point is that any and all treatment for AF is only ever about improving quality of life as of course there is no cure.
Ablation may not be offered if the risk/reward balance is wrong. Sadly we fear that in some countries doctors who get paid by patients do occasionally put income before the patients welfare. There are probably far less EPs per 10.000 patients here in UK than in some places and as a result the pressure on them is high so any procedures performed are on the whole deemed necessary. I do know of people being refused the procedure for either life style or other health reasons as success would be unlikely and risk would be equal. It really is a hard balance to make and I would not wish to be in that position.
That's very interesting, Bob. It's good to hear that that financial factor seems to be removed. It's far more sensible, as is taking into account factors such as lifestyle in the decision making.
I have had direct experience with doctors who put income before patient welfare and it is not much fun. The financial factor in health care looms rather large here in general. In response to the improvements made to the system in recent years, some doctors' response is to refuse to treat patients who have this new government-subsidized insurance. One of my recommended EPs was in that camp. My health and the risk/benefit was not even on the table. They would simply not make enough money from me, so they refused to even see me.
Fortunately, I found another EP who did take my insurance. One must be mindful of these kinds of things, though.
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I think Bob will agree with me Nella but using private insurance with a view to queue jumping is severely frowned upon and NHS employees will do their best to make sure this does not happen. However, because initial consultations can take several weeks, even months, for peace of mind some will opt for a private consultation but the waiting time for any procedure to be carried out and funded by the NHS will not reduced. A recent post from Oyster shows that whilst GP’s may encourage patients to be treated locally, patients do have the right to be treated at any NHS hospital but it is unlikely that you can insist on having a specific EP and if you try, the waiting time is likely to be even longer. If someone’s condition is chronic and potentially life threatening then it is likely that a procedure might be quicker but fortunately, it is rare that the need for an Ablation falls into that category. In the U.K. we are lucky, but don’t forget, we pay for the services we receive through our taxes so it is not free although those in need may not contribute as much as others. All in all, we are fortunate to have the NHS plus, for those who can afford either the insurance or the direct cost of treatment, the option to have their treatment within weeks rather than months.......
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Yes, of course, I recognize that health care is not free, and I understand that you pay for it through your taxes. Even with higher taxes, it seems that it would be a relief to not have financial pressure added to being sick in the form of astronomical bills.
I am hoping that the powers-that-be here will come to the conclusion that increasing taxes so as to fund health care that doesn't bankrupt people is a more sensible approach and ultimately better for everyone in the long run. We'll see!
In the meantime, it's interesting to learn how care is handled in other cultures.
I think that here in the US, many people do like to be able to have some choice with doctors, etc., not that the current system really allows for so much of it. But having more money often does mean that you can access better care.
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As a fellow cat lover, almost all veterinary care here has to be funded privately and apparently, more medically minded folk are attracted to veterinary care than human care because the rewards can be much greater! Fortunately, there are some animal charities that do very good work for pets owned by folk who cannot afford to pay some fairly extortionate fees!
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In honor of your comments, the Real Nella, is having a ball chasing her tail!😹😹
Our vet care is expensive, too. Good thing she’s so cute.😻
the posts above from UK forum members are understandably specific to NHS treatment of atrial fibrillation and atrial flutter. The NHS is magnificent if there is a possibility of life-threatening disease, for example referrals for possible cancer are within two weeks. I had a phone call from my doctor at 6 pm on a Friday saying that my PSA figure - possible indication of prostate cancer - had nearly doubled. On the Monday I had a letter from the hospital with an appointment for that Thursday for an MRI and a discussion about the MRI results with a specialist oncology nurse. That was followed in days by a biopsy and we will discuss the results next week, 14 days after the biopsy. I have also had exemplary care from the NHS once I was diagnosed with pulmonary toxicity secondary to dronedarone and amiodarone. The NHS struggles with increasing demand, shortage of staff, funding, inadequate buildings, and sometimes clinical mistakes, but in general it does a magnificent job and has kept me on this planet.
That's very interesting, john-boy-92! Glad to hear that you received such excellent care.
It's interesting to learn the ways the different countries represented here have chosen to design their health care systems. I suppose there will always be complaints, shortages, imperfections, etc., but the big question is how do we eliminate the greatest stressors? Which, these days in the US, is the financial burden people end up getting stuck with.
Hi Nella, while we work we pay National Insurance which is deducted automatically from our pay, this goes towards health costs. Then quite separately, as other countries, we pay a tax on what we earn. I worked many years for a large company that gave free private health cover, so at that time was able to receive private healthcare quite quickly. Don't have it now though as it's too expensive for a lot of retirees. All in all, apart from waiting times to see a consultant our NHS is very good.
Last year I had a squamous carcinoma appear just above one of my knees, saw my GP one week, the consultant the next and had it removed a few days later. Now I go for check ups every three months - now that's service!
A friend who had suspected cancer last year was whisked through the NHS system. I witnessed the service she received and the speed and kindness was nothing short of amazing.
In short, if it looks as though you have something life threatening you get through the NHS system quickly, otherwise there could be a wait of a month to a year - hip, knee replacements as an example of a lengthy wait.
Thanks, Jean. That sounds quite sensible and, ultimately, better care all the way around!
I think that the health care system reveals a lot about the values of a culture. So many countries understand that the care of people should come first, and not profit.
I’m hoping we’ll get there in my lifetime. In the meantime, the status quo is good incentive to do all I can to take care of my health!😂
As Jean says, if you need urgent treatment/investigation you usually get it. I developed a breast lump recently, was pretty sure it was a cyst but took it to the GP anyway, she referred me 'under the two week rule' ie for suspected cancer, and in ten days I was in hospital breast care centre having examination, mammogram, ultrasound and 'phew!' cyst drained. Wonky hip is another matter 🙁
It must have been a relief to be able to get in quickly and have it taken care of! Glad it wasn't serious.
I had a suspicious mass on a mammogram, then an ultrasound and radiologist who wanted to do a biopsy. In the necessary American way of doing health care, I had to ask how much it would cost - $3000! 🙀
Then a miracle happened...
I went for the biopsy, but in the ultrasound, they couldn't find the mass!! My lucky day...
I later went to another doc for a second opinion. She saw it, said the technician hadn't been holding the paddle properly, but that she wasn't worried about the mass. My acupuncturist had encouraged me to eat seaweed regularly, since it has properties that can help reduce these kinds of masses.
It worked! The thing had disappeared by the next visit.
In the UK you can jump the queue by paying for a private consultation with a cardiologist. You`ll see him (or her) within a few days. Then ask to be referred on the NHS. It cuts the wait down for the initial consultation and will cost around £180 - £250. Worth it IMO.
Different countries seem to have different ways of doing things.
I`m in Bucharest as I type this - I work abroad. I know for a fact I could book a CV for Monday and have it done and dusted here. It would be cheap to have done - I think having it done privately in the UK costs about £1800. Over here the cost would be a fraction of that.
I`m on the waiting list in the UK and booked in for May 11th to have my CV. It will be the third one - however I`m on 200 mg Flec a day. Fingers crossed the two combined will keep me in sinus. If I can get a few years out of it I`ll be well happy.
I would have it done here but the doc`s in the UK have told me, either be treated abroad, or go though the NHS.
That`s what they have said - no middle ground. It seems daft to me - I could have my CV done here and reduce the burden on the NHS.
Each country seems to have a different way of dealing with a-fib.
Nella wrote;
.......I'm wondering if these types of concerns come up at all in other countries. I'm curious if my assumption that you don't have these kinds of financial headaches with health care in other countries are true.........
Yes I think so. It tends to hold true anywhere in the world. The UK is great for treatment - better still if you have the funds to pay. The same for eastern Europe - if you have the funds you`ll get treatment there and then.
I cant answer totally for UK but in reverse Australia :
Residents of some countries may qualify for access to Medicare via Reciprocal Health Care Agreements (RHCA). The Australian Government has RHCA with the governments of the United Kingdom, Sweden, the Netherlands, Finland, Norway, Malta, Italy, Belgium, the Republic of Ireland and New Zealand.
Under the reciprocal healthcare arrangements, British citizens resident in the UK and travelling on a British passport are entitled to limited subsidised health services from Medicare for medically necessary treatment while visiting Australia.
This will not cover everything but in an emergency they will be fully covered the same as any citizen.
I have never taken out health insurance for travelling in or to the UK because of this agreement - used it a couple of times over a thirty year span.
does the NHS only include England?
No - all UK - Scotland - Nth Ireland - Wales - England
Kaz could probably explain the Australian system better as she has been through the private Health system .
Australia has Public Hospitals that treat Medicare (NHS) patients but they also do private ( insured ) patients . Then there are Private Hospitals which only treat fully insured patients or non insured - that is you pay all bills after Medicare rebate is taken out.
My Cardiologist is Private but he works in both systems so he can put me straight through the Public system very quickly.
A CV would take only 7 to 10 days from first consultation but any major non life threatening procedure ( hip replacement ) could take years on the Public waiting list .
Like the UK a tax is paid for health but billions are added to that by Govt. funding's - each Australian State also has a Health budget funded outside of the Health tax.
You can pick your GP and change at will , some charge the Medicare rate so are essentially free others have a surcharge on top of the Medicare rate ( can be double the rate ).
Most drugs are subsidized by 90% and those with a Health Care Card only ever pay $6.50 for any script.
So mostly if you use private Insurance you will be treated in a Private Hospital and if your a public uninsured patient you go through the Public Hospitals - but there is always a cross over at times. If a particular procedure is having an unacceptable backlog the Govt. pays the Private Hospitals to clear up some of the backlog.
I wont try to explain the difference between Commonwealth funding of health and the various State Health systems - just to say they vary .
Thanks, sleeksheep. That's very interesting.
Am I correct in understanding that everyone will have medical care, whether employed or not, no matter what their income level is?
Before President Obama got the Affordable Care Act passed (known as Obamacare), American insurance was pretty much entirely connected to employment, unless you were really poor or 65 or older. It was also legal for insurance companies to deny paying for coverage on the basis of "pre-existing condition." They would declare that you already had whatever condition you were being treated for and so it would be too expensive for them and so they wouldn't pay for it. That's what they did in my case, though I beat them, in spite of all the mistakes the doctors made on my medical records. I had to prove that I didn't already have a heart condition, which I was able to do.
Obamacare made the pre-existing condition nonsense illegal. I'd never experienced a public policy change quite so personally. I wrote President Obama to thank him and got a lovely note in return.
As the owner of a small business, I've discovered that I need to be sure that I don't make too much money, as weird as that sounds. The monthly insurance premium is based on my projected income for the year. At tax time, in April, if I've made just $50 over the specified income limit, I will have to pay the government back all of the subsidy, which can be around $6000-$7000.
It's all better than it used to be, but there is room for improvement! It will surely be the main issue in our next elections.
A lot of people have really good insurance if they have good jobs and the standard of care is good, too.
Am I correct in understanding that everyone will have medical care, whether employed or not, no matter what their income level is?
Yes everyone has universal health cover , if your outside the capital cities or large regional Hospitals the Hospital , Surgeons , etc, will be the same for private or public , the only major difference is you have a choice of who treats you if your insured otherwise as a public patient you get who is rostered on.
I've discovered that I need to be sure that I don't make too much money, as weird as that sounds.
In Australia if you dont have private health cover and earn over $90,000 single or $180000 families you get charged a Medicare Levy surcharge of 1% - its a way of encouraging private Insurance uptake.
As it stands 2% of all tax collected is directed to the Health budget by way of the Medicare Levy - but thats just ongoing not covering Infrastructure .
As Sleeksheep has said, in Australia everyone is entitled to medical care under Medicare. If you are working and paying income tax you pay a 2% Medicare levy. If you are a pensioner, are unemployed or don’t have a taxable income you won’t pay any levy but are still entitled to be treated in a public hospital for free. If you have a life threatening emergency (heart attack, car accident, major trauma) you’ll be taken to a public hospital and receive amazing care and not pay anything.
The waiting times for non emergency problems can be long though so that’s where having private health insurance comes in. You can see a specialist a lot quicker, have whichever doctor you want and have surgery performed in a private hospital quite quickly.
Medicare covers payments to GPs, medical specialists, pathology, radiology, public hospital admissions, etc. Sometimes there is a gap that needs to be paid by the patient, eg a GP may charge $70 for a visit but Medicare only rebates $40 so you have an ‘out of pocket” expense of $30. For chronically ill patients, pensioners, etc most GPs will bulk bill meaning they only charge the Medicare rate and the patient has no out of pocket expense.
Private health insurance covers admissions to private hospitals and gaps between the Medicare rebate and what doctors who treat you in hospital may charge. We have top level cover and the premium is now around $450 per month but I have paid nothing for my hospital stays and procedures. Private health insurance also covers dental, optical, physio, etc. I recently purchased a $1500 CPAP and got a $720 rebate from my private health insurance.
Ablations here cost $20-25K including the overnight hospital stay so far cheaper than in the US.
Medicines are covered by the Pharmaceutical Benefits Scheme (PBS). If you are a pensioner or hold a concession card you pay $6.50 for your medications. If not you pay a maximum of $40.30 or the actual cost of the drug if it is less. In my case I pay $40.30 for Xarelto - the full price is $87.40, $20.55 for Digoxin (200 pack) and $18.25 for Atenolol. There is a PBS safety net too so once a family has spent $1500 on drugs in a year, the price is reduced to the concessional rate $6.50 for the rest of the year. Last year we hit the safety net in August so had a few months of cheaper medications.
Hi Nella, private health insurance is paid for by the individual and there is a small government subsidy to help, the amount of which depends on your income. I was at an event recently talking to a senior marketing manager from my health insurance company saying how grateful I was to have been a member for most of my life and that I was taking out much more than I was putting in. I’ve now been asked if I’ll do a video testimonial for use on their social media platforms. I’ve said I’ll think about it.
I'm in the province of Saskatchewan, in Canada, and we have universal health care here. Paid for by our taxes. Visiting a physician is free, we can pick anyone for a GP. No charge for tests either. Some provinces have a small user fee, (30$ or so), but generally all health care in Canada is free. We pay for our medications, but we have subsidy programs, based on our income, so most of the cost of prescriptions can be covered. (For example, I pay $25 for 3 months of Apixaban (Eliquis), and my private insurance refunds me $20, so it costs me only $5 for 3 months.)
The GP makes the referral to the specialists, we can ask for anyone, and if the GP agrees, fine. Most specialists, if not all, will not take patients without a referral from a GP, so it's very difficult to bypass the waiting lists. Most waiting lists for specialist visits and surgeries are based on urgency of need. If you're in urgent need, you get bumped to the top of the list. There might be an additional cost for hospitalizations, if you ask for a private room. Standard hospital care is covered. (But you pay for the TV in your room).
Ambulance trips are not covered.
Most of the physicians get paid by the government per procedure or per visit. There's a small number of clinics that have doctors on staff, that are paid by the hour. It's a wonderful health care system, and I have difficulty understanding why the U.S. does not have better health care for everybody.
Finances are NEVER a concern here when you're considering a procedure or a doctor's visit.
I could write pages about our health care, but will stop here.
By the way, universal health care in Canada was started here in the province of Saskatchewan. It's a national policy, but provincially administered, so there are a few variances with the minor details from province to province.
I thought of running away to Canada more than once during my 2013 adventures with my diagnosis and ablation! 😂
And I strongly considered it again after that person who will not be named somehow landed in the White House. The best role that he continues to play is to wake people up.
I am actually hopeful that significant changes will come about in health care in the next few years. Even since 2016, as pathetic as the situation has been politically, there has been a significant change.
Not sure how much folks abroad follow it, but we have had a vocal contingent of politicians who were gleefully hell-bent on dismantling Obamacare, thereby taking away health insurance from millions and millions of people. For real.
Hence the waking up I mentioned. Lots of those dopes got themselves voted out of office in the most recent election.
The ones remaining seem to have learned a lesson from that and managed to rein in the guy in the White House, who recently declared -again - that he wanted to prove the entire Obamacare law unconstitutional. Then he changed his mind. Again.
At least they get that, no, we will not stand for them stealing what health care we have.
We watch the news in disbelief, when we see that yellow-haired guy in the White House telling lies after lies, and in his rallies, he's still got people cheering for him.!! Unbelievable!!
And dismantling Obamacare? Why? It needs to be carried forward, not backward.
We have definitely had a lot of US people come across into Canada in the past few years.
It must be very scary to have a chronic condition, like AF, knowing you may need surgeries, which you may or may not be able to afford.
I think Canada is the safest place to live!!!
Although my husband just told me I'm lucky I'm using a code name, or 'someone' might send his goons after me. LOL.
Haha! He'd probably come looking for me sooner than you. I sent an email or two in the past to him before realizing what a waste of time it was. 😂 Apparently, he really doesn't read anything.
As far as his followers, I consider it a cult of personality and they have been taken in hook, line, and sinker. The worst, IMHO, are the politicians in his party who have enabled his behavior all along.
The having AF and dealing with insurance part was actually much scarier back in 2013 than it is now. Back then I was far sicker, had never had a problem with my heart, had never even been in the hospital, and had never had to navigate that kind of insurance nightmare.
Fortunately, my primary care doc (GP) is amazing. I'll never forget talking to her about whether I should have an ablation. I had no idea how much it would cost, no one would tell me, and I had no idea if any of it would be covered.
It was a matter of not having it and getting too sick to work and crash financially or have it and possibly crash financially. Yay! She told me her patients faced these decisions every day and that I should put my health first and the financial would sort itself out. So that's what I did. And then got the bill for $104,000 for the ablation and one night in the hospital. Plus another $20,000 for the EP, anesthesiologist, etc.
I'm actually rather proud of how it all turned out. I was sick, vulnerable, ignorant, and overwhelmed, but I made my way through it over a year and a half. Like I mentioned, I learned great skills for getting things done in bureaucracy. There were a lot of miracles along the way, too. I was tenacious and persistent. The final thing I did to resolve it all was hand-deliver a letter to the CEO of the hospital system in which I told him my story and asked for his help. Within 3 days, I had a $0 balance. My story was later included in a longer story in the NY Times about health care nightmares that was intended to educate people about this kind of stuff.
It was scary when the Republican Congress tried to trash Obamacare a year or two ago. I made a lot of phone calls to members of Congress, told my story and asked them if they'd want their family members to go through this kind of thing. Lots of people made calls and I read that this made a difference. Those attempts at killing it got a bunch of those politicians voted out, so I do think the tide has turned.
I've basically learned to not let fear about it all take over my life.
I have decent, though expensive, insurance now, and I know how to work the billers and insurers to save money. For the last ablation, I saved $5000 by forcing them to be accountable, as they regularly screw up. I connected with a nice, sane hospital billing manager who promised to help me if I return. Not typical patient stuff, but it works for me! 😂
The health care situation is, in part, why I've explored metabolic cardiology, work with a naturopath, and have looked for approaches that might help me other than relying on medication (too strong) and ablation. It turns out that so far, these approaches have helped me more than the 2nd ablation did and my docs don't recommend a 3rd.
It's been a crucible, for sure. I've tried to make the best of it, hope that Canadian-style sanity will enter our health care system, do what I can to help, and hope the changes we need will happen.
Here you can see what happens with our healthcare system. You either pay for health insurance which the costs are rising above the inflation rate every year or you go into the Public System. The public system is very good although people complain about it all the time. They want to see how long wait times are in other countries. I have only had experience with the UK and Australia systems having spent my first thirty years in the UK and the next 40 years in OZ. Am I glad I came here?......YES I am. I have always had health insurance but it is getting more and more difficult to keep affording it. The health funds are constantly cutting services so you get less cover for more money. It is certainly still worth having as I have found out this year, the first time I have really called upon it in excess in 40 years. I have had a cardiac angiogram, a pulmonary vein ablation, colonoscopy and endoscopy and 4 days in hospital and my out of pocket expenses have only been $AUD500. I only have to pay that $500 once per year, so as I have Top Cover all other admissions to hospital are totally free for this year starting 1st January 2019. I have my choice of doctor Whereas in the public system you usually only see a registrar. He/she is accountable to their senior so whilst you may not see a Consultant, they are advising from the sidelines. We are known as the Lucky Country and it sure is.
Thanks, lizardo.
I think that some of the fears around making major changes to our current system are about long wait times and losing services, things like that. And it's such a huge, complex, entrenched system, that it will require a major overhaul. Those making so much money don't tend to want to lose it!
Doctors are wealthy in the States. They need to make a lot to pay for their very expensive training, but it still strikes me as ridiculous how much money some of them make.
I'm wondering if docs are as well-paid in other countries.
I know that I'm unusual because of my experience, in that I saw the "underbelly" of how some private insurers would take advantage of vulnerable patients before certain regulations were put into place with Obamacare. I worked with an amazing Health Care Advocate who helped me navigate the system and ultimately beat them.
I've become passionate about advocating for health care reform in the US from the experience. I saw firsthand how people can go bankrupt and I also saw that literally everything is negotiable in health care. I got over $20,000 in bills written off just by asking! Hospitals have a Charity Care fund that they don't really advertise, but they'll write off bills if you can't pay. Most people don't know about this. I still regularly get bills reduced or written off or things covered that are not on my plan. I just ask for it. That was a benefit of the first ablation experience.
As challenging as the experience was, I'm actually grateful for the skills I gained and the strength I got from it all. Those skills have been very helpful in the years since. Life brings difficulties in different forms and this just happened to be one of mine.
Thank you to everyone again for sharing. It's very interesting to discover how other countries have designed their health care systems.
Yes, I saw that article. Interesting, isn’t it? Taiwan has a wonderful system. I’ve worked with many Taiwanese over the years, so have had a chance to learn about it. Everything is in one place-they just go to the hospital to see a doc for a check up. The advantage of it being such a small country helps.
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