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Source: (consider it) Thread: The Medical system
Belle Ringer
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# 13379

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I was rear-ended, car wreck. Foot hurts, wait a few days for it to heal but it gets worse, go to hospital - "Xray says not broken, go home." Week later go to foot doc - "come back in 2 weeks if it still hurts." Two weeks later - "foot fractures don't always show in Xrays, we'll do an MRI" but the next opening for an MRI is a week later. Doc will call when he gets the MRI, doesn't call. I finally call him - whoops he forgot, now he's on vacation.

Seven weeks after the injury he still hasn't looked to see if a foot bone - which would heal (possibly wrong) in 5 weeks - broke.

And that's just the beginning. (Like, the hand doc won't look at the elbow because that's a different body part, even though closely connected.)

Everyone I meet has a horror story, like the woman I met in a doc waiting room who told me a few months earlier she went to the hospital saying "I am having a heart attack," hospital said "no you aren't, go home." She collapsed of a heart attack on the way out the door.

Bloomberg says of 49 industrial countries, USA is top in diagnostics, and bottom in health improvement by the medical system.

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Amanda B. Reckondwythe

Dressed for Church
# 5521

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quote:
Originally posted by Belle Ringer:
USA is . . . bottom in health improvement by the medical system.

Everyone knows that except Congress. Take away their health insurance, I say, and let's see how fast they enact a really useful healthcare plan.

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"I take prayer too seriously to use it as an excuse for avoiding work and responsibility." -- The Revd Martin Luther King Jr.

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Schroedinger's cat

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# 64

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I hear people who have problems with the NHS. It is not perfect, there are sometimes delays, and sometimes it doesn't work.

Then I hear stories from the US of the alternative, and I realise that the problems we have are just the nature of a large health system. Sometimes things go wrong, but often - very often - they go brilliantly well.

I feel for those in the US, especially those who don't have massive, all-encompassing insurance cover. Really, your system sucks like a black hole.

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Pyx_e

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Listen carefully you can hear the ghostly chomp of alligator teeth.

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Yam-pk
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Yes, I guess in most countries' health systems people will have horror stories about mis-diagnosis and medical incompetance, however, amongst developed nations, the USA surely takes the gold in terms of denying access to people who can't afford to obtain treatment in the first place [Frown]

[ 30. March 2014, 13:28: Message edited by: Yam-pk ]

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Tubbs

Miss Congeniality
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quote:
Originally posted by Amanda B. Reckondwythe:
quote:
Originally posted by Belle Ringer:
USA is . . . bottom in health improvement by the medical system.

Everyone knows that except Congress. Take away their health insurance, I say, and let's see how fast they enact a really useful healthcare plan.
Put them on politicians on the minimum wage ... And then sit back and watch things change. [Biased]

Tubbs

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"It's better to keep your mouth shut and be thought a fool than open it up and remove all doubt" - Dennis Thatcher. My blog. Decide for yourself which I am

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Yam-pk
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Of course they'd vote themselves a pay-rise before anything else! [Devil]
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Belle Ringer
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quote:
Originally posted by Schroedinger's cat:
I feel for those in the US, especially those who don't have massive, all-encompassing insurance cover. Really, your system sucks like a black hole.

And oh the money it sucks up! Trip to the hospital in an ambulance, 1 or 2 miles, 5 minute ride, $900.

3 hours in the hospital mostly lying in a room staring at a ceiling and wondering about being forgotten, $11,000. To be fair, that included a CAT scan at $3000 and two X-rays.

Probably more, the radiologist probably bills separately.

Where does all that money go?

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Rowen
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Popped into an ER last week, whilst in another state. Medication for something else had made me severely constipated, and somewhat embaressed. Certain things were done, and I left, good as ever.
No cost.
Nice.

Ps. I live in Oz.... Universal health care.

I feel sorry for those going thru difficult times...

[ 31. March 2014, 02:42: Message edited by: Rowen ]

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"May I live this day… compassionate of heart" (John O’Donoghue)...

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Mere Nick
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Our most recent experience went really well. My wife's right side had started to hurt two Fridays ago. Two days later it was hurting worse so she had me take her to the Urgent Care. The doctor there checked her out and scheduled an MRI at the hospital to be taken four hours later. I took her to the hospital that afternoon and at 7:30pm they rolled her into surgery for laparoscopic surgery to remove her gall bladder because it had a massive stone. I brought her home the next morning. Her regular doctor followed up by having her come to his office on Thursday. She's back to her old self now.

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"Well that's it, boys. I've been redeemed. The preacher's done warshed away all my sins and transgressions. It's the straight and narrow from here on out, and heaven everlasting's my reward."
Delmar O'Donnell

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Anglican't
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While it's easy to feel smug about Britain's free-at-the-point-of-use health care system, I understood Belle Ringer's OP to be about the standard of care once one is within the system, not about access to it. In that respect, I think her experiences could probably be common place within the NHS.
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Golden Key
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quote:
Originally posted by Pyx_e:
Listen carefully you can hear the ghostly chomp of alligator teeth.

Exercising her teeth on...?

[Votive]

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Blessed Gator, pray for us!
--"Oh bat bladders, do you have to bring common sense into this?" (Dragon, "Jane & the Dragon")
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ken
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# 2460

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quote:
Originally posted by Belle Ringer:


Where does all that money go?

Profits of large corporations and making a few hundred very rich people a bit richer.

There are plenty of other countries where you can buy the same treatment on the open market for far less.

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Ken

L’amor che move il sole e l’altre stelle.

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no prophet's flag is set so...

Proceed to see sea
# 15560

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quote:
Originally posted by Belle Ringer:
And oh the money it sucks up! Trip to the hospital in an ambulance, 1 or 2 miles, 5 minute ride, $900.

3 hours in the hospital mostly lying in a room staring at a ceiling and wondering about being forgotten, $11,000. To be fair, that included a CAT scan at $3000 and two X-rays.

Probably more, the radiologist probably bills separately.

Where does all that money go?

Yup, it must be profit. Ambulance rides here cost $385 flat rate, and they are a non-insured service except if between hospitals. The following are insured costs. CTs cost between $700 and $1500, with most heads and neck scans (the commonest, being 900-1200 depending on how much they scan down the neck). Xrays, not sure of the costs.

On another forum, I learned that it is about $820, billed to medicare for a gallbladder surgery or appendix, and $75/day billed re the hospital fee for the doctor. There are fees attached to the reports and letters, ranging from $22 to $125.

The hospital fees for basic care are about 1500/day.

All I can say is that the amounts charged to the south for some services appear excessive, and yup, it must be profit.

So a patient going by ambulance and having emergency care gets a bill for $385. Everything else is paid. If it is a car accident, the auto insurance will always pay.

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ken
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There are places in Britain where you can walk in and pay for a simple CT scan for 200 pounds. Say 300 dollars. More complex ones done privately will be 3-4 times that

The NHS internal costs are almost certainly less because of higher rates of utilisation of both equipment and staff.

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Ken

L’amor che move il sole e l’altre stelle.

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Offeiriad

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# 14031

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My wife had an X-Ray here in France.
The bill was £22.
I had an hour with a specialist, with an ultrasound investigation and report included.
The bill was £52.

Both were paid by my medical insurance. Glad I live here!

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Antisocial Alto
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# 13810

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quote:
Originally posted by ken:
quote:
Originally posted by Belle Ringer:


Where does all that money go?

Profits of large corporations and making a few hundred very rich people a bit richer.

It's probably also the fact that instead of a single national or state insurance company, our doctors have to bill a squadrillion private companies. It requires them to keep a hilarious number of billing specialists on staff. Without all the complication and duplication of effort our bills would probably be lower.
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Karl: Liberal Backslider
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# 76

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quote:
Originally posted by Antisocial Alto:
quote:
Originally posted by ken:
quote:
Originally posted by Belle Ringer:


Where does all that money go?

Profits of large corporations and making a few hundred very rich people a bit richer.

It's probably also the fact that instead of a single national or state insurance company, our doctors have to bill a squadrillion private companies. It requires them to keep a hilarious number of billing specialists on staff. Without all the complication and duplication of effort our bills would probably be lower.
Well, it keeps people employed. And they need to be, to have medical insurance...

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Might as well ask the bloody cat.

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Boogie

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# 13538

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quote:
Originally posted by Schroedinger's cat:
I hear people who have problems with the NHS. It is not perfect, there are sometimes delays, and sometimes it doesn't work.

Then I hear stories from the US of the alternative, and I realise that the problems we have are just the nature of a large health system. Sometimes things go wrong, but often - very often - they go brilliantly well.

I feel for those in the US, especially those who don't have massive, all-encompassing insurance cover. Really, your system sucks like a black hole.

Germany has the best system as far as I can see.

Everyone has insurance, including the unemployed. Everyone has fast, efficient access to health care.

My son had a knee problem. He called in at the doctor (of his choice - you get to choose and don't have to 'register' with a particular doctor). Had an appointment within 15 minutes, followed by a scan, followed by injections in his knee. All done and dusted in his lunch hour!

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Garden. Room. Walk

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Anglican't
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quote:
Originally posted by Boogie:
Germany has the best system as far as I can see.

Crikey, we agree on something!
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Boogie

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# 13538

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quote:
Originally posted by Anglican't:
quote:
Originally posted by Boogie:
Germany has the best system as far as I can see.

Crikey, we agree on something!
And in hell too!
[Yipee]

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Garden. Room. Walk

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Penny S
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Heard an odd thing today, A friend in Sarf Lun'on has a mother who has something wrong with her hand. She refused to go to A&E because, she said, her doctor will be charged for the visit. Can this be true? Even if there is real cause to go? (Hopefully she will go to the doctor tomorrow, anyway.)
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Chocoholic
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Well I doubt it will be her dr personally [Big Grin] but, depending on the department and funding agreement type, whenever a patient is seen in an nhs hospital the hospital gets paid for their treatment, tests etc. Others have an overall budget.

It used to be the primary care trusts but is now the clinical commissioning groups which GPs are heavily involved in, who commission care and provide the funding.

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busyknitter
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These days, pretty much the whole NHS budget goes in the first instance to clinical commissioning groups (run by committees of GPs and other people), who contract with hospitals, surgeries and other providers to provide care and treatment for their patients.

Some of the contracts will result in payments for individual treatments, mostly likely routine, planned surgery, where the costs are very well defined (this system has been in place for over 20 years in one form or another).

The funding for A&E is almost certainly handed over to the local hospital as a block grant, based on the number of people covered. But even if there is a payment per visit arrangement, the GP practice is funded for it. Please encourage your friend's mother (and anyone else who has the wrong end of the stick about this) to visit A&E if she needs to.

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Penny S
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Ha. You know the other thread, not a million miles from here, about relations? Encouraging cannot happen.

But thanks, anyway.

[ 07. April 2014, 12:27: Message edited by: Penny S ]

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Anselmina
Ship's barmaid
# 3032

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I suppose one good thing about universally accessible health care is that if someone feels they've got the brush off from one doctor, they can go to any number of others (at least in theory). Many folks attached to their NHS surgeries here will rarely see the same doctor two/three times in a row, unless specifically requested. It's completely normal to see any one of maybe four or more doctors when making an appointment. So if you're unhappy with treatment from Doctor A there's nothing unusual or difficult about booking in with Doctor E or F to see what her take on the problem is.

Currently, I'm working for a hospital day procedures department. The amount of people getting regular scopes to check digestive and toilet problems, or minor surgeries for various lumps and bumps, and participating in the national bowel screening initiative, all makes for an impressive achievement. It's hectic sometimes, a bit messy administratively; but paid for by the tax-payer and saving lives probably every week of the year.

It's quite miraculous to think that people who wouldn't be able to afford these procedures, privately and who would therefore remain undiagnosed can be, as a matter of course, sent by their doctor for a quick camera-probe, and maybe have their lives saved.

I'm comparing this, too, with the Republic of Ireland, where I paid for my scopes a few years ago, privately - the national health service waiting list was over a year, I think. I actually had private health insurance (which is highly recommended in the Republic of Ireland) but hadn't been on the scheme long enough to claim. I think it all came to just under €1200, or something.

Typical trip to the GP - €50. Typical prescription with say three items - €50. The HSE do subsidize some treatments and operate a bit like the NHS in Britain, but private insurance is the commonest way to get things done, I think.

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Huia
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# 3473

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Last time I was taken to hospital by ambulance it was $60. If I was in Wellington I think it would be free.

Huia

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Charity gives food from the table, Justice gives a place at the table.

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Olaf
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# 11804

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I'm just thankful Belle didn't have to go before a death panel to get her foot checked out, as some would have had us believe would happen.

Seriously, our health care mess is embarrassing. I'm consoling myself with the fact that it's generational.

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ken
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# 2460

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Well, I've been in hospital for pretty much the the lifetime of this thread and if they think I need something I just get given it. On this level the NHS just works.

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Ken

L’amor che move il sole e l’altre stelle.

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Belle Ringer
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# 13379

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I've heard this one from several people now. In hospital as patient, some procedure to be done (childbirth, a minor operation with patient fully awake, etc). An extra nurse, or some medical students, ask "do you mind if I watch?" OK.

Bill comes - they all billed their "watching" time as "assisting with procedure."

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Sioni Sais
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# 5713

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quote:
Originally posted by Belle Ringer:
I've heard this one from several people now. In hospital as patient, some procedure to be done (childbirth, a minor operation with patient fully awake, etc). An extra nurse, or some medical students, ask "do you mind if I watch?" OK.

Bill comes - they all billed their "watching" time as "assisting with procedure."

You should bill them, for "assisting with tuition".

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(Paul Sinha, BBC)

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Belle Ringer
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# 13379

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quote:
Originally posted by Sioni Sais:
quote:
Originally posted by Belle Ringer:
I've heard this one from several people now. In hospital as patient, some procedure to be done (childbirth, a minor operation with patient fully awake, etc). An extra nurse, or some medical students, ask "do you mind if I watch?" OK.

Bill comes - they all billed their "watching" time as "assisting with procedure."

You should bill them, for "assisting with tuition".
I have learned to ask of any "do you mind if" to ask "will it cost me extra?" But the woman whose childbirth was "watched" had specifically been told the extra person's time would not be charged.
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Curiosity killed ...

Ship's Mug
# 11770

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Here, if you're in a teaching hospital and it's an interesting procedure you get a large audience. Particularly if you really mistime that procedure and end up with both the outgoing and incoming rotation of medical students coming to watch. (I had an epidural caesarean for placenta praevia and had two lots of medical students watching.) And no, I wasn't asked, I just got told it would happen. But then again I didn't get charged either.

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ken
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# 2460

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I've often been asked if I would agree to a student nurse or doctor practicing on me. Its happened at least five times in the last six months. So far I always say yes, after all they have to start somewhere. Got two different students inserting cannula into a live patient for the first time ever in December - both messed it up and a more senior person stepped in and finished it. In February there was a nervous pair of beginning medical students who had only started in September being shown how to examine abdomens and what questions to ask. So lacking in confidence that it was almost funny. I'm sure they will change.

But that is part of their training. Not part of my medical care. And their tutor or supervisor or whatever is always there to do whatever. And under the rules we have here a patient must give informed consent to any medical intervention. And if its partly or mainly educational or experimental then that's included in the information you need to be given.

[ 14. April 2014, 04:48: Message edited by: ken ]

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Ken

L’amor che move il sole e l’altre stelle.

Posts: 39579 | From: London | Registered: Mar 2002  |  IP: Logged
ken
Ship's Roundhead
# 2460

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quote:
Originally posted by Belle Ringer:

But the woman whose childbirth was "watched" had specifically been told the extra person's time would not be charged.

If that is true then its not just a violation of medical ethics, its fraud or theft. It ought to lead to a criminal trial. Like any other con trick.

Quite a different question from informed consent - I don't know if you have rules on that though I'd be surprised if there wasn't something like it.

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Ken

L’amor che move il sole e l’altre stelle.

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Belle Ringer
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# 13379

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quote:
Originally posted by ken:
quote:
Originally posted by Belle Ringer:

But the woman whose childbirth was "watched" had specifically been told the extra person's time would not be charged.

If that is true then its not just a violation of medical ethics, its fraud or theft. It ought to lead to a criminal trial. Like any other con trick.
Oh she protests the bill, hospital keeps resending the same bill. Of course a person who was "watching" could have handed the doc a towel at the end and use that to justify claiming the watching turned into helping. How do you show it wasn't really help? There's an industry that does nothing but fight hospital bills, getting paid a portion of the money they save you. That's how common inflated bills are.
Posts: 5830 | From: Texas | Registered: Jan 2008  |  IP: Logged
ken
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# 2460

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That's not the point. If she was told that the other person would not be charged, but they were, that is not an "inflated bill". That's a fraud.

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Ken

L’amor che move il sole e l’altre stelle.

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Olaf
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# 11804

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quote:
Originally posted by ken:
That's not the point. If she was told that the other person would not be charged, but they were, that is not an "inflated bill". That's a fraud.

True. I'm surprised the hospital wouldn't simply delete the charges when confronted.

The sad state of affairs is that nobody in a doctor's office or hospital seems to be able to state clearly what anything will cost.

Yet, we have people defending health care as it currently runs.

[ 21. April 2014, 20:51: Message edited by: Olaf ]

Posts: 8953 | From: Ad Midwestem | Registered: Sep 2006  |  IP: Logged
jacobsen

seeker
# 14998

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I am scheduled for a hip replacement in July - result of wear-and-tear arthritis. I was able to chose the approximate date of the op in order to fit in with teaching commitments, and, under the NHS won't pay a penny. What is more, equipment to raise chair heights, toilet seats and give secure handgrips is also provided. All I need to organise is the obligatory friend(s) to be there for me in the first couple of weeks when I get home... [Smile]

Health care heaven, provided I'm not one of the unlucky 2% for whom the op doesn't work. [Eek!]

But I'm optimistic. And my consultant, who will do the op, is a lovely Frenchman... [Big Grin]

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But God, holding a candle, looks for all who wander, all who search. - Shifra Alon
Beauty fades, dumb is forever-Judge Judy
The man who made time, made plenty.

Posts: 8040 | From: Æbleskiver country | Registered: Aug 2009  |  IP: Logged
Gee D
Shipmate
# 13815

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Jacobsen, alas, not for many here. The taxation system forces those of us with an income over a certain level to have private medical insurance. That sounds good, and indeed the insurance fully covers the hospital charges for room and so forth. It does not cover medical bills. So if I were to have the hip replacement you are looking forward to (I understand that the op is not as bad as you might think and the benefits later make it all worthwhile) I would have to pay the surgeon, any assistants, the anaesthetist, and any pathology tests. I'd also have to pay for the replacement hip.

Now, it's not quite as bad as that. I can then get refunds from the Commonwealth Govt which cover a lot of this. But when it comes to the doctors' accounts, I only recover a percentage of an amount set by the Government. This amount is about 75% or so of the surgeon's fees. and half the anaesthetists, so I only receive a portion of that. And by law, I cannot insure against this gap.

The same with seeing the GP. I pay the GP, and get back a determined sum from the Govt. That's about half what I actually pay. Again,insurance to cover this is forbidden. It makes planning for health care in retirement years very difficult.

OTOH, if my income were below the initial figure, or were I prepared to suffer the heavier taxation burden, I could simply enter the public system and have the sort of financial outcome you describe.

And good luck for your operation.

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Not every Anglican in Sydney is Sydney Anglican

Posts: 7028 | From: Warrawee NSW Australia | Registered: Jun 2008  |  IP: Logged
Jane R
Shipmate
# 331

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Curiosity killed:
quote:
And no, I wasn't asked, I just got told it would happen.
You should also have been told that you had the right to refuse consent.

Our GP sometimes does training for students from the local medical school. My husband allowed them to practice on his badly sprained ankle (it was very painful and he was worried he might have cracked a bone; IIRC he'd torn a ligament).

The medical advice he got was spot-on, but he found their enthusiastic comments about how his ankle looked 'just like the illustrations in the textbooks' slightly off-putting...

[ 23. April 2014, 22:28: Message edited by: Jane R ]

Posts: 3958 | From: Jorvik | Registered: May 2001  |  IP: Logged
Boogie

Boogie on down!
# 13538

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quote:
Originally posted by Curiosity killed ...:
Here, if you're in a teaching hospital and it's an interesting procedure you get a large audience.

Yep.

When I gave birth to my firstborn I tore badly and in an 'interesting' way. The doctor who stitched me up was learning how. He did a brilliant job, so afterwards the midwife called all and sundry to admire his work. At one stage I had six people admiring my fanny!

(Now not many people can say that!)

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Garden. Room. Walk

Posts: 13030 | From: Boogie Wonderland | Registered: Mar 2008  |  IP: Logged
Curiosity killed ...

Ship's Mug
# 11770

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I was told it was a teaching hospital and the students needed to learn, so we were expected to put up and shut up. Ward rounds with the consultant had a group of students in tow and I was one of the lessons of the day. By that time I knew the answers better than they did and got to answer the questions when the students couldn't.

I don't remember being asked when I had students practising on me for my daily blood tests - and having had two muck it up I was glad when the nurse rescued me. (Cross matching for transfusions - the hospital had just had one go badly wrong so were taking a lot of care)

I was, however, asked if a student could sit in on my follow up consultations, which I remember as being the first time. But that wasn't in the hospital.

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Mugs - Keep the Ship afloat

Posts: 13794 | From: outiside the outer ring road | Registered: Aug 2006  |  IP: Logged
Lamb Chopped
Ship's kebab
# 5528

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just spent eight days in hospital with full flights of young student doctors, nurses and phlebotomists practising on me (with permission), all extremely polite and with instructors hovering. It looked like a party in my room, particularly when my mother, a retired nurse, came in. Very entertaining watching her fingers twitch as she nobly refrained from taking the doohickey of the moment away and doing it herself, or offering instruction....

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Er, this is what I've been up to (book).
Oh, that you would rend the heavens and come down!

Posts: 20059 | From: off in left field somewhere | Registered: Feb 2004  |  IP: Logged


 
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