Facts about Government Health Plans around the World

There's been a great deal of discussion about getting Universal Healthcare here in the US. I've seen bits and pieces about plans in other industrialized countries, but never complete descriptions so that we can compare and see what works and what doesn't.

To get a clearer picture of what's out their I've listed several questions to be answered by our overseas members. Please tell us what the country is.

US members please feel free to insert questions of your own.

1. How is the plan paid for and approximately what percent of your income (taxes) goes toward the plan?

2. How long does it take to get an appointment with a doctor?

3. Do you see the same doctor or is it who ever is available?

4. Once in the office, how long until you actually see the physician?

5. Can you see a specialist if you choose to without going through a gatekeeper or getting prior approval?

6. If you need a MRI, scan or x-ray for diagnostic purposes, how long do you have to wait?

7. In the hospital, how many RNs per patient?

8. How many beds per room?

9. Are there limits to the number of pap tests, mammograms, prostate exams you can have during a specific period of time. (Under Medicare Pap tests are covered every two years rather than annually unless medically necessary.)

10. Can you get private supplemental insurance and if so, why would you need it?

11. What limitations are there that you know of?

12. To be fair, what don't you like about your system?

13. Tell us anything else that might help us better understand how other countries provide healthcare for their citizens.

•  Tip Jar...just the facts m'me.

  I'm really curious and hope you all want more info.

  by auapplemac on Sun Sep 16, 2007 at 11:43:58 PM PDT

•  one quick point

  Individuals go bankrupt in the US--covering their medical bills.

  That doesn't happen in France, UK, Canada, Japan, Germany.

  That is the bottom line.

  by Salo on Sun Sep 16, 2007 at 11:44:10 PM PDT

•  If you want information

  about health care in other countries, check out the diaries by Dr A
  http://dr-a.dailykos.com/

  by TheMomCat on Sun Sep 16, 2007 at 11:53:53 PM PDT

•  I have two friends who live in Canada

  I asked one of them last month about it because I was curious to and she said no waits, no problems. Paid for in her taxes, didn't say how much. She has regular check ups like i do yearly.

  My other friends husband had lung operation with no problems or waits for it. They both have had two kids.

  She said she feels bad for her relatives in the U.S. that can't afford medical. I went to college with these two girls and they married canadians so know both ways.

  by marlakay on Sun Sep 16, 2007 at 11:58:56 PM PDT

•  Here is a link to

  the HSE Ireland:
  http://www.hse.ie/...

  by langerdang on Mon Sep 17, 2007 at 12:39:58 AM PDT

•  I live in Sweden

  But moved from the USA only 1.5 years ago...so I cannot answer all of the questions...But I will give it a shot...

  They tell me 10% of our paychecks go to healthcare. Keep in mind though, this also covers prescription drugs. I have a friend that had a stroke a few years ago. He refills his precriptions every month and comes home with around 10 different drugs...all of which costs him nothing.  

  We only have two personal experiences over here..both times we saw a doctor within 2 days. Both instances were minor and we just called for an appointment. Our realtives over here seem pretty satisfied. For the most part if is not critical, you might wait a few days or weeks.  

  I toured 2 hospitals. One in Stockholm and one in my home town. I would say they were both very comparible to the USA. Up to date, high tech, clean. Here in Jönköping, I noticed a lot of art on the walls and sculptures. The nurse giving the tour explained that a certian percent of funding goes towards creating a relaxing environment for the patients. They change all of the art out every 6 months. They usually buy from local artists.

  Nursing shortages seem to be a reality in the summer months as everyone wants to take a vacation in July. We have a law that says we can use our vacation whenever we wish, the employer has to find a replacement. We get 5 weeks of paid vacation here so that really puts a strain on our system.

  Hospitals seem very acessible here. All that waiting in-line-bullcrap seems to be over hyped in the states. In our admitably few experiences, we have had short waits and good service. I probably need to stay here a few more years before my rose colored glasses come off, but I will NEVER miss the broken system in the USA.

  by swedenusa on Mon Sep 17, 2007 at 12:47:33 AM PDT

•  Germany

  A lot of people on DK have read all this from me before, but I guess it’s worth saying again.  Anyway, I was just godamned lucky.  A couple of months earlier and I would have been stuck in the Americn hospital system.

  How is the plan paid for and approximately what percent of your income (taxes) goes toward the plan?

  Not exactly sure.  Most of the population pays 19% tax here for social services (I’m pretty sure)

  How long does it take to get an appointment with a doctor?

  On average a week or so for a  specialist, sometimes sooner. I an get in to see my GP in 1-2 days.

  Do you see the same doctor or is it who ever is available?

  The same doctor

  Once in the office, how long until you actually see the physician?

  Less than an hour, sometimes less than half and hour

  Can you see a specialist if you choose to without going through a gatekeeper or getting prior approval?

  No, you must see your GP for a referral and pay the GP 10€/quater

  If you need a MRI, scan or x-ray for diagnostic purposes, how long do you have to wait?

  I had mine in the hospital the night I was admitted.

  In the hospital, how many RNs per patient?

  Not sure, I counted a rotation of 4.

  How many beds per room?

  2 unless you have good private insurance.

  Are there limits to the number of pap tests, mammograms, prostate exams you can have during a specific period of time. (Under Medicare

  Pap tests are covered every two years rather than annually unless medically necessary.)

  Not sure. I think there is no limit if you are willing to pay OOP for any tests that aren’t really necessary.

  Can you get private supplemental insurance and if so, why would you need it?

  Yes. for the extra coverage. Be careful in Germany, because if you go beyond a certain limit, you can’t get back into the state plan. If you lose your private insurance you can’t get back onto the state plan, either.

  What limitations are there that you know of?

  None, as far as I know, unless you count unnecessary care.  I might be wrong

  To be fair, what don't you like about your system?

  Coming from America, there is nothing here that I don’t like

  Tell us anything else that might help us better understand how other countries provide healthcare for their citizens.

  There is more compassion,  much less paperwork, shorter wait times and the care is equal to or better than in the States. The whole process of medical care, all the way from the waiting room is quick, cheap and the big surprise is the low cost of medicine at the end of the trip.  Oh yeah, the OTC pain killers are a lot better here and don’t have caffeine that gets you hooked.  The doctors all complain that the system is going to be "americanized" (something you have to get used to, but they are a LONG way from becoming "americanized." they like to complain over here. Seems to be an art form.  The contracts for doctors are worse than they were, so there’s a strike about once a year.  A lot of these docs can go to the UK and make a lot more money.  The standard of living is not as good, though (IMO).   The whole political thing confuses the hell out of me.

  I went into the hospital for about 2 weeks.  2 CT scans, 2 MRIs, X-rays. 2 EEGs, Spinal tap, PT and a balcony with a view.  Cost? I think it was about 200€

  by gringoringo on Mon Sep 17, 2007 at 01:24:57 AM PDT

•  Spain

  I live in Spain. The public system here is solid, though of course has its issues. The doctors and nurses are at least as good as in the US, and the outcomes are better - higher life expectancy and lower infant mortality, for example, although these may have as much to do with the society as with the healthcare system.

  If one has a chronic or serious problem the system here is much better than that in the US; one does a little paperwork and pays nothing. I have a paraplegic relative, and know someone with a brain-damaged son (of 50 years), and the care and assistance they receive is basically quite good.

  There are waiting lines for surgical procedures; I have no experience with this. In general going to the doctor would be just like going to the doctor in the US. You make an appointment, go and wait a bit, see the doctor, get referred to a specialist if you need one (not if you don't; and that's a good thing).

  The thing is paid for basically off of payroll taxes, like FICA, which are a percentage of the paycheck similar in size to FICA.

  Two or three beds to a room in the (public) hospital is the normal thing.

  There are private hospitals and private insurance. People get them because they have money and find them more convenient. The quality of the care they provide is no better (perhaps worse) than the public system (my family has used both), but they are more flexible (you have more choice of your specialist).

  Generally I am quite happy with the system; there is some irritating paperwork, but it is nothing like the bother of receiving unreadable printouts telling you obliquely that your insurance company has declined to pay for your trip to the doctor because it was not pre-approved before the car wreck that left your paraplegic, much less paying for those uncovered bills. The US would do fine to copy it.  

  by xylon on Mon Sep 17, 2007 at 01:25:36 AM PDT

•  addendum

  Maybe to amplify on a previous comment. A relative in Spain became paraplegic after an accident; he spent two or three months in intensive care, another three or four months in a national hospital for rehabilitation of paraplegics, and continues to receive regular doctor's visits at home and take lots of medications.

  Total cost: 0 euros.

  Actually in some sense it is better than that. His income taxes are heavily discounted because he is discapacitated.

  In the US the same situation would have bankrupted the family.

  by xylon on Mon Sep 17, 2007 at 01:28:24 AM PDT

•  Japan National Health Care info.

  I wrote a diary about Japanese national health care a while back that is more in-depth than this will be:

  http://www.dailykos.com/...

  But to answer your basic questions:

  1.  Cost of Japanese national health care is calculated like Social Security deductions are calculated in the US and top out at about $100,000 of income.  The rough table of monthly costs can be seen below and basically gets you about 70% coverage of your medical bills:

  Annual Income:  Employer cost    Employee cost:
  $10,000             $50             $50
  $20,000             $75             $75
  $30,000            $110            $110
  $40,000            $140            $140
  $50,000            $180            $180
  $60,000            $200            $200
  $70,000            $235            $235
  $80,000            $260            $260
  $90,000            $320            $320
  $100,000+          $410            $410

  2.  Appointments with doctors can be made with a few days advance notice (or less).  You can also drop in on a different doctor, if you want.  there are no restrictions on who you can see.

  3.  As far as I know, you can see your preferred doctor, if you want.

  4.  Wait times in my experience are about 10~30mins.

  5.  As far as I know you can go to any specialist you want.  The only caveat is that the procedures need to be covered by national health care.  The doctors will know whether or not it's covered.  Some things aren't covered:  cosmetic surgery, viagra, abortions, braces (for teeth), etc.  For things that aren't covered, you need to pay out of pocket.

  6.  MRI scans... my girlfriend got one recently and I think she made the appointment 2 days in advance.

  7.  How many RNs per patient - don't know.  Doesn't seem much different from the US (I worked at a hospital in the US).

  8.  Beds per room:  2~6?  You can get a private room, but you need to pay the extra amount out of pocket, I believe.  Supplemental insurance might also pay extra if you need a private room.

  9.  Limits for tests?  Not sure.  I get a card from the national health care people every year encouraging me to get certain tests done for free.  If you want more than that, I think you have to pay out of pocket.

  10.  Private insurance is available.  the most common type here is cancer insurance because cancer treatment is still expensive even when you have nat'l health care.  I think it costs around generally costs around $100/month and some of them might include a life insurance benefit, as well.  It depends on the seller.

  11.  Limitations:  See my answer for #5 above.

  12.  What don't I like?  

  • Dentists seem to require multiple visits for checkups/fillings, etc.  I think it's because they can't make enough money with just one visit.  It's kind of annoying.  I always tell them I need checkups/cleaning done in one sitting and it seems to work.  
  • There's also a lot of old, crummy neighborhood hospitals in Japan.  I tend to avoid them.  
  • For some reason, hospitals also have fairly regular business hours, which I always find strange.  I'm not sure what people do in emergencies.  I guess the ambulance shuttles them to a hospital that's open.  FWIW, ambulances in Japan are little more than medical taxis.  I don't think the paramedics can do much to help you.

  13.  The system in Japan is not perfect and it's not free.  In addition to the above deductions taken from your paycheck, it also covers about 70% of the medical/drug bill.  You still have to pay for the other 30%.  But the system is very transparent and easy to use.  It's basically stress free, if you ask me.  Doctors here still tend to be wealthy so they aren't getting screwed by the system, American pharmaceutical companies (who always bitch that government shouldn't dictate prices), still sell in Japan.  the Japanese gov't negotiates prices and American pharma companies have not bailed out of the market; in fact, Pfizer and other drug firms have big offices near my home and have been on a hiring spree of sorts for the past couple of years.  Lastly, everyone is covered - even people earning minimum wage.  If you're unemployed, you simply go down the the ward office and enroll yourself at the costs above.  No one is ever denied covereage and in fact, it's illegal for people legally working/living in Japan to not be enrolled  

  by YoyogiBear on Mon Sep 17, 2007 at 01:37:04 AM PDT

  •  One very important good point about Japan is

    that the costs above cover your whole family.  if you're single you pay the same as someone who's married with 3 kids.

    It's family friendly!  Something even a conservative would have a hard time objecting to.

    by YoyogiBear on Mon Sep 17, 2007 at 01:48:24 AM PDT

•  US here

  How is the plan paid for and approximately what percent of your income (taxes) goes toward the plan? 100% paid for by my employer.  Premium they pay is 10K a year regardless of income paid to employee.

  How long does it take to get an appointment with a doctor?   GP is a couple of days.  A specialist can take 10 days.  

  Do you see the same doctor or is it who ever is available?  Same one, if you are willing to wait when they have a day off.

  Once in the office, how long until you actually see the physician?  Had one doctor it was 2 hours in the lobby and another hour once you got into a room.  Current doctor is about 20 minutes in lobby and 10 minutes in the back.

  Can you see a specialist if you choose to without going through a gatekeeper or getting prior approval?  Yes, because I have a PPOM.

  If you need a MRI, scan or x-ray for diagnostic purposes, how long do you have to wait?  X-ray is same day.

  In the hospital, how many RNs per patient?
  How many beds per room?  One of the best in SE MI, I swear there's only RN on the whole freakin floor. Awful care in the rooms.

  Are there limits to the number of pap tests, mammograms, prostate exams you can have during a specific period of time. (Under Medicare Pap tests are covered every two years rather than annually unless medically necessary.)  No limits, but I don't have coverage for "routine" medical exams despite the hefty premium my employer pays.  This non coverage includes the doctor's vists and tests.

  Can you get private supplemental insurance and if so, why would you need it?  Suppose, never looked.

  What limitations are there that you know of?
  To be fair, what don't you like about your system?
  Tell us anything else that might help us better understand how other countries provide healthcare for their citizens.

  Absolutely no coverage for help with the elderly with dementia. Medicare plus private insurance, and they don't cover a dime.   Can't be pulled out of the expensive 911/emergency system regardless of age or health - unless they are actively dying and qualify for hospice.   The price of help in the home is about $15.00/hr, and it is pretty awful - generally speaking.   Unless they are placed into skilled nursing (paid for by Medicare or Medicaid), the cost to medically care (feed, cook, bathe, ambulate, medicate, sleep and recreate) is $6,000/month. If you are old an indigent, I guess you get a cardboard box under the via duct.  If you take in your elderly parent, you can work all day and sundown all night.  The American system sucks.  

  by dkmich on Mon Sep 17, 2007 at 02:20:31 AM PDT

  •  Maybe you can share more details?

    I never understand how health insurance works in the US.

    Do you have a 'co-pay' and do you need to go to 'network' hospitals or can you go anywhere?

    What's the deductible for care?

    If these are ignorant questions, please forgive me.  I truly cannot understand how American health care works.

    by YoyogiBear on Mon Sep 17, 2007 at 02:24:31 AM PDT

    •  How it works, depends on how much money one has.

      Do you have a 'co-pay' and do you need to go to 'network' hospitals or can you go anywhere? The answer is no and no for me because I have exceptionally good insurance.  

      What's the deductible for care?  Again, for me it is none.
      If you are rich and buy or have "dinosaur" health care benefits from an employer like government, schools, or General Motors (heavily unionized), you get good health insurance that pretty much lets you go where you want when you want to.  If you are the average Joe and get the "usual" and what has become "standard health insurance" benefits from an employer, you get co-pays, deductibles, HMOs which won't let you go anywhere and try to deny everything, as well as having to pay a part of the premium.  Like homeowners, you can crap shoot with your deductibles.  If you are young and healthy, say a deductible of 3k leaving you with catistrophic coverage only. If you are really, really poor and can stand the treatment dished out, you can get medicaid.  This is government funded insurance which is greatly underpriced in the market place and thus accepted by only a handful of doctors.  If they don't accept it as payment, you can't go.   If you are everybody else and uninsured, you get nothing.  When you get sick, you show up at an emergency room.  If you aren't dying, they tell you to go away or leave you there for hours.  When you get the bill, you make arrangements for little payments that go on forever or go into collection because you can't pay it.   None of these include prescriptions unless it is the welfare one.  None of these include care for the elderly who are just too damned old to take care of themselves and not sick with anything "acute".  If they were 20 and demented, they would be under a bridge in a cardboard box.  They also closed down our mental health facilities where they could live and receive treatment.

      by dkmich on Mon Sep 17, 2007 at 02:37:53 AM PDT

      •  How did you get your insurance?

        Do you work for the government?  A large financial institution?  Are you an executive?

        I'm just wondering where someone gets insurance that pays for everything (except tests), as yours seems to do.

        It sounds like it's decent and I seldom hear Americans talk about how great their health insurance coverage is so if you don't mind me prying, can you at least give us some background on your industry, your position, etc.?

        by YoyogiBear on Mon Sep 17, 2007 at 02:48:28 AM PDT

        •  I am a non-rep. employee of a k-12 public school.

          Although we are not unionized, we get the residual benefits of having unions (teachers, clerical, and custodial) in our mix.  Our benefits are truly the last of a dying breed. We also have "gasp" a pension.  Because our schools are now broke (thanks to Republicans and slick Willie and NAFTA), they are doing everything they can to cut their costs.  So is the State's Republican Party.  

          Traditionally - schools and government paid low wages and made up for that in benefits. So one could either work for a for-profit business making them rich or work in a helping profession/environment in exchange for low pay,  stable employment, and good benefits.  For me it was an easy choice.  Money and profit margins don't motivate me a bit. I thoroughly enjoy my job and appreciate my employer.   I have been lucky, and I want the same opportunity for my grandkids.  I am a staunch supporter of single payer or medicare for all.  If Clinton could blow away manufacturing without a second thought, I think the medical insurance industry needs to go without a doubt.  We don't need any middle men sucking up money that could pay for health care.  After them, comes the pharmaceuticals.  Our politicians apparently think teeth are extraneous as well since no one has dental insurance in this country either.

          by dkmich on Mon Sep 17, 2007 at 02:04:15 PM PDT

    •  American Health

      If these are ignorant questions, please forgive me.  I truly cannot understand how American health care works.

      Don't feel bad. Most Americans don't understand it. But your question got me thinking.

      We're constantly told about the 45 million people without insurance. Or sometimes the number is a little lower or higher. About ten million of those people are not Americans, they're here illegally. Millions more qualify for the socialized medicine programs but have failed to sign up for benefits. Many more millions are young, healthy and think themselves invincible, so they choose to forgo insurance and spend the money on something else.

      There is no health care crisis in America. There are some serious problems with the system, but it doesn't rise to the level of crisis.

      The health care crisis is like the crack cocaine crisis. It's just another way for politicians to grab more power by scaring the crap out of voters.

      by StainlessSteelUrsus on Mon Sep 24, 2007 at 12:36:00 AM PDT

•  Australia Info

  1.  How is the plan paid for and approximately what percent of your income (taxes) goes toward the plan?

  Nominally, every tax payer pays a 1.5% levy, low incomer earners are exempt. It doesn't cover costs, and paying for medicare now chews up 43% of the government's health budget. In the past year the whole thing cost $18.3 billion Australian dollars.

  2. How long does it take to get an appointment with a doctor?

  Varies. Unfortunately bulk billing has collapsed in the past few years, so if you want to see a doctor in under a week, go to a hospital. Hospitals see people based on urgency. I went in with food poisoning and saw someone in twenty minutes. go in with a bee sting and you'll be waiting for up to six hours.

  If you need surgery for something that isn't immediately life threatening, the waiting period can be months.

  It never used to be this hard, but the conservative Howard government has been gradually undermining the previously successful system.

  3. Do you see the same doctor or is it who ever is available?

  Depends. Goto a hospital and you will see who ever is available.

  Goto a private practice and see the same doctor time and again. The problem is that fewer and fewer practices are prepared to see patients for the paltry sum of money the government is prepared to pay them for a consult these days.

  4. Once in the office, how long until you actually see the physician?

  Private practice, depends on the efficiency of the practice. Hospitals, as above.

  5. Can you see a specialist if you choose to without going through a gatekeeper or getting prior approval?

  Only through a GP (general practitioner, aka the doctor)'s referral.

  6. If you need a MRI, scan or x-ray for diagnostic purposes, how long do you have to wait?

  Depends. If your life hangs on it, damn fast. I haven't been in with anything needing an x-ray in recent years.

  7. In the hospital, how many RNs per patient?

  By this I take it you mean nurses?

  This is where the Australian system goes all strange. Funding medicare is a federal responsibility, providing nurses is a state responsibility. It depends on the state. the ACT is the best, dont even bother in New South Wales.

  8. How many beds per room?

  Again, the buildings and facilities are a state responsibility.

  9. Are there limits to the number of pap tests, mammograms, prostate exams you can have during a specific period of time. (Under Medicare Pap tests are covered every two years rather than annually unless medically necessary.)

  Not that I'm aware of.

  10. Can you get private supplemental insurance and if so, why would you need it?

  Yep, the conservative idiots that run this country have slowly been undermining medicare by re-directing medical spending into subsidies for private health care.

  They want everyone to get private cover, and they're slowly trying to reduce the universal system to little more than a safety net.

  On principle I refuse to get private cover. Basically private cover gets you through the queues much faster. It's disgusting. Because they are effectively in competition with medicare, the private providers push the fact that they offer "extras". These extras range from non-tradional medicine to things that border on lifestyle (free gym membership!)

  11. What limitations are there that you know of?

  It hinges on doctors being prepared to see patients for the price the government is offering them. And the government hasn't increased that price since the 1980s. Doctors struggle to make a living for government money.

  Also, states are responsible for hospitals. The hospital system is in a state of decay in some places, and world class in others.

  12. To be fair, what don't you like about your system?

  The trend towards seeing it as a safety net. The push to "americanise" it.

  There is another aspect to the Australian system, call the pharmaceuticals benefits scheme. Basically guaranteed affordable drugs. The problem is that the government effectively controls what a drug can be used for, and is slow in adding new drugs to the scheme. Plus the cost is sky rocketing.

  13. Tell us anything else that might help us better understand how other countries provide healthcare for their citizens.

  You wont die for lack of care in Australia. You might spend a miserable time in a queue at a hospital, it might take months to get to see a dentist, months for surgery and the time to see a specialist varies radically.

  Medical care in rural areas suffers due to a complete inability to attract qualified professionals. A lot of towns only have doctors because of our concerted efforts to poach them from India. Seriously, India should hate Australia for what we do to their pool of skilled medical professionals.

  The public mental health system sucks. The private system costs too much.

  It used to be much better than it is. But private providers prepared to see people for public rates are all to often a thing of the past.

  The governments response to this issue has been to push increased private health cover, because it is loath to do anything that results in an increase to an already massive public health budget.

  The think that checks the collapse of universal health care in Australia is fear of massive voter backlash. Australians support their health system.

  by Kieran Bennett on Mon Sep 17, 2007 at 03:31:58 AM PDT

•  I think

  you have put forth some good ideas and I appreciate your effort to educate people with facts.

  But, what I usually see discussed makes me believe that the issue isn't framed correctly.

   -1. Health is a right, not a privilege.

   -2. If we are trying to evaluate a system by the way it treats the people that make $100,000/year we are negating point#1. Fuck them. I make $70k, fuck me too! I can take care of myself if I have to.
  It's the 47 million uninsured that matter. Take care of them. Then, it's the next 47 million that barely make it. Then, it's the seniors that were promised a few good years after a lifetime of work and service to the country.
  Sounds cruel for the rich? Fuck them again!

  by Euroliberal on Mon Sep 17, 2007 at 03:47:07 AM PDT

•  Canada - Province of Ontario

  Answers- #1 - see below
          #2 - Family doctor-no problem. Emergency-immediately. Specialist for NON-Emergency 4-6 weeks.

          #3 - Same Doctor
          #4 - Doctors appointments !!! That's why they call it a 'waiting room', time varies between 5 mins to 45 mins. Depends on if Doctor gets backed up.
          #5 - Must be reffered by Family Doctor to see a specialist for NON-Emergency complaint.
          #6 - Again it depends on if it's an Emergency or not. Non Emergency 4 days. Emerg-immediately. (I had a CT Scan in the spring for my back this year, so I know this one first hand).
          #7 - Not sure about nurse ratio but they do have those buzzers to ring them up.....
          #8 - 1 bed to 4 in a room. You need private Ins for a 'Private Room'.
          #9 - Yes there are guidelines for regular visits BUT if you are high on the suspectibility scale you will get additional monitoring.
          #10 - Yes you can, if you want a Private
  room (one bed) for example and to cover certain drugs outside of the hospital and for 'wage loss' and Out of Country Travel. Other than that Private Ins does not influence your speed of assistance etc..
          #11 - No limitations; can go anywhere in Canada no questions asked. They will even pay for Out Of Country BUT it takes a while to get it so most of us get Private Ins when we travel just to expedite the process.
           #12 - Bit of a wait for Specialists but that is a world wide phenominian. Other than that I and no one I know has had a problem worth complaining about.

  Allthough Canada's Health care is a Federally mandated program the Provinces administer their version of it with differences. One of the big differences is that in 2004 a new Provincial govt instituted an additional 'OHIP Tax' to be paid by employees. Previously the cost was paid by employers.

  While I can't find the actuall portion of out Taxes used for Health Care ( it appears to be 8.5% of each TAX dollar collected)I do have the following numbers.
  --------
  The Canada Health Transfer last year provided provinces and territories with cash support for health programs equal to more than 8½ cents of each tax dollar ($19.0 billion).

  http://www.fin.gc.ca/...
  --------
  Canada's per capita spending in 2004 was $3,165 US. It is above the OECD average but below Norway, Switzerland and Luxembourg. The U.S. spent $6100 per capita in 2004.

  Before Canada introduced a single-payer system, spending in Canada and the U.S. was escalating in parallel. After 30 years of single-payer administration, Canada now spends almost fifty percent less than what Americans spend (9.9 per cent of GDP in Canada versus 15.2 per cent in the U.S.) while providing equal or better care. All Canadians are covered while the U.S. has 46 million citizens with no coverage.

  --------
  The new Ontario Tax rate -scroll up when you open the link

  http://www.fin.gov.on.ca/...

  by scrambler on Mon Sep 17, 2007 at 04:44:39 AM PDT

  •  Canada - Manitoba

    It's pretty much the same as in Ontario, but there are a few differences -- we don't have any extra tax and we do on not pay premiums to the public system. I expect we pay higher provincial income tax though, and we are a smaller, poorer province.

    #2 In fairness, this depends on where you live and how far you are from a major centre, but generally, how fast you get into any doctor will depend on how sick you are.  The usual wait time would be 2-3 weeks for a non emergency, but I have got appointments the same day when I needed it.  Six weeks would be normal for a specialist unless you were really ill. I also think this time has a lot to do with who your own doctor knows.

    #3 Same doctor, but there are many  multi doctor practices where you may see someone else if it is an emergency. Also walk in clinics are growing.

    #4 Apparently the same as in Ontario.

    #5 Must be referred, but once referred you make your own appointments -- important also that you can ask for another referral if you don't like the doc you have and you can ask for second opinions.  

    #7  This would depend on the service I would think and how big a hospital, and whether it was a teaching hospital.

    #8 One to two.  Most hospitals have been renovated here so there are no four bed rooms.  You need private insurance for a private room, but if only a private room is available and you need a room, you aren't charged for it.

    #9 Tests are done at the request of the physician.  One full physical per year - you'd have to pay for third party required exams.  Eye exams every two years unless you are a senior or have some disease (like diabetes) that requires more regular exams. This is pretty subjective -- but individuals can't go around demanding tests whenever they want.

    #10 Yes.  The cost varies and this insurance is almost always a perq at employment. Drugs are covered in Manitoba according to a sliding scale according to income.  Extra insurance picks up the slack.

    #11  Can't expect coverage for experimental drugs and treatments, and there are some limits on drugs which can be overridden by special request from a physician.
       Will pay out of country but only to THEIR scale. Canadian provinces have been known to fly citizens out of the US by air ambulance rather than pay American rates.  
       I can tell you that at our local hospital, the rate for out patient care in emergency for foreigners is $299 CDN per day and for in patient $1329 CDN. I would suspect that that would be all inclusive.

    #12 I use the system a lot and have no complaints.  You sometimes hear grumbles about waits but I think those are from people who want instant gratification.  What I would like to see is better administration by medical professionals, not bureaucrats. I can't add anymore to scrambler's comment, other than to say that I know Ontario can be quite different and that whatever you may hear, there are no long waits for most care where I live, and that our doctors and nurses are as good as anywhere else.

    by Aunt Arctic on Mon Sep 17, 2007 at 06:58:07 AM PDT

•  Canada- Ontario

  I forgot to mention No copay when you go to a doctor or hospital.

  by scrambler on Mon Sep 17, 2007 at 04:46:28 AM PDT

•  England

  Note that the following applies to England only. There are slight variations in the other constituent countries of the UK, eg in Wales, drugs are free.

  
    1.  How is the plan paid for and approximately what percent of your income (taxes) goes toward the plan?
  Through a "National Insurance" payment that also covers unemployment benefits and retirement pensions. The latter means there are different schemes but for only a basic pension and where the employer has a good scheme, the deductions are 9.4% for the employee and 9.3% for employers (different rates outside a minimum and maximum pay band but the central band is very wide and covers most people).

    2. How long does it take to get an appointment with a doctor?
  
  With a GP, maximum 2 working days, urgent visits and home visits for more serious cases possible.
  
    3. Do you see the same doctor or is it who ever is available?
  Can be either in a group practice. Requesting a specific doctor may mean exceeding the 48 hour limit.
  
    4. Once in the office, how long until you actually see the physician?

  Government target is 30 minutes max.
  
    5. Can you see a specialist if you choose to without going through a gatekeeper or getting prior approval?

  GPs act as gatekeepers but are able to treat a wide range of illnesses and minor surgical procedures.
  
    6. If you need a MRI, scan or x-ray for diagnostic purposes, how long do you have to wait?

  Depends on urgency. Immediately in cases of emergency or injury, routine tests can mean a wait of a couple of months.
  

    7. In the hospital, how many RNs per patient?
  Depends on specialist ward and time of day. Obviously more for intensive care/special care baby units. General wards seem to be about 1 per 4 to 6 patients.
  
    8. How many beds per room?
  Varies enormously. Open wards of 15 - 30 beds being replaced by "bays" of 4 to 6 in newer hospitals. Single rooms available in case of need eg compromised immune systems after transplant.
  
    9. Are there limits to the number of pap tests, mammograms, prostate exams you can have during a specific period of time. (Under Medicare Pap tests are covered every two years rather than annually unless medically necessary.)

  Standard intervals laid down by National Institute of Health and Clinical Excellence (weigh cost against benefit and likely risk of procedures) Doctors get bonus payments for ensuring regular tests like pap are performed on time.

  
   10. Can you get private supplemental insurance and if so, why would you need it?

  Yes. Private patients can get better "hotel" facilities - single rooms etc. Also allows limitation of waiting periods (one offers a "if NHS cannot do procedure in 6 weeks, we pay for it privately" policy) Insurance common for procedures not covered/limited cover by NHS such as dental care and glasses.
  Privately insured may opt out entirely of non-emergency treatment but still have to pay National Insurance contributions. (Everyone, including tourists, are covered for accident and emergency treatments.)
  Note: NHS can recover the cost of treating road accident patients from the "guilty" driver's insurance company.
  

   11. What limitations are there that you know of?
  
  Usually based on a clinical assessment of outcome. Smokers less likely to get heart or lung transplants for example. This can lead to age restrictions by some surgeons. Age restrictions on free fertility treatment.

   12. To be fair, what don't you like about your system?
  
  Drugs not available as too costly for benefit (eg very new Alzheimers or cancer drugs) cannot be purchased by patient and continue to receive NHS care (ie must be fully private). Government targets mean elective/non urgent cases can delay more urgently needed treatment.

  13. Tell us anything else that might help us better understand how other countries provide healthcare for their citizens.

  NHS founded at a time when country was bankrupt after war and in the face of opposition from senior doctors (the minister said he "stuffed their mouths with gold" to stop the opposition)

  That was however at a time of great social solidarity and egalitarianism after the mutual suffering of all classes in WWII. During the war, free treatment was given to all workers and children, to the former to ensure wartime production.

  The formal NHS system was built both on a system of National Insurance that covered some industries established after WWI (but not dependents like wives and children) Mutual societies, trades union and charities provided care on a patchy basis up to WWII.

  GPs get additional payments for reaching targets in preventative medicine. Initially these were for such things as percentage of children immunised, number of cervical smear tests undertaken on time but are now moving on to things like obesity and hypertension reduction.

  by Lib Dem FoP on Mon Sep 17, 2007 at 06:02:18 AM PDT

•  Big thanks to everyone who particpated!

  I've learned a lot. Although I want UC, still don't know what type of plan is best for US. For me it's important to see a specialist when I feel it's necessary. My GP is an Internist.

  I've found that some GP's may be slow to recommend specialists because they don't want to let go.

  Also ward type hospital rooms can be very unpleasant for the patients.

  May sound elitist, but even semi-private (2 to room) can be a problem (although I don't expect private rooms for all) when the odors and moaning of other patient are extremely upsetting, when you yourself of in pain or you're trying to recover.

  Imagine what it would be like with even more in same room. I've also seen patients embarrassed because they are concerned about disturbing the other patient.

  Thanks again for your input.

  by auapplemac on Mon Sep 17, 2007 at 11:52:01 AM PDT