Is access to medical care something that governments should provide, or is it better left to the private sector? Are there drawbacks to your choice?
I have lived in two systems, and I mean live. Twenty-two years with the British National Health Service and forty-six with the privately organised Swiss Health system, so now might be an opportunity to judge the two systems.
The British National Health Service was most likely created that everyone had a right to a qualified doctor and treatment in a hospital without the weight of heavy costs, it is and always will be free, although I believe there are so.called perscription charges for the medicine. I grew up with this. If you were ill you went to the doctor’s surgery. When I was younger you just went, took the chance that you had a good doctor, and might have to wait for an hour or so to take your turn to see the doctor.Today things are a little bit different. You first of all make an appointment, the doctor sees you, but as far I can judge, you still have to wait for an hour or so to see the god in white.
As far as hospitals are concerned in England, under this NHS system, it is every man for himself. You have an emergency? Let us hope that they have a free bed, time and a good organisation in the particular hospital you are delivered to. They may not have room, so you get directed to another hospital. If they are badly organised (and some are), you might not be seen as soon as you would like to. Note: this does not apply to all hospitals, mainly those in London which seem to be bursting at the seams in some places. If you are lucky enough to live outside of London or other large cities, then you would probably be seen to quite quickly.
Of course you always have the option to pay for your treatment, in which case you will not be seen by the NHS system, but are immediately put into a private ward, attended to by private and well paid nurses and everything is fine: something like the Queen and her family, perhaps a well known artist or politician: no problem. If you are Fred a common worker, then it is more luck than judgement that you get correct treatment. This is all based on my experience, remembering my dear uncle who was diagnosed with diabetes. He was given an appointment a few months later (they had no time for him). Unfortunately he could not keep the appointment, he had died in the meanwhile.
My experience remains vivid in my imagination. I had an unfortunate accident whilst on holiday in London of falling and breaking my lower left arm – on Tower Bridge of all places. Luckily my friend was with me and she took me to the hospital which I chose as it was near my father (thinking of the problems he would have visiting). First of all I had to wait for an hour amongst others until I was actually seen. I was x-rayed and taken to a ward as an operation would be necessary. Luckily it was a clean break of my lower left arm. I was wheeled to the ward although I was perfectly able to walk. My first contact with health and safety in England I suppose. My ward was more like a hall with at least forty beds, and we were a mixed bunch. Some had been there for a few weeks, some a few days, and we all had something different. I seemed to be the only broken arm. Probably realising that I was Swiss and used to other things I was offered a private room, knowing that I would be privately insured. I saw the private room and said no thankyou. It was partitioned off from the main ward by glass windows and contained two beds. The beds were the same low class of bed as the one I was to occupy in the ward, so I really did not realise the difference.
Cleanliness: Well you expect a hospital to be clean, to stop germs spreading. The windows were filthy, although they sent a man to clean them, but he did not clean them. He had a filthy rag, wiped over them a bit, leaving a frame of dirt and grime at the edges, and considered his job done. As far as the floor was concerned: it was about the size of a football pitch in a long way. One woman cleaned it while I was there. She had one bucket of water and one mop. She never changed the water or cleaned the mop and did the complete hall with it. I think she just spread the germs and dirt in a different direction.
I had a visit from a group of doctors who were planning on my operation. They seemed to be quite surprised that I actually asked questions about my operation, something never dared by english patients.
“Will I have a full aneasthetic” was confronted with looks of disbelief.
“Of course” was the answer, the lumber anesthesia seemed to be something unknown in a British hospital, which I had gone through a few times in a Swiss hospital as a normal process, although I would say for a broken arm it might even be refused in a Swiss hospital, due to complications. When I asked about the lumber anesthesia I was met by bewildered faces. Probably only available for private patients in England.
Anyhow my operation was performed, everything went well. They put me on a drip afterwards, which I still had suspended the next morning, although it was completely empty for a few hours. I asked the nurse if I could go to the toilet.
“I will bring you a bed pan.”
“Huh, but I can walk, I am ok, just remove the empty drip.”
“Oh no, the doctor has to do that.”
In Switzerland our drips are on wheels and we can actually walk around with them. I promptly removed the drip myself (oh horror for the nurse) arose and went to the toilet. The food was absolutely inedible and if the operation and the accident did not kill you, the food probably would. I ate almost nothing. Other patients that had a longer stay only ate salad, at least it was not cooked.
One evening I remember the door of the ward opened and a young man clad only in a pyjama burst into the ward. He sat down and moved around by sliding on his solar plexis. The nurses wanted to help and tried to sustain him. He eventually found his way to the fire staircase and wanted to use it to “break out”. We were on the fourth floor. The nurses could do nothing to stop him, so I really expected a doctor or medical personelle to give him some sort of tranquilising injection, but this was not a thing of reality in the english system, probably too expensive. Anyhow we were eventually saved. The caretaker arrive, who seemed to be an ex wrestler or boxer and removed the intruder by the shoulders. It seemed the solution was often there is no room in england in the psychiatric wards for patients, so they are transferred to a normal ward. I also learnt from some other female patients, that they had actually spent some time in a male ward, because there was more room.
Another point I would add: it seem that today in England you actually only get a chance to see a specialist or have the necessary treatment if you doctor gives you a letter of referral for the hospital. What that is I do not know, and how the doctor bases his reason for giving one is also a mystery to me. Other countries, other systems I suppose.
The result of this free Government Medical Care, at least British – definitely no thankyou.
So now let us switch to Switzerland: a country that has no government care, but based on private insurance. What you pay and what you are insured against, is basically your own business, but there are certain basics which almost everyone has. You are covered for your doctor, you are covered for general wards in hospital and for operations. You pay a certain amount per month (I pay mine every two months) which can be about four hundred Swiss francs a month (give or take 50-100 francs). Every new year you have to pay the first three hundred swiss francs yourself (this amount is based on my experience), afterwards you pay 10% of every bill yourself, the rest being covered by the insurance. Hospital costs are completely covered as well as basic operation costs. This is basic general insurance and you can expect up to perhaps 6-8 people in a ward, but no more.
As a comparison I was unfortunate enough to break the top half of my left arm a few years after my first breakage (in the meanwhile I had had the wire removed from my first breakage in a Swiss clinic, thank goodness). Anyhow after breaking my arm an ambulance was called for which arrive a few minutes after the telephone call. I was given a pain killing injection already at home and was shipped off to the hospital in an ambulance in our local town straight away. After arriving at the hospital I was immediately x-rayed and it was found that I had knocked a lump of bone out of my arm, a complicated compound breakage. Immediately I was seen by the surgeon, my arm was fixed in a resting position and I got an apology from the surgeon that he would only be able to operate the next morning. I was put in a bed in a ward. My family had been visiting (we have no visiting hours in Swiss hospitals – it might be there is a doctor visit, then you just have to wait until he is finished, but no problem). I was operated the next morning, also with a full aneasthetic. The surgeon explained how he would do the operation and the reasons why I would have to be put to sleep though the complete operation.
After the operation I was put in my hospital bed. The next morning I was asked if I wanted to wash at the sink or take a shower. I said shower – no problem. The shower room was in the ward, the nurse came with me and helped. Just packed my damaged arm in plastic. The food was quite good and edible. Perhaps a bit tasteless, but hospital food never really uses a lot of spices for health reasons. I had a drip which I could take with me to the toilet and back to the bed which was on wheels. I could even walk around in the hospital and go outside into the garden or to the hospital restaurant if I felt like it and wanted to. I was on about the seventh floor, but no problem, I could take the lift. After a week or so I was released from the hospital. A week later I had an appointment at the hospital with the surgeon who operated. I knew his name, what he looked like and he even knew me and showed me my x-rays once again. I was even given my x-rays of my arm, complete with metal plate and screws on a DVD – no problem.
So you ask what I prefer? This is no problem for me. I would rather pay for a treatment that I trust than have a free treatment that I do not trust. I could write more, but long blogs (and this is long enough) are not so interesting perhaps, can be a bit boring. Perhaps I am lucky to be able to afford my Swiss health treatment, but I know what I have. Just to mention you can have half private (2 people to a room), or private (a room on your own). It is a matter of cost of the insurance. By the way the beds are fully electronic: just push the right button and you are in a sitting position, laying flat, higher up or lower.
As far as what is better, my example in only based on the British and Swiss system. I know from others that Sweden has a very good state medical system, Italy is not to be recommended, or Russia for that matter. Each country seems to develop its own way. I only know that the States is quite expensive, but who am I to judge it.
Photo: Entrance to our local hospital in Solothurn