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Navigating the National Health System: A personal experience
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An experience abroad had me contemplating the state of our health system in the United States and the implications of nationalized health care.
It is evident that no nation’s health system is ideal and satisfies all the needs of its population.
Weighing the risks and benefits of a nationalized or universal health system compared with a privatized health system — or a thoughtfully constructed hybrid — is an ongoing battle in our country and across the globe. In fact, the United States is the only industrialized nation in the world without nationalized health care, and the debate about changing that has become a popular topic.
A WHO report indicated the U.S. health system spends significantly more money on health care — on both a per-capita basis and as a percentage of gross domestic product (GDP) — than countries with nationalized health care, yet it ranks 37th out of 191 countries in performance. The United Kingdom, on the other hand — which spends just 6% of GDP on health services — ranks 18th in performance.
Notably, the United States ranks as the most responsive health system to patients’ needs.
There are advantages and disadvantages to the current health system in the United States compared with nationalized health systems implemented by most other industrialized nations.
My experience
This summer, I sustained a closed spiral fracture to my distal diaphyseal tibia in London.
I will share my personal experience and struggle with the National Health System (NHS) — a system of free public care and costly private care — from the perspective of both a clinician and patient.
After waiting 25 minutes for an ambulance to arrive at the scene of the incident, my experience in the ED was nothing short of sitting in a room with a plaster cast covering my entire right leg for nearly 10 hours until a specialist — or “consultant” — could assess me.
During this time, X-rays confirmed my right tibia and fibula were fractured. I later was informed that the surgeon would perform an intramedullary nail placement the following day due to lack of available surgeons and operating rooms.
Taking his word for it, I agreed to be transferred to the general inpatient ward for one night, unbeknownst to me that I would be sharing the room with seven other patients, one nurse, no television, no wireless internet connection and no phone.
This ended up being a 4-night stay — keeping in mind that visiting hours only totaled 6 to 8 hours per day, depending on the nurse in charge.
The surgeon visited me the following day and explained that my surgery was delayed an additional day, similar to most patients on the ward, due to lack of adequate staff and unavailable operating rooms. The same happened the next day, and again the following day.
I languished in the hospital bed, unable to move and in pain for 4 days, hoping each day would be my “lucky day” for the surgery.
During these 4 days, I met with the surgeon for no more than 20 minutes; observed one elderly gentleman receive the wrong medication and another younger gentleman receive the wrong operation; waited for upward of 45 minutes to receive my own pain medications; and had to explain to the staff that I required thromboprophylaxis given my inability to move and high dose NSAIDs due to severe inflammation.
After demanding to be transferred to private care for the last 48 hours, I finally hit the jackpot and was transferred from the sixth floor to what I could only assume was the “penthouse” floor. There, I received royal treatment with my own room, including a private toilet, shower, window with a beautiful view, television, internet and at least three nurses caring for me at any given time.
The disparity in quality and quantity of care was shocking. Ironically, my private surgeon was the same surgeon from the general ward. Most physicians in the United Kingdom split time between general and private practice and, by law, physicians must spend at least 60% of their time working for the government in NHS.
Inconceivably, I was forced to pay more to finally receive the care I needed. Then, I thought about all the patients who cannot afford private care, like the gentleman I met in the general ward who received the wrong medication, or the young man who had the wrong operation performed.
Ultimately, my surgery was performed and I was discharged after 7 days in the hospital. Orthopedic surgeons in the United States with whom I spoke told me this surgery should have been completed on the same day, with a maximum 1-night stay in the hospital.
That was my experience with NHS. I will not even get into the medical bills, except to say that, as a non–United Kingdom citizen, I was forced to pay everything out of pocket and provide several thousands of dollars in deposit before anyone would treat me. I also had to sign a waiver indicating I would pay any remaining balance; otherwise, I would be banned from traveling to the United Kingdom.
My perspective
This experience had me contemplating the health system in the United States — albeit still a relatively expensive health system that many cannot afford — and how much I value the quality and responsiveness of care.
My story may sound biased, and this is not to say the NHS does not benefit many people, because there are obvious advantages to the system.
For example, I met a waiter at Pizza Express who asked me, “As a non–United Kingdom citizen, how was your experience with NHS?” I explained how tough it was to navigate the system and the poor quality of care I received.
It turned out his 4-year-old daughter required open-heart surgery. Typically, this would have cost upward of $400,000, including surgery, treatment, hospitalization, follow-ups, and so on. With NHS, however, he did not have to pay a dime.
It is easy to see that the nationalized system worked in this family’s favor. I can only imagine this is the case for most individuals who require unaffordable and complex, lifesaving treatments.
From my experience speaking with hospital staff in NHS, clinicians are overworked and largely unhappy. Each physician is required to spend at least 60% of their time working for the government, and they can work privately for the remaining 40%. One can imagine this is where they make most of their money, leading to an imbalance of care.
It is important to realize that free health care is not really “free.” Expenses for health care must be paid for with higher taxes or spending cuts in other areas, such as defense or education.
Many people feel that, as a citizen, you are entitled to free health care, but the government must pay for it somehow. Free health care also may increase drug costs and doctor visits.
With nationalized health, doctors may be forced to spend more time on noncritical care, due to patients feeling entitled to seek care for minor concerns, forcing the patient who really needs immediate help to wait even longer. Alternatively, the noncritical care patient may wait days before being treated, possibly escalating his or her medical issue to critical status.
A major divide
We need a system that would give everyone the same access to health care regardless of health, wealth, age or employment, at least for critical and life-threatening disorders. A nationalized health system may offer this; however, this should not come at the expense of quality of care.
The intent of the Affordable Care Act was to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage, and reduce health care costs.
The individual mandate, largely disliked by the public — particularly those who are young and single — requires all individuals not covered by an employer-sponsored health plan, Medicaid, Medicare or other public insurance programs to secure an approved private insurance policy or pay a penalty. This individual mandate, coupled with subsidies for private insurance as a means for universal health care, provided a means for uninsured citizens to purchase more affordable insurance.
In 2015, a poll reported that 47% of Americans approved of the health care law, whereas 55% responded it was good but needed changes, and 31% suggested it needed to be repealed. This year, approximately 58% of Americans favored replacing the Affordable Care Act with a federally funded health care program that provides insurance for all Americans.
We are living in a critical time with major shifts in the health care paradigm. Although not meant to be generalized, my personal experience with the nationalized health system made me further appreciate the quality and responsiveness of health care in the United States and leads me to remind “experts” with no experience of nationalized health care to investigate its nuances carefully before legislating expansion of the current system.
References:
CBS News. Poll: Obamacare and the Supreme Court. June 22, 2015. Available at: www.cbsnews.com/news/poll-obamacare-and-the-supreme-court. Accessed on Aug. 12, 2016.
Gallup. Majority in U.S. support idea of Fed-funded healthcare system. May 16, 2016. Available at: www.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx. Accessed on Aug. 12, 2016.
HHS. The Affordable Care Act, Section by Section. Available at: www.hhs.gov/healthcare/about-the-law/read-the-law. Accessed on Aug. 12, 2016.
WHO. World Health Organization assesses the worlds health systems. Available at www.who.int/whr/2000/media_centre/press_release/en/. Accessed on Aug. 12, 2016.
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Jai N. Patel, PharmD, is chief of pharmacology research and phase 1 trials at Levine Cancer Institute at Carolinas HealthCare System, as well as adjunct assistant professor at UNC Eshelman School of Pharmacy. He also is a HemOnc Today Editorial Board member. He can be reached at jai.patel@carolinashealthcare.org.
Disclosure: Patel reports no relevant financial disclosures.