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Source: (consider it)
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Thread: The health care system is ill.
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no prophet's flag is set so...
Proceed to see sea
# 15560
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Posted
In Canada we have publicly funded medical care, which is run by the provinces in accord with federal standards. It's relatively similar across the country. This week I heard two stories, similar to some I've heard before, and I find myself concerned and very ill at ease again.
One of these cases: a 70 year has had a stroke, gets admitted to hospital, they do the medications to break down clots, CT/MRI scans etc. Put on stroke ward for 2 weeks, sees speech pathologist twice, sees physical therapist 3 times, occupational therapist fits a wheelchair and walker. The person is agitated we think because they are waiting for rehab care which never comes. Lots of sedating medications. 1-3 days go by with nothing but meals, medications and cleaning staff. Then they hold a discharge conference with family and announce they are shipping off to a temporary bed in long term care home, where speech, OT, PT etc will not be provided.
The person's spouse asked at the conference if the idea was to medicate and warehouse, and hope for an early death. Of course this saying the emperor has no clothes, and the hospital people indignantly responded. The spouse will have to travel 50 km one way to see stroke partner. The first available placement in the district is the rule.
The family discussion later rolled around to the legalisation of assisted death/suicide which is required under a Supreme Court judgement. I expect that although the court has said it must be the choice of the individual with various 'safeguards', that like in cases of constructive dismissal (where an employee resigns because the employer has created a hostile and untenable work environment), assisted death will become the inevitable outcome. The person will choose this because the alternative, of barely basic medical care, makes it inevitable.
I think the situation is outrageous though banal. I have no doubt that there will parallel stories and reactions from others.
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Out of this nettle, danger, we pluck this flower, safety.
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Posts: 11498 | From: Treaty 6 territory in the nonexistant Province of Buffalo, Canada ↄ⃝' | Registered: Mar 2010
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anteater
Ship's pest-controller
# 11435
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Posted
I'm sure the UK has similar issues. But I would like to air an argument against public-funded healthcare which I've heard a lot, and which has an initial appeal to common sense. But may be specious. I'm genuinely not sure as to how valid it is. And it is an old one, so no surprise.
The argument is that as medical technology advances, and people are older for longer, medical costs go up and so not all needs can be met. So you have to prioritize, aka some people will not get what they need even though it is available.
The latest issue of this type in UK is another expensive drug that can greatly help young people who are otherwise going to need a wheelchair for life, but is judged as too expensive.
Of course, the supply/demand/cost equation will be there whatever system you have, but the problem with a public one is that the decision has to be taken by doctors or appointed bodies (like NICE in the UK) who have, to say the least, an unappealing task. (So called in the US death-panels).
If healthcare is private, it's no less unfair, since your wealth decides it, but at least the pressure isn't on medics. And personally, as a near 70 year old, I can see sense in discriminating against the elderly.
So the question boils down to: Is it inevitable that a public funded healthcare system will become unaffordable if it meets all demands that could be medically jusified (if cost were not an option)? And if so, which is the best way to prioritize? Leave it to the market, or have panels to decide?
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Schnuffle schnuffle.
Posts: 2538 | From: UK | Registered: May 2006
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Schroedinger's cat
Ship's cool cat
# 64
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Posted
It is a problem with a publicly funded system that at some point, decisions have to be made that the best for this person is not to apply x treatment. It may not seem like the best to them and others, but it is, because they have no chance of benefiting from it in the longer term.
I have watched the Great Ormand Street series and know that these are sometimes the best decisions, to let a patient die, because the alternative is a very poor quality of life. Nobody wants to let a young child die, but sometimes it is the "right" decision.
The only difference with a privately funded system is that the justification is often the cost. Cost does come into it, but when it is medical staff making the decisions, I believe this is not usually the driving factor.
Maybe communication is the issue. Maybe they should explain their decisions better.
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Blog
Music for your enjoyment
Lord may all my hard times be healing times
take out this broken heart and renew my mind.
Posts: 18859 | From: At the bottom of a deep dark well. | Registered: May 2001
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L'organist
Shipmate
# 17338
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Posted
Perhaps this discussion is of particular pertinence today when we have news that the UK's oldest person - born 18 January 1903 - has just had a hip replacement following a fall at home.
Another reminder that maybe the subject of NHS priorities needs to be discussed (decided by referendum?) is that the UK the fastest growing population in Western Europe but we still see fertility treatment as an NHS priority - especially odd when you consider the number of children in state care.
While I couldn't support assisted dying I think the case for assisted conception is very shaky.
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Rara temporum felicitate ubi sentire quae velis et quae sentias dicere licet
Posts: 4950 | From: somewhere in England... | Registered: Sep 2012
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Albertus
Shipmate
# 13356
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Posted
quote:
Originally posted by anteater:
...
If healthcare is private, it's no less unfair, since your wealth decides it, but at least the pressure isn't on medics....
Usn't it? If anything I'd have thought that a systen where the patient directly purchases healthcare within the limits of his or her means might put medics in a more difficult position- having to say 'this is what you need, this is what my professional judgement says I should be giving you, but you can't afford it so I can't give it to you'. The element of professional judgement means that medics are not, on the whole, like shopkeepers whose job is just to sell you what you ask for and might advise if asked but at the end of the day will just as happily sell you an acrylic jumper as a cashmere one.
But in practice, from what I hear of the US system and also of private physiotherapy (Mrs A's profession) in the UK, medics and allied practitioners are increasingly constrained by what the health insurance companies will pay for. So you end up with them in a similar position to a publicy-funded system which incorporates a NICE-style body, except that whereas NICE was set up to make judgements about cost-effectiveness considering the overall financial resources of the health service, the insurance companies have an eye to their profitability.
Except in the case of the extremely rich, and perhaps sometimes even then, constraints on resources mean that healthcare has to be rationed in some way. I'd rather that was done by a publicly accountable body trying to use limited resources as effectively as possible than by a private one looking at its corporate bottom line.
[ 17. October 2015, 11:01: Message edited by: Albertus ]
Posts: 6498 | From: Y Sowth | Registered: Jan 2008
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Arethosemyfeet
Shipmate
# 17047
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Posted
quote:
Originally posted by L'organist:
Perhaps this discussion is of particular pertinence today when we have news that the UK's oldest person - born 18 January 1903 - has just had a hip replacement following a fall at home.
Another reminder that maybe the subject of NHS priorities needs to be discussed (decided by referendum?) is that the UK the fastest growing population in Western Europe but we still see fertility treatment as an NHS priority - especially odd when you consider the number of children in state care.
Increasing the number of wanted children is a good thing, generally. I'd bet good money that if you were to do a study of the children born via IVF in the UK that they're a net benefit to the UK in financial terms over the course of their lives, particularly if you account for treating the psychological impact of infertility.
Posts: 2933 | From: Hebrides | Registered: Apr 2012
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
At least half people born now are expected to live to be a hundred. Independently mobile people usually require less ongoing care than those who are not. We need surgeons to learn how to operate effectively on the elderly.
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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alienfromzog
Ship's Alien
# 5327
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Posted
quote:
Originally posted by Albertus:
Except in the case of the extremely rich, and perhaps sometimes even then, constraints on resources mean that healthcare has to be rationed in some way. I'd rather that was done by a publicly accountable body trying to use limited resources as effectively as possible than by a private one looking at its corporate bottom line.
This is the point. All healthcare is rationed. Anyone who says otherwise is lying. The only question is how you ration it.
AFZ
[ 17. October 2015, 13:16: Message edited by: alienfromzog ]
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Everyone is entitled to his own opinion, but not his own facts.
[Sen. D.P.Moynihan]
An Alien's View of Earth - my blog (or vanity exercise...)
Posts: 2150 | From: Zog, obviously! Straight past Alpha Centauri, 2nd planet on the left... | Registered: Dec 2003
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
quote:
Originally posted by Doublethink.:
At least half people born now are expected to live to be a hundred. Independently mobile people usually require less ongoing care than those who are not. We need surgeons to learn how to operate effectively on the elderly.
Minor additional point, it was an emergency surgery for a hip fracture - what exactly would have been a good alternative L'organist ?
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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Chocoholic
Shipmate
# 4655
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Posted
And help preventing falls which can result in fractures, surgery, hospital stays, reduced independence etc.
Countries with widespread tai chi practise for example have much much lower rates of elderly fallers.
The 5 year forward NHS plan prioritises prevention and I think we need to invest in preventative care for the elderly but in the current climate I'm not sure how that wil happen.
(Cross post X 2, this followed Doublethink's post)
[ 17. October 2015, 13:20: Message edited by: Chocoholic ]
Posts: 773 | From: London | Registered: Jun 2003
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Arethosemyfeet
Shipmate
# 17047
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Posted
Anything involving investment that doesn't also involve weapons is pretty unlikely in the present climate.
Posts: 2933 | From: Hebrides | Registered: Apr 2012
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Boogie
Boogie on down!
# 13538
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Posted
quote:
Originally posted by alienfromzog:
All healthcare is rationed. Anyone who says otherwise is lying. The only question is how you ration it.
I would do like Germany. All private with excellent insurance schemes and automatic insurance for the unemployed.
My son had a bad knee. He went to a GP in his lunch hour - no appointment. He was seen and sent to the consultant, then straight across the road to the specialist who did the injections. Back to work in time for the afternoon session.
You get a health card and take it to whatever GP you want - no registering, no faffing.
He's training to be a nurse in Heidelberg where they get excellent training, no specialising 'till the end of the course and they are paid while they train.
UK health service seems to be 80% admin 20% nurses and doctors ![[Frown]](frown.gif)
quote:
Originally posted by Doublethink.:
At least half people born now are expected to live to be a hundred. Independently mobile people usually require less ongoing care than those who are not. We need surgeons to learn how to operate effectively on the elderly.
A woman of 112 has just had a hip replacement - they can do it, it's about the will - not the way.
[ 17. October 2015, 13:47: Message edited by: Boogie ]
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Garden. Room. Walk
Posts: 13030 | From: Boogie Wonderland | Registered: Mar 2008
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Belle Ringer
Shipmate
# 13379
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Posted
quote:
Originally posted by no prophet's flag is set so...:
a 70 year has had a stroke, gets admitted to hospital, they do the medications to break down clots, CT/MRI scans etc. Put on stroke ward for 2 weeks, sees speech pathologist twice, sees physical therapist 3 times, occupational therapist fits a wheelchair and walker... they are shipping off to a temporary bed in long term care home, where speech, OT, PT etc will not be provided.
We the people, each of us, needs to take control of our health and avoid relying fatalistically on MDs as if there is nothing can be done if they say no.
For this 70 year old, family or friends need to discuss with the OT and ST how much recovery they think possible based on observation from the few treatments. Then learn some basic OT and ST to do with their loved one. The exercises aren't hard.
Doctors fundamentally believe the body cannot heal, they mostly focus on slowing the decay and masking the symptoms. This model is wrong, bodies are designed/evolved to self heal if given the right tools. Brains especially can heal, but a dozen doctors told me the brain damage is permanent and nothing can be done. The knee doc said I'd never climb stairs again but PT has me climbing stairs - slowly and with pain but it re-opens worlds the knee professional insisted were closed forever.
Writing off people old enough to be retired is common. We may see increasing budgetary pressures to write them off. A society that primarily values money and values people based on how much they earn isn't going to view oldsters as worthy of community effort and cost. Older people need to look out for each other.
It's up to us, not the docs. When Medicare said "no more PT" for my elderly post-hip-surgery Mom, we used her money to hire private PT and she got a lot better!
The physical and occupational and speech and cognitive therapists can do so much more than doctors admit! At your own expense, alas - we are forced to support a limited and expensive system plus pay for our own care that actually heals.
Posts: 5830 | From: Texas | Registered: Jan 2008
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
Boogie, I know, I was respnding to L'organist's criticism of that decision to operate on her.
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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no prophet's flag is set so...
Proceed to see sea
# 15560
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Posted
Private PT is quoted a $80 per treatment (~£40) plus travel. So about $100. Speech therapy quote is $150 per. We will likely do what is suggested. Watch the treatments and family and friends will try to administer. Those without family or friends to help are SOL. Who is to live and who is to die.
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Out of this nettle, danger, we pluck this flower, safety.
\_(ツ)_/
Posts: 11498 | From: Treaty 6 territory in the nonexistant Province of Buffalo, Canada ↄ⃝' | Registered: Mar 2010
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Uriel
Shipmate
# 2248
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Posted
quote:
Originally posted by L'organist:
While I couldn't support assisted dying I think the case for assisted conception is very shaky.
I'll pass those sentiments onto my 11 year old daughter, very much wanted after three sub-fertile and soul destroying years, conceived following investigations and medication on the NHS (not IVF, so not mega-expensive, but still at public expense). I'm sure her contribution to society over her lifetime, and the immense joy she has brought to her family, will more than compensate for the public cost of helping her to exist.
Posts: 687 | From: Somerset, UK | Registered: Jan 2002
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Belle Ringer
Shipmate
# 13379
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Posted
quote:
Originally posted by no prophet's flag is set so...:
Private PT is quoted a $80 per treatment (~£40) plus travel. So about $100. Speech therapy quote is $150 per. We will likely do what is suggested. Watch the treatments and family and friends will try to administer. Those without family or friends to help are SOL. Who is to live and who is to die.
Expensive, yes.
Many (not all) therapists are willing, even glad, to teach the patient and family, partly because they believe in their work, partly because an engaged patient and family recover much more than someone dependent on therapist to make them do it.
The physical therapy I've been doing, they intentionally gradually disengage over many weeks, until a session is little more than going to a gym on your own. Instead of being right there with you, they put you on an exercise and turn their back to chat with another patient, or walk away and come back about when it's time for you to be finishing that exercise.
They are withdrawing to teach you independence, because a lot of what happens in a major health crash is fear, and the fear constricts ability to reach out and engage life with an "I can do this!" confidence.
A therapist meeting an engaged patient or family is thrilled, and will gladly work on helping the family set up a schedule that minimizes the need for therapist appointments. Just occasional to see progress, critique method, suggest and teach new exercises, give encouragement.
I'm sure there are some therapists who insist they must be present every moment of exercise. If you bump into one of those, just go hire someone else.
Remember that nutrition is the basis of health. My brain injury started improving fast when I added mineral supplements to the diet. USA soils and foods are seriously mineral deficient because of modern farming methods. Also look up vitamin k-2 for it's artery cleaning effect (this is not the vit K for coagulation). Institutional food is often nutritionally poor.
Yes people with no family are hosed. I can't even find a friend willing to be the "person to call in an emergency". No one wants that kind of responsibility.
A huge part of therapy is judging what level of challenge the patient can reach for and grow by trying, but not so much challenge the patient gives up. With an engaged family it shouldn't need much outside help to judge which exercises to progress to and how soon.
I am not a medical professional.
Posts: 5830 | From: Texas | Registered: Jan 2008
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Albertus
Shipmate
# 13356
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Posted
quote:
Originally posted by Uriel:
quote:
Originally posted by L'organist:
While I couldn't support assisted dying I think the case for assisted conception is very shaky.
I'll pass those sentiments onto my 11 year old daughter, very much wanted after three sub-fertile and soul destroying years, conceived following investigations and medication on the NHS (not IVF, so not mega-expensive, but still at public expense). I'm sure her contribution to society over her lifetime, and the immense joy she has brought to her family, will more than compensate for the public cost of helping her to exist.
Lovely for you and for her. But the brutal question is why should the NHS have helped her to come into existence in this not exactly underpopulated island- rather than, say, helping you to come to terms with not being able to conceive? I'm not saying it shouldn't have, mind- just that 'it has made me very happy' is not a self-evidently sufficient reason for doing so.
Posts: 6498 | From: Y Sowth | Registered: Jan 2008
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L'organist
Shipmate
# 17338
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Posted
Thank you Albertus, that was exactly what I meant.
Incidentally, I wasn't criticising the decision to do a hip replacement on the 112 year old, just noting that it had happened so not all health care in the NHS is rationed according to age.
But a broken hip/femur is a medical emergency: infertility may well be a private tragedy but is isn't a health issue.
Again, for me I'd say fine, assist with conception using drugs, etc, but I'd draw the line at IVF simply because the success rate is so very low and the cost per cycle so exorbitant.
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Rara temporum felicitate ubi sentire quae velis et quae sentias dicere licet
Posts: 4950 | From: somewhere in England... | Registered: Sep 2012
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Jengie jon
Semper Reformanda
# 273
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Posted
Well, the logical end of that argument is the Church should get back on its high horse about celibacy and encouraging that as a way for all.
Jengie
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"To violate a persons ability to distinguish fact from fantasy is the epistemological equivalent of rape." Noretta Koertge
Back to my blog
Posts: 20894 | From: city of steel, butterflies and rainbows | Registered: May 2001
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Albertus
Shipmate
# 13356
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Posted
It might indeed be a good thing if the church reminded people that sex and parenthood are not the only ways to achieve fulfilment.
[ 17. October 2015, 21:56: Message edited by: Albertus ]
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My beard is a testament to my masculinity and virility, and demonstrates that I am a real man. Trouble is, bits of quiche sometimes get caught in it.
Posts: 6498 | From: Y Sowth | Registered: Jan 2008
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North East Quine
Curious beastie
# 13049
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Posted
Infertility isn't the only non-health issue treated by the NHS. Two years after going over the handlebars of my bike I had plastic surgery on the NHS to remove the residual facial scarring.
Prior to the plastic surgery I felt people weren't looking me in the eye when talking to me, because they were either looking at the scarring, or trying to avoid looking at the scarring; and so the plastic surgery has certainly made my life much pleasanter, but there was no medical justification for it.
I think infertility treatment is more important than scar removal; if the NHS was restricted to purely medical issues a lot more than infertility treatment would go.
Posts: 6414 | From: North East Scotland | Registered: Oct 2007
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North East Quine
Curious beastie
# 13049
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Posted
Originally posted by l'organist:
quote:
Another reminder that maybe the subject of NHS priorities needs to be discussed (decided by referendum?) is that the UK the fastest growing population in Western Europe but we still see fertility treatment as an NHS priority - especially odd when you consider the number of children in state care.
I could be wrong, but I'd guess that if you held a referendum on NHS priorities, it would lead to a cut in the treatment of alcohol-related cirrhosis of the liver, and smoking-related lung cancer before it affected IVF treatment.
Posts: 6414 | From: North East Scotland | Registered: Oct 2007
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
quote:
Originally posted by North East Quine:
Infertility isn't the only non-health issue treated by the NHS. Two years after going over the handlebars of my bike I had plastic surgery on the NHS to remove the residual facial scarring.
Prior to the plastic surgery I felt people weren't looking me in the eye when talking to me, because they were either looking at the scarring, or trying to avoid looking at the scarring; and so the plastic surgery has certainly made my life much pleasanter, but there was no medical justification for it.
I think infertility treatment is more important than scar removal; if the NHS was restricted to purely medical issues a lot more than infertility treatment would go.
On the other the social anxiety or depression that may develop in reaction to these issues being untreated, are medical conditions. Press coverage of relative treatment costs often assumes the alternative is no cost. This is rarely the case.
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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lilBuddha
Shipmate
# 14333
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Posted
quote:
Originally posted by Doublethink.:
On the other the social anxiety or depression that may develop in reaction to these issues being untreated, are medical conditions. Press coverage of relative treatment costs often assumes the alternative is no cost. This is rarely the case.
This is a rabbit warren of issues, though. If I jam a hose down this hole, where is the rodent going to pop up next?
IVF is unnecessary. It should be legal and accessible, not certain it should be a priority.
Funny, this thread. When studying early humans, we place great significance on when we began caring for those who could not survive on their own.
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I put on my rockin' shoes in the morning
Hallellou, hallellou
Posts: 17627 | From: the round earth's imagined corners | Registered: Dec 2008
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no prophet's flag is set so...
Proceed to see sea
# 15560
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Posted
IVF is not an insured service in Canada in any province as far as I know. People we know have paid $10-40,000 to conceive. People often suggest adoption, but the wait is to to 7 years
Mental health care in the public system is available from a family physician in the form of medication, hospital emergency if crisis from psychiatry residents and no follow-up just a consult after a wait of 5-12 hours, and mental health clinics where the waiting list is currently 5 months. The mental health clinics are staffed by social workers with MSWs and people with MA or MEd degrees in psychology, with the allocation being 6 hours per person per year in most cases.
The going rate for psychotherapy from a licenced psychologist is $160 to 250 per hour in the private user pay situation. More in larger cities. Unlicenced counsellors may cost as little as $100/hour. None of these services are publicly funded. There was more of this in the public system until about 1990, when they disbanded community mental health clinics.
I understand there is more mental health care under the UK's NHS. Dental and eye care are also de-insured here.
The de-insuring of services has meant bustling and profitable practices for licenced practitioners. However we are seeing corportaions moving in, mostly from Ontario, but also American, who are offering employer plans for employees which do it all by app, phone and online. But these are the worried well, not the seriously ill.
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Out of this nettle, danger, we pluck this flower, safety.
\_(ツ)_/
Posts: 11498 | From: Treaty 6 territory in the nonexistant Province of Buffalo, Canada ↄ⃝' | Registered: Mar 2010
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North East Quine
Curious beastie
# 13049
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Posted
Biennial eye tests are free here (Scotland) because the government believes them to be cost effective. Other health conditions such as diabetes can sometimes be picked up from an eye test, and apparently there are costs attached to having swathes of the population being put off from having an eye test because of the cost.
Posts: 6414 | From: North East Scotland | Registered: Oct 2007
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alienfromzog
Ship's Alien
# 5327
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Posted
quote:
Originally posted by North East Quine:
Biennial eye tests are free here (Scotland) because the government believes them to be cost effective. Other health conditions such as diabetes can sometimes be picked up from an eye test, and apparently there are costs attached to having swathes of the population being put off from having an eye test because of the cost.
That's wise and without checking the figures, I suspect it really is cost effective. For me, the cost of eye tests in not a big deal (~£15-20). I've worn glasses since I was 6. It's the cost of the glasses that is ridiculously expensive.
On the whole though, as Doublethink noted, the media reporting is very misleading as they often leave out the cost of doing nothing. NICE isn't perfect but, on the whole they do an very difficult job surprisingly well. There's a lot of references to NICE in the medical literature in the context of other countries using NICE analysis to aid their decision-making.
I would argue vociferously that the NHS model (pre-2011, at least) is the best one. People who love to talk about how great Germany and France are neglect to mention how much more expensive they are. (I've just looked up the latest data and it's a significant difference), and overall, if you look at the evidence properly, the UK's health outcomes are at least as good overall.
It makes me so cross that when people knock the NHS, it's almost always from a position of ignorance. It's definitely not perfect, there's a lot that could be done better. We should start by actually funding mental health services at a level that has some chance of meeting the need rather than the abomination it is now. And I work in a specialty that is very protected in terms of its funding compared to many, although increasingly struggling.
AFZ
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Everyone is entitled to his own opinion, but not his own facts.
[Sen. D.P.Moynihan]
An Alien's View of Earth - my blog (or vanity exercise...)
Posts: 2150 | From: Zog, obviously! Straight past Alpha Centauri, 2nd planet on the left... | Registered: Dec 2003
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North East Quine
Curious beastie
# 13049
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Posted
My experience of the NHS has been overwhelmingly positive. My only quibble has been long waiting times for something minor which has evolved into something more major by the time it was treated. But I feel my whole family's health is in safe hands with the NHS.
When my father-in-law had a heart attack, the hospital got computer readings whilst he was being blue-lighted by ambulance, meaning he was diagnosed before he reached the hospital and went straight from ambulance to theatre.
My father's cancer was picked up by a routine blood test before he had any symptoms, and he had been through his first round of chemo and was in remission before he would have shown any symptoms.
The level of care both my father-in-law and father have received has been superlative.
The NHS is amazing.
Posts: 6414 | From: North East Scotland | Registered: Oct 2007
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Amika
Shipmate
# 15785
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Posted
quote:
Originally posted by no prophet's flag is set so...:
Private PT is quoted a $80 per treatment (~£40) plus travel. So about $100. Speech therapy quote is $150 per. We will likely do what is suggested. Watch the treatments and family and friends will try to administer. Those without family or friends to help are SOL. Who is to live and who is to die.
My mum had a stroke aged 70 and lost the use of her left arm and leg. She had no clot-buster medication because it wasn't available at our local hospital outside 'office hours'. She was in a stroke ward for ten weeks during which time she received limited physiotherapy, after which she was discharged to her own home with carers coming in (my dad was still alive at this time but this was when his dementia became apparent in the extreme so he was no help).
She went to the hospital every week for physiotherapy for around a year, but in all that time there was little improvement and she was in a wheelchair and unable to even transfer herself to the sofa, etc. Along with my sister I started making her try to walk every day. At first it was hard and we had to hold her up, but after she suddenly regained a little use of her leg it became easier until eventually she was able to walk with a quad stick.
We were still not satisfied though, hoping for more, so we took her to a personal trainer subsidised by a UK charity (ARNI)and after that she came on rapidly, improved her balance and was able to walk with just a standard walking stick. She only walks very slowly but it made all the difference. A huge contrast with what we were told on her discharge from hospital, which was pretty much 'abandon hope'. Quite a few OTs, physios and carers have expressed surprise and even amazement at her improvement.
It's sad that if you don't have friends and family who are able and willing to help you seem to be stuffed these days. No one should be shuttled off to a care home and abandoned with no rehab or physiotherapy. I don't know if that was the original plan for my mum, because we just insisted on and expected her to come home.
Posts: 147 | From: Ingerland | Registered: Aug 2010
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Belle Ringer
Shipmate
# 13379
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Posted
quote:
Originally posted by Amika:
quote:
Originally posted by no prophet's flag is set so...:
Those without family or friends to help are SOL. Who is to live and who is to die.
My mum had a stroke aged 70 and lost the use of her left arm and leg...She was in a stroke ward for ten weeks during which time she received limited physiotherapy, after which she was discharged to her own home ...
my sister I started making her try to walk every day. At first it was hard and we had to hold her up, but after she suddenly regained a little use of her leg it became easier until eventually she was able to walk with a quad stick.
we took her to a personal trainer subsidised by a UK charity (ARNI)and after that she came on rapidly, improved her balance and was able to walk with just a standard walking stick... A huge contrast with what we were told on her discharge from hospital, which was pretty much 'abandon hope'.
It's sad that if you don't have friends and family who are able and willing to help you seem to be stuffed these days. No one should be shuttled off to a care home and abandoned with no rehab or physiotherapy.
The brain can heal amazingly after a stroke, with guidance. A friend was in ICU, a year later just a little tripping over words and some right hand weakness.
Another friend had a minor stroke, the local doctors dismissed the symptoms as just another little old lady falling apart and falsely claiming symptoms were sudden and new because she's just not accepting that she's getting old like everyone else. Two years now, no therapy.
"Old folks" get written off unless they have middle age family who will fight for them. Lots of old folks don't.
Posts: 5830 | From: Texas | Registered: Jan 2008
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la vie en rouge
Parisienne
# 10688
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Posted
quote:
Originally posted by alienfromzog:
I would argue vociferously that the NHS model (pre-2011, at least) is the best one. People who love to talk about how great Germany and France are neglect to mention how much more expensive they are. (I've just looked up the latest data and it's a significant difference), and overall, if you look at the evidence properly, the UK's health outcomes are at least as good overall.
Meh. You pays your money, you takes your choice. The French system is more expensive, but waiting times are much shorter. Also more things are included in it. For example dentistry is covered 100% at standard rates by the Social Security and my insurance.
There are advantages to both.
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Rent my holiday home in the South of France
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Boogie
Boogie on down!
# 13538
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Posted
quote:
Originally posted by la vie en rouge:
You pays your money, you takes your choice. The French system is more expensive, but waiting times are much shorter. Also more things are included in it. For example dentistry is covered 100% at standard rates by the Social Security and my insurance.
My MIL was taken ill on Reunion island and had to spend months there. When she was air-ambulanced home to a UK hospital she couldn't believe the drop in standards - due to lack of nurses and investment, not due to lack of care or expertise.
We need extra beds to cut waiting times - extra capacity. But the financial models and top-heavy administration in the UK leaves little left for extra nurses, doctors and beds. It's crazy
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Garden. Room. Walk
Posts: 13030 | From: Boogie Wonderland | Registered: Mar 2008
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Lucia
Looking for light
# 15201
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Posted
quote:
Originally posted by alienfromzog:
For me, the cost of eye tests in not a big deal (~£15-20). I've worn glasses since I was 6. It's the cost of the glasses that is ridiculously expensive.
That is because the cost that you or the government (via the NHS) pay for a sight test does not reflect the cost of providing it when you take into account professional and practice overhead costs. Therefore when you buy glasses you are not only subsidising your own sight test but also the sight tests of all the other people who didn't need glasses or took their prescription elsewhere to get their glasses made. Neither the government nor the public are prepared to pay the true cost of a sight test so I'm afraid those who purchase glasses have to make up the difference.
Believe me this has been being bemoaned for years in optometry professional circles in the UK!
[ 19. October 2015, 11:30: Message edited by: Lucia ]
Posts: 1075 | From: Nigh golden stone and spires | Registered: Oct 2009
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Arethosemyfeet
Shipmate
# 17047
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Posted
I don't think the £30 I paid for my last pair of glasses was excessive. If I think I'm being ripped off I'll just go online to zenni or similar. I got an excellent pair of prescription goggles from them.
Posts: 2933 | From: Hebrides | Registered: Apr 2012
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Alan Cresswell
Mad Scientist 先生
# 31
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Posted
Part of it is the (probably necessary) fragmentation of health care. Eye tests can pick up signs of other diseases, which by catching them early saves the NHS money. But, those savings are in other departments so the optometrists don't see any of it.
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Don't cling to a mistake just because you spent a lot of time making it.
Posts: 32413 | From: East Kilbride (Scotland) or 福島 | Registered: May 2001
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Alan Cresswell
Mad Scientist 先生
# 31
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Posted
quote:
Originally posted by Arethosemyfeet:
I don't think the £30 I paid for my last pair of glasses was excessive. If I think I'm being ripped off I'll just go online to zenni or similar. I got an excellent pair of prescription goggles from them.
But, because the online retailers are not conducting eye tests they don't need to cover those costs within their glasses sales. And, as more people opt for cheaper glasses then the cost for an eye test will have to increase - whether paid for by the patient or the NHS.
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Don't cling to a mistake just because you spent a lot of time making it.
Posts: 32413 | From: East Kilbride (Scotland) or 福島 | Registered: May 2001
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North East Quine
Curious beastie
# 13049
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Posted
Just to add - although the basic eye test is free here, retinal photography is extra. I think I paid £25 to have a photograph of my retina added to my optometric records when I had my last eye test.
Posts: 6414 | From: North East Scotland | Registered: Oct 2007
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Ricardus
Shipmate
# 8757
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Posted
quote:
Originally posted by Boogie:
We need extra beds to cut waiting times - extra capacity. But the financial models and top-heavy administration in the UK leaves little left for extra nurses, doctors and beds. It's crazy
But surely insurance companies constitute an extra tier of administration? It's hard to see how a payment model of patient > means-testing > private insurance or state support > hospital is somehow less administratively complex than Treasury > hospital.
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Then the dog ran before, and coming as if he had brought the news, shewed his joy by his fawning and wagging his tail. -- Tobit 11:9 (Douai-Rheims)
Posts: 7247 | From: Liverpool, UK | Registered: Nov 2004
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Sioni Sais
Shipmate
# 5713
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Posted
quote:
Originally posted by Ricardus:
quote:
Originally posted by Boogie:
We need extra beds to cut waiting times - extra capacity. But the financial models and top-heavy administration in the UK leaves little left for extra nurses, doctors and beds. It's crazy
But surely insurance companies constitute an extra tier of administration? It's hard to see how a payment model of patient > means-testing > private insurance or state support > hospital is somehow less administratively complex than Treasury > hospital.
Here's a comparison of the growth in NHS staff between 1999 and 2009. In percentage terms little has changed since then (an excel sheet on the Health & Social Car Info Centre site which shows the stats now: see first xls.). Overall the split is about 50/50 between clinical staff (ie, those who treat patients in one way or another) on one hand and support staff on the other.
The former link states that "The NHS Confederation, which represents NHS organisations and independent healthcare providers, argues that the proportion of NHS managers is relatively low given the size of the organisations that they run. They point out that it is lower than the proportion of managers in the whole of the workforce in the UK (NHS Confederation 2007), which in 2009 was 16 per cent (Office of National Statistics)". Overall the split is 50/50 between clinical staff on one hand and support staff on the other.
The failure of the NHS Patients Records IT project probably means that the NHS will have to employ tens of thousands more support staff for decades to come.
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"He isn't Doctor Who, he's The Doctor"
(Paul Sinha, BBC)
Posts: 24276 | From: Newport, Wales | Registered: Apr 2004
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no prophet's flag is set so...
Proceed to see sea
# 15560
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Posted
My last eye exam was $220 (£110), my glasses cost $900 which would have benn more but I bought frames online.
Dental exam was $275.
Your UK prices are a bargain. We do eyes and teeth every 2 to 3 years.
Prescription drugs are also user pay. It is not unusual for people not to take medicine for cost reasons.
Ambulance costs $250 call out fee and the per Km for what they drive plus a time cost. Many elderly refuse ambulance here and try to take a taxi. An Uber Ambulance app should be invented.
What is NICE?
[ 19. October 2015, 13:22: Message edited by: no prophet's flag is set so... ]
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Out of this nettle, danger, we pluck this flower, safety.
\_(ツ)_/
Posts: 11498 | From: Treaty 6 territory in the nonexistant Province of Buffalo, Canada ↄ⃝' | Registered: Mar 2010
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Belle Ringer
Shipmate
# 13379
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Posted
quote:
Originally posted by Boogie:
When she was air-ambulanced home to a UK hospital she couldn't believe the drop in standards - due to lack of nurses and investment, not due to lack of care or expertise.
We need extra beds to cut waiting times - extra capacity. But the financial models and top-heavy administration in the UK leaves little left for extra nurses, doctors and beds. It's crazy
One aspect of bean counters running things like as business is extra beds are seen as a wasteful financial drain. The ideal is to have the number of beds you keep full. NOT to have extras.
There's a cultural push to more administrators. We live in a "success means moving up" culture. People looking for a job want to know the job's future potential, and not hear "you'll be doing exactly the same work for the same pay for 40 years." A generation or two ago that was the norm, get good at something and do it all your life and be proud of the work. Now, "success" means moving up, gotta have lots of slots for people to move up to or they won't take the initial job.
I'm overstating I know, but I've watched a number of health care employees aspire to move away from hands on healing to management for the money, prestige, and better work hours.
Posts: 5830 | From: Texas | Registered: Jan 2008
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North East Quine
Curious beastie
# 13049
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Posted
I have a dental check up every six months; it costs about £20. My kids also have a check up every six months, but theirs is free as they're both still in full time education at University.
Prescriptions are free here in Scotland.
Inoculations for foreign travel have to be paid for, which is fair enough.
My impression is that things have got better since devolution; the Scottish government has tried to introduce relatively low cost measures to reduce smoking, increase breast-feeding, improve school meals etc as well as removing prescription charges and charges for eye tests.
Posts: 6414 | From: North East Scotland | Registered: Oct 2007
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North East Quine
Curious beastie
# 13049
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Posted
Missed edit window - I should have added that life expectancy is still lower in Scotland than in the rest of the UK, and that Scottish life expectancy is still low by European standards.
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alienfromzog
Ship's Alien
# 5327
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Posted
quote:
Originally posted by Lucia:
quote:
Originally posted by alienfromzog:
For me, the cost of eye tests in not a big deal (~£15-20). I've worn glasses since I was 6. It's the cost of the glasses that is ridiculously expensive.
That is because the cost that you or the government (via the NHS) pay for a sight test does not reflect the cost of providing it when you take into account professional and practice overhead costs. Therefore when you buy glasses you are not only subsidising your own sight test but also the sight tests of all the other people who didn't need glasses or took their prescription elsewhere to get their glasses made. Neither the government nor the public are prepared to pay the true cost of a sight test so I'm afraid those who purchase glasses have to make up the difference.
Believe me this has been being bemoaned for years in optometry professional circles in the UK!
That's a fair point. And I wasn't trying to say that I'm being ripped off. It's a professional and technical service and hence costs to get it right. My point is that my glasses and sun glasses which I find vital for driving in bright sun (2 days a year in the UK...) with my combination of relatively strong short-sightedness / astigmatism is fairly expensive and hence the cost of the test is generally less than 10% of my outlay. So free eye tests don't make a lot of difference to me.
AFZ
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Everyone is entitled to his own opinion, but not his own facts.
[Sen. D.P.Moynihan]
An Alien's View of Earth - my blog (or vanity exercise...)
Posts: 2150 | From: Zog, obviously! Straight past Alpha Centauri, 2nd planet on the left... | Registered: Dec 2003
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Arethosemyfeet
Shipmate
# 17047
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Posted
quote:
Originally posted by Alan Cresswell:
But, because the online retailers are not conducting eye tests they don't need to cover those costs within their glasses sales. And, as more people opt for cheaper glasses then the cost for an eye test will have to increase - whether paid for by the patient or the NHS.
I know, but the £30 was not online, and I don't think it was unreasonable. I have gone online to get my wife some rimless tinted glasses because they'd have cost 6 times as much from an optician, and she'd already bought her main pair from our local optician.
Posts: 2933 | From: Hebrides | Registered: Apr 2012
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no prophet's flag is set so...
Proceed to see sea
# 15560
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Posted
I suppose we're ahead of you here. The cost of your eye exam is going to rise by 4 times the amount. Eye exams were de-insured in the 1980s if memory serves, about the same time as one-fee level of prescription drugs and dental checks for children up to age 16. We thought the massive cuts in tax paid by richer people and companies meant the tax base couldn't afford it any more.
I think, in Canada at least, we need to start calling the health system "the doctor payment scheme" because 75% of the cost is for the private physicians who are paid publicly on a per patient and per service basis.
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Out of this nettle, danger, we pluck this flower, safety.
\_(ツ)_/
Posts: 11498 | From: Treaty 6 territory in the nonexistant Province of Buffalo, Canada ↄ⃝' | Registered: Mar 2010
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Alan Cresswell
Mad Scientist 先生
# 31
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Posted
In all but a very few cases where medication is particularly expensive, medical care costs will always be dominated by staff costs - doctors, nurses, clerical staff, porters, cleaners all deserve a decent salary. Even management do important work to keep the health service working and deserve a decent salary for that. Those salaries (and associated costs such as pension provision) need to be met from the health care budget, and 75% of that budget being for staff costs doesn't surprise me.
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Don't cling to a mistake just because you spent a lot of time making it.
Posts: 32413 | From: East Kilbride (Scotland) or 福島 | Registered: May 2001
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Lucia
Looking for light
# 15201
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Posted
quote:
Originally posted by alienfromzog:
quote:
Originally posted by Lucia:
quote:
Originally posted by alienfromzog:
For me, the cost of eye tests in not a big deal (~£15-20). I've worn glasses since I was 6. It's the cost of the glasses that is ridiculously expensive.
That is because the cost that you or the government (via the NHS) pay for a sight test does not reflect the cost of providing it when you take into account professional and practice overhead costs. Therefore when you buy glasses you are not only subsidising your own sight test but also the sight tests of all the other people who didn't need glasses or took their prescription elsewhere to get their glasses made. Neither the government nor the public are prepared to pay the true cost of a sight test so I'm afraid those who purchase glasses have to make up the difference.
Believe me this has been being bemoaned for years in optometry professional circles in the UK!
That's a fair point. And I wasn't trying to say that I'm being ripped off. It's a professional and technical service and hence costs to get it right. My point is that my glasses and sun glasses which I find vital for driving in bright sun (2 days a year in the UK...) with my combination of relatively strong short-sightedness / astigmatism is fairly expensive and hence the cost of the test is generally less than 10% of my outlay. So free eye tests don't make a lot of difference to me.
AFZ
And I'm afraid the stronger your prescription is the more difference it makes to the optical and aesthetic properties of your glasses when you pay out for good optical design/thinner/coated lenses. If you've got a low prescription you can probably get away with basic, cheap lenses if that is what you want. The optical difference, although still there, is less. Like many things in life, to a large extent you get what you pay for!
When it comes to companies offering "free" sight tests to those who are not entitled to an NHS funded eye examination I think you have to be realistic and realise that this is not out of altruism. These companies are out to make a profit and those that work for them are under considerable pressure to meet 'conversion rates'. That is they have to produce enough sales of glasses out of the tests they perform. So who do you think is more likely to recommend you need new glasses if there is only a small change in your prescription? The "free" sight test or the one where you actually paid for service being given?
Posts: 1075 | From: Nigh golden stone and spires | Registered: Oct 2009
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