Hey everyone. I've been in Australia 2 months now, and things are sure a lot different here than in the U.S. For my Aussie friends and relatives as well as my non-Aussie counterparts, I thought I'd do a little comparing and contrasting of life in Australia versus life in the U.S.
First of all, the U.S. healthcare system. Most Australians I've talked to have the impression that healthcare in the U.S. is so expensive that only wealthy people can afford it. They have the impression that if you don't have health insurance, you will not receive medical treatment. I've even heard the slogan, if you're visiting the U.S., "If you get a pain, take a plane", meaning if you develop a medical issue while in the U.S., you should seek medical treatment in another country.
It's a shame Australians have gotten this impression, because it's totally inaccurate.
The U.S. is a mostly private healthcare system. The vast majority of hospitals are private. The only ones I can think of that are public are Ben Taub in Houston, Cook County Hospital in Chicago, and I think Washington Hospital Center in Washington, DC and Massachusetts General Hospital in Boston are semi-private. Because hospitals are private and independent, policies and employee wages vary from hospital to hospital.
Health insurance: I think all employers are required to provide health insurance for full-time employees. The basic coverage is free for the employee. The employee can choose to add their spouse and children to the plan, but the employee will be responsible for the extra cost. Some health insurance plans include dental; some do not. Employees can choose to pay a little extra to have dental and/or optical coverage included in their health plans. For the unemployed, part-time employees, and the self-employed, if they want health insurance, they must pay for their own plan. Co-pays are common with health insurance plans for routine dentist or doctor's visits. $15-$30 per visit would be the amount the insured patient would be responsible to pay.
Medicare and Medicaid: Medicaid is a government health program for poor people. I don't think people covered by Medicaid pay any health costs. Medicare is a government health program for the elderly. Medicare covers most health costs, but the covered individual might be responsible for a very small portion of costs.
The uninsured: Not everyone in the U.S. has insurance, Medicare, or Medicaid. For those without coverage, they must pay the full fee for medical treatment. For example, an uninsured person may have to pay $150 for a doctor's visit, while someone with insurance may only have to pay $30, as the insurance company will pay the rest of the cost. If an uninsured person were admitted to the hospital for surgery or any other medical issue, the cost of their stay would be higher than a person with insurance. Once the person was discharged from the hospital, they would receive bills from the hospital and doctors. They would most likely be on a monthly payment plan until the balance was completed. For a lengthy or expensive hospital stay, an uninsured person might be making monthly medical payments for years.
What about people without any money? What about, for example, homeless people? All hospitals in the U.S. are required by law to treat everyone in need of emergency medical treatment, regardless of ability to pay. If a homeless person were to come to an ER with pneumonia, the hospital would admit him, treat him until he was well enough for discharge, then discharge him. The hospital would have to eat the cost of his stay. They would not, however, have given him what would be considered optional treatments, such as chemotherapy or a joint replacement.
At the hospital where my mom works, 30% of the patients do not pay anything.
How payment from an insurance company, Medicare, or Medicaid works. Insurance, Medicaid, and Medicare payment for services is usually based on DRG's (diagnosis related groups). Medicaid, Medicare, and insurance companies have a set max amount they will pay for a particular medical treatment or condition. For example, Medicare may have a $7000 set cost for a hip replacement. Regardless of whether the person receiving the hip replacement stays in the hospital for 2 days or 2 weeks, Medicare will not pay more than the $7000 set amount. If the person's hospital stay cost more than the $7000 cap, the hospital would have to eat the rest of the cost of the patient's hospital stay. Because of this, doctors, nurses, social workers, etc. are encouraged to discharge patients in a timely fashion. Patients who develop secondary conditions or infections while in the hospital and thus end up staying longer cause the hospital to lose money. Medicare and Medicaid will not pay the cost of expenses incurred if a patient develops a bed sore while in the hospital. For this reason, recognition of preexisting bed sores upon admission and prevention of future bedsores is highly harped upon. In my last job, a patient was admitted to the hospital with a preexisting bedsore, but the nurse admitting the patient failed to notice it. Because the bedsore was not documented upon admission, Medicare/Medicaid considers it to have developed while the patient was in the hospital, therefore Medicare/Medicaid will not pay any of the costs realated to the bedsore. The hospital has to eat those costs. Insurance companies also operate on DRG's. If the costs of a hospital stay exceed the insurance cap, the patient will be billed by the hospital for those costs.
A few Australians have also expressed concern that a hospital would discharge a patient before the patient was well enough to go home. Doctors, nurses, and hospitals all have liability and could be sued if a patient was discharged and developed a worsened condition after discharge. ER doctors are especially leary of this, and because of it, I have seen so many patients admitted, who, in my opinion could have been safely discharged home.
Wait times. For a visit to an internal medicine or family practice doctor (the equivalent of an Australian GP), in a non-urgent situation, the wait time might be a couple of days. For a dermatologist, the wait time would likely be 3-6 weeks. For a gynecologist, the wait time would be anywhere from a few days to 6 weeks. For a dentist, the wait time would be 1-6 weeks. For a non-emergent surgery, the wait time would probably be anywhere from a few days to less than a month.
Having worked in the U.S. healthcare system for 4-1/2 years, I can say that it is by no means a perfect system, but it actually works pretty well. Athletes from Europe will come to the U.S. for sports-related repairative surgery. If the U.S. healthcare system were truly inadequate, stuff like that wouldn't happen.
I'm sure I've probably left out a lot of stuff, but this is a start. If you have any questions, about the U.S. healthcare system or any other comparison of Australia and the U.S., let me know.
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