US vs UK healthcare

Hi all,

Noticing that a lot of you are from the US, (#Barnclown )I was wondering how you compared the difference in health care?

I lived in the US for many years and although expensive, I found the health care top notch. The main difference for me is A+E or ER. Here, the tendency is to run bloods and do an ECG then send you home. In the US I recall the ER not releasing you until they had diagnosed you and found out what is causing the problems.

I also loved the fact that you could call up and book appointments with specialists direct rather than having to be referred via GP and then wait months for an appointment.

Sure it was expensive but when you consider the amount of NI some people here are paying I wonder if there's that much in it. And yes I know you can go private here but it is an awful lot more expensive than in US and you'd still be paying NI too.

Does anyone have any views?

19 Replies

  • hi georgie-girl: interesting question!

    i grew up partly in the usa & in ireland. but i left the usa at 21 in the 1970s and have lived & worked in the UK ever since. i'm a british citizen, as is my husband. so for 40+ years my healthcare has been thanks to the NHS.

    but i remain close to my usa family, and have been intimately involved in their health care. and i feel it vvv hard to take a view on which country i'd rather be ill in...each time i try to generalise about this, i realise there are exceptions.....

    i can see your points, but, on balance, i think i'd rather be in the UK. the nhs definitely has its faults...hey: it missed my infant onset lupus for 40+ years and spent 14 years misdiagnosing a growth in my hand which turned into a malignant tumor...but also the NHS saved my life several times, and my husband's. and i've got a gp who is v cooperative about referrals for private treatment...her letter is sent over promptly and i just phone the consultant's sec direct to set a date. but yes: nhs referrals are more problematic, and i don't always see the consultant i'd like to

    the east coast USA health systems my family have been treated but have their faults too....of course, these vary greatly from state to state. i have family with top level usa health insurance and they have had both great care as well as awful care...e.g. one family member was given IVIG treatment due to a blatant misdiagnosis and has had terrible full body rashes ever since, but he has had successful knee repalcement surgery, and excellent skin cancer treatment. my 80-something year old mother with basic health insurance was sent home by ER being told she was "fine" when she actually had a rectum tumour the size of a large plum. but then she went on to have cancer treatment + surgery and is still with us at 95

    am looking forward to following this discussion

    🍀🍀🍀🍀 coco

  • That's a very interesting read Barnclown. So pleased to hear your mother got sorted and is going strong at 95. Wow, what a celebration of life.

    Like you, I am aware there are pros and cons to both so I guess it's six of one and half dozen of the other. I know the NHS is a very cheap healthcare plan, and when functioning properly is wonderful but I was just curious as to what others thought of the level of care and expertise.

    My Mother at 87 had a nasty fall in the street (UK) and shattered her shoulder, wrist and upper arm bones, severed all the nerves and tore the muscles. She was sent home from A+E because she wasn't considered urgent on a Friday evening and told to come back Monday. When I complained they eventually kept her in but left her without treatment till the Monday. Then she was strapped up in a very unnatural position for weeks to see if it would heal itself. When they finally realised it wouldn't, she had an xray followed by surgery. The shoulder was replaced but it was too late to do anything with the nerves and consequently she never regained the use of arm or hand.

    Perhaps it's just me who has a catalogue of bad NHS treatment versus wonderful US medical care. Interesting.

  • Am so sorry about your mother: a v sad story. 😏 I think you're not USA family all have the impression the USA system is better, but they're amongst the less disadvantaged few. Now the NHS is more consistently giving much better attention to my care generally (i.e. Not just my emergencies) my USA family is more impressed by the NHS. Swings & roundabouts? 😏

  • We've just had a similar conversation on another forum - and I can tell you that the NI contribution to the NHS is minimal compared to other countries. NI covers healthcare - and state pension, sickness benefit, unemployment benefit, social care including for the aged and probably things I have left out. I worked freelance for many years and paid NI that ONLY entitled me to healthcare and state pension in the form of direct benefits. No sick pay, no job seekers allowance, nothing. That contribution this week would be £2.80 for the first 8K, plus 9% of earnings up to 42K and 2% above that. That isn't a lot for pretty much free at point of service healthcare is it? Had I not been working - I wouldn't have paid anything but I'd still have been entitled to healthcare at exactly the same standard. Of course there is income tax which also contributes some to healthcare if you are picky.

    I live in Italy now, my husband has been self-employed here for a few years - and his contributions for the equivalent of NI are nearly £300 per month. That's why he's given up his hobby work - he can't afford to do it as he pays out more than he earns! I had to too a few years ago although I carried on under his name for a while. But that doesn't give us totally free healthcare - we pay co-pays for all blood tests and specialist appointments unless we are exempt due to the designated illness or income - but the income limit is household income of about 35,000 euros. That is for everyone in the household, not the person, and it applies to all ages - in the UK prescriptions for example are free at any age in Scotland and over 60 in England. Plus there are low income exemptions in the UK if you apply - I was told once by someone who should have known that only 10% of prescriptions are subject to the £8.40 fee. Here in Italy there is no subsidised dental care or hearing aid or spectacles - unless you are registered disabled. Our tax bill is similar here to in the UK.

    The fundamental difference from the USA in both the UK and Italy (and the rest of the European socialised care systems) is that no-one will be refused healthcare without having to prove they can pay it and will never become bankrupt paying for emergency healthcare - or care for a chronic illness. No person who is chronically sick and unable to work to obtain insurance cover will be left untreated. Even with Obamacare there are still millions in the USA who hang in a limbo - they are too poor to afford insurance cover and feed themselves as well but too well off to come under Medicaid (or whatever it is called). There was an excellent article in the Guardian last week about a charity that travels around providing free care for that limbo group in pop-up clinics, it made sobering reading.

    I don't dispute that the US can provide top notch healthcare - for those who can afford it. But it is more expensive per capita than any other healthcare system in the world and has the poorest outcomes overall. Unnecessary investigations are done as part of CMA medicine (cover my a**) and they can also lead to longer term illness. It is a phenomenon that has been identified in the private sector healthcare in Germany - they operate to keep their income up. In my 7 years involved with the PMRGCAUK charities I have come across a lot of US contributors who struggle to get any specialist care, either because they cannot afford to go to a rheumy and pay the charges or because the insurance they have does not have a doctor who takes it within 4 or 5 hours drive. PCPs are scared to dish out steroids for PMR - which is the only treatment option, nothing else works and insist the patient must see a rheumy. In the UK, while they may not be perfect, GPs are usually confident enough and allowed to prescribe pred.

    With all its flaws - and there are many, I worked in it so I won't deny it - the NHS is an amazing institution. You have the option of going privately if you can afford it - but no private company will cover you for chronic illness or if, like my husband did, you have had cancer. You might be too expensive. You always have the option of going privately to get a diagnosis - but since most private specialists also work in the NHS they will often add you to their NHS list if that is where you should be and then there will be no charges for that MRI or CT or surgery. And when push comes to shove and you have a life-threatening cancer, injury or other illness - the NHS is absolutely top.

    I think too you are being unfair to A&E even in the UK - one daughter is a nurse, one is a paramedic so I do know a bit about hospital care. My granddaughter has severe asthma, last night she ended up in A&E because mum had done all she could - it was time for the doctors to have a go. She was admitted after being stabilised and may be discharged tomorrow morning - after the requisite tests have been done. I have been to A&E and admitted until the diagnosis was confirmed - had it been up to a lazy consultant on take I'd have been there for a week blocking a bed but that is another story.

    If anything is apparent at A&E patients will be admitted to the Acute Assessment Unit or the appropriate ward if it is a specialist problem - many people go to A&E for things that should have gone to the GP and are sent home to follow-up with their GP. A pain you have had for a week does not usually constitute an emergency - and it will be fairly obvious if it isn't. If someone dials 999 for chest pain they more often than not will be transported for more detailed investigation than the paramedic can do on site - tests done and the patient probably sent home.

    Overall - I feel the NHS wins for most people. But the current government is determined to privatise it. You run a system into the ground so you can say "See, it doesn't work - we'll privatise it and it will be perfect...". Except it won't - but that is another discussion for another time, preferably somewhere else and not here.

  • Crikey, I only asked ;-)

    Thanks for your input PMRpro. I agree 100% that the NHS is absolutely wonderful and probably the cheapest healthcare anywhere, but I only speak from my own personal experience.

    What I paid for healthcare when I lived in US wasn't that much more than I have sometimes paid here in NI contributions.

    As one example, My daughter had her appendix removed in the US and she was admitted to surgery from the ER. A specialist paediatrician was called in and I was telephone linked to the theatre all the way through so I knew at all times what was happening. She was back to normal in a few days with a tiny scar about 1 inch long which doesn't even show now.

    My son had his appendix removed here in the UK. After being sent home from A+E 3 times being told it was just a tummy ache, we finally managed to get someone who diagnosed him correctly. He was kept in to have surgery in the morning. Afterwards he couldn't walk for a week and has been left with a 6 inch scar which caused all manner of problems.

    I agree there are good and bad elements to both sides and I know others may have had different experiences, but this is just my view from my experience.

    There are also countless people who save and fund raise tirelessly to go to the US for life saving surgery as we are just not equipped and able to offer it here. Is that due to better doctors or more money for research or are they more advanced medically or what?

    Having said that, I wouldn't be without the NHS and the staff who do a fantastic job and I certainly have been well cared for when needed.

  • You must have had a pretty good job in the US or earned an awful lot in the UK! Except - I explained what NI covers in the UK and when you are employed, only a part of the NI deductions on your salary slip are directed at health. So what you paid in NI in the UK won't have only been for healthcare.

    It's difficult to say about the differences with the appendix - I had a 1 inch scar in the UK nearly 50 years ago but was in hospital for 2 weeks. One daughter had hers out in Germany 25 years ago - in hospital for a week with a not terribly large scar but done traditionally, the other had hers out laparoscopically (keyhole) a few years later so a tiny scar and home fast. The inability to diagnose an appendix seems strange - but it is sometimes difficult and we had the same experience as you. Your son's surgeon may have thought there was more involved and wanted to have a good guddle around - bit rough on the patient at the time but perhaps useful. Different patients react differently too, shouldn't compare them even if they are siblings ;-)

    There are a lot of things they do in the US because they do have lots of money - but where there is a technique available there or in mainland Europe that would be felt to benefit a patient the NHS will often pay, including the travel. But there are some people who fund raise for lost causes - hope springs eternal. And some of the techniques you can buy in the US (and elsewhere) aren't proven - but are still available for privately-paying customers. You always hear about the fundraising - but you don't hear as many success stories, which is perhaps telling.

    That said - I'm not going to defend the NHS and contribute to this nonsense about it being the "best in the world". It jolly well isn't - there are things it does wonderfully and then it may be. But overall, there are a load of services in mainland Europe that are just as good, often better, don't cost at point of service or have perfectly acceptable charges and where they are far more realistic about what the punters have to cough up in terms of taxes.

    But where it and other socialised medicine systems win hands down over the US is that no-one falls down the cracks for lack of insurance cover if they need an operation or cancer treatment or have an accident or chronic illness. Mental health is another matter altogether - won't defend the UK on their record there, it is often shameful, but I suspect the US isn't much better. But there aren't the millions of people with no or next to no healthcare.

    If you are rich then perhaps the US is better, although you are at risk of unnecessary procedures being done which may not be good for your health - the mind boggles about the radiation load for children who are clumsy! If you are of rather more moderate means - I'll take my chances with socialised medicine I think. After all, you do always have the choice of going privately anywhere you like. But private health insurers will quickly wash their hands of you for chronic illnesses!

    PS - sorry if it seemed OTT, it is a question I meet on the forums a lot and most people are so convinced that socialised medicine is total rubbish. It probably is if you have loads of money...

  • Oh no PMRpro, I wasn't comparing siblings, I was comparing surgical techniques and doctors skills. And I never said that any health care was rubbish. It really wasn't meant to be about the money and cost at all. I was just asking for opinions on treatment and case handling, ie, medical techniques and procedures and doctors skills etc.

  • No, I didn't mean it that way - but the 2 different people may be part of the reason for the different technique and different recovery. The age of the surgeon makes a big difference too - my tiny scar 50 years ago was from a young ambitious surgeon standing in for the boss who had just had a heart attack. My luck - my friend had had her appendix out a short while before and had the boss: he was renowned for bucket and spade surgery! There are some things that haven't changed - surgeons have their predilections!

    On the whole though - I suspect that there are aspects of care in many US hospitals that are a reflection on their desire to achieve good Press Ganey scores for customer satisfaction! Think about how you would have responded to one in each case. The surgeons are also subjected to pressure to please the customer - and the customer's mother - and, not surprisingly, you were obviously very impressed with the smooth operator and his minute to minute reporting. It is sometimes the same in UK private hospitals - but in the UK you aren't necessarily going to have a better doctor privately than in the NHS since most of them work in both. The extra cost is to reflect better food, flowers in the hall and so on.

    Maybe I should have been clearer, sorry. You didn't say it, no, and I also appreciate you know a lot more about UK medicine than most - but the last time I had this discussion it was with someone who insisted (quite nastily) that socialised medicine of all sorts was rubbish. No consideration on his part that in the US there are still millions with no care, even with Obamacare, and that cannot be said in Europe. Which is a frequent image I see - I'm alright so it must be wonderful. Don't get that feeling with you though but you also don't know me as well as BC!

    BC - I've enjoyed it too though I've taken over...

  • No you haven't PMRpro. You've just joined in a discussion with your opinions which is what was intended so no apologies needed. (Even if your replies did take me longer to read than war and peace) ;-)

    Only joking, great response.

  • Georgie: when were you living in the states? and which states did you live in?

  • I lived in the states from 1999 to about 2008. Louisiana and Florida.

  • I'm an American and would love to just pay regular taxes in order to ensure my health care, rather than it being tied to a job. I'd gotten my first ever job with health care, got sick and diagnosed with lupus, and then fired. So I'm currently juggling trying to apply for Disability (one govt instutition) so I can qualify for Medicaid (a seperate govt institution) so I can not have to pay a primary (a seperate office altogether) fully out of pocket.

    I have found, though, if I am really sick, to go to the ER. I'll get admitted into the hospital from there and that way, even without insurance, they have to treat me, no matter how much I owe them. (Something around 150,000$ at this point.) Going to a doctor's office requires payment upfront and the most they do is order more tests.

    I don't know how different it is overseas, but man, a lot of us here stateside view the NHS as what must be a socialist paradise. I mean, FOR REALS, we are envious.

  • I have to agree with you Qwirkytizzy - my sister is a US citizen and although now able to get Medicaid when we compare it with NHS there is no contest. I wish tho that we could "fix" the NHS - staff and facilities are so stretched - it is very sad. Good Health!

  • This is a v interesting discussion: thanks! 😊

  • Glad to entertain you Coco X

  • Me too - you'd better kick me out though xxxxx

  • Hi all Wrote a response last night after great thought on the subject and went to hit the submit button and then lost trying again tonight as the discussion carried on today.

    I thought the views given were reflective of how I was feeling. Married to a Brit and having lived (and worked) here for quite sometime I will say not having to worry about medical bills is a blessed relief. I remember popping over to see the family in the States had a small infection on my finger, paid (cash) for the doctor';s visit and then medication, not though waiting to see doc tomorrow after several weeks (she is on holiday), I get my meds for free (Wales) and bloods etc. Down side for me at the moment is no Lupus specialist doc or nurse in the south (Wales) and I am going to London in a few weeks to see one (privately) as I am on an 8 month re-referral to the Rheumatologist, a little discouraging, but at least I can see a specialist and I would pay a lot more in the States for his expertise. So it is a give and take.

    My sister has a Masters in Business specialising in Healthcare and worked in California and here. One thing I remember her saying was when potential employers here looked at her CV and the amount money she negotiated for contracts (for a major health insurance company in the West) it was bigger than the whole NHS Budget that was part of just one state. It is a very expensive business and the health professionals here had a hard time understanding the amounts of money she was working with, millions and millions, it is a bigger population compared to the UK and they have a lot of money being spent on hospitals, equipment, etc.

    Still I know when I had my lovely daughter here in the UK, that when things were not working out, a team of doctors were ready to help me and the nursing staff to support me, wow it was impressive, there were a lot of people around me, (it was a happy ending by the way). I am not sure if I would have had that amount of support in the states without paying dearly for it (or I would have needed a fabulous private health insurance plan through a good job)...nor do we get dragged into lawsuits like the states because of medical bills attached to accidents, etc.

    And things can go wrong medically in the States reflecting on my families experience despite the amount of money being spent there.

    I am glad that right now, to know if things get worse, I am covered here. Thanks for the discussion, ML :)

  • I agree it is a case of good and bad in both and I'm glad that you are happy with the level of care here. The NHS is wonderful and I certainly couldn't live without it but I have had some pretty raw deals over the years. I know in an emergency situation the care here is top class....usually....but there are times when they just can't cope. people being left on trolleys in corridors is just not acceptable either. Part of me thinks that if we did have to pay a small contribution to the NHS , apart from our NI contributions then perhaps it wouldn't be abused and taken for granted meaning more time for the really sick.

    I know also that many people in US are without health care which is scandalous but I still believe, money and cost aside, the level of care and expertise in the US is far better than here. Perhaps I was just lucky there and unlucky with my bad experiences here. All that aside though, I still love and respect our NHS.

  • I have been to the USA a couple of times but my doctors and most of the treatments I had were in the UK. I went to Mayo clinic twelve years ago and so many tests done, the answer was I was a strange difficult case. My GP in London got me an appointment with Professor I think he is Lord now Ara Darzi described what I'm going through and he immediately told me I have Pseudo-Obstruction with so many more tests it was confirmed, and I was diagnosed with Antphospholipid and Sjogrens more things developed and was advised to seek further help and went to Columbia University in the states and muscle atrophy was added to the other conditions.

    The research in USA is more advanced than UK. My conclusion is wherever you are the right doctor at the right time is the important thing.

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