Feb 8, 2021 04:13PM moth wrote:

1) Canada.

2) You choose your family doctor - but there's a shortage of family doctors and some people are struggling to find regular ongoing care & relying on drop in clinics. The cancer agency in Vancouver now has Nurse Practitioners to provide ongoing care for those who don't have a family GP. For an oncologist, you are kind of assigned but you can make requests and changes and get 2nd opinions. But the cancer care system in my province is highly integrated - all the cancer centers work together from the same guidelines and any cases that don't fit into neat categories are discussed at regular tumor board conferences so my sense is there is not much variation in treatments. I had a choice of surgeons and endocrinologists etc.

3) For me they have been. I'm in a large metropolitan area though. In some smaller towns there are delays and levels of service are not the same. Everything for me has been smooth and quick, even during covid.

4) in my group of friends & family, yes. There is also pretty broad support for expanding healthcare to include a pharmacare program (currently drugs are not covered unless you are on social assistance and even then, not always; or if you have private extended health insurance through an employer. Cancer therapy drugs are *mostly* covered but the drugs to deal with side effects are not.Also, new cancer drugs are often not covered.) and also some coverage for dentistry

5) best - we don't go bankrupt for medical care whereas I understand it's one of the leading causes of bankruptcy declarations in the US. Worst- things take a while to get approved (we're often a couple years behind the US for cancer drugs for ex) and some are approved but NOT covered by the gov't. Nationwide, decisions on whether a cancer drug will be recommended for financial coverage are based on recommendations that will benefit the most people. So a very expensive drug that only helps a few and only a bit, will likely not get approved because it's better to provide other, more effective therapies to more people. Needs of the many outweigh the needs of the few....
And again, on the worst side - wide disparities based on region. Remote areas of Canada have greater health challenges and poorer services.

Feb 9, 2021 02:15PM sondraf wrote:

1. What country are you from?

Currently in the UK; have used both NHS (public, universal care provider) and private services

2. Are you able to choose your doctor and hospital or are you assigned to one?

Under NHS - I was assigned to a hospital for my initial dx, and would have had surgery there had that been the proper route. I was not happy with the surgeon OR the hospital, which was miles from my house, and I felt it was of questionable cleanliness. I was then reassigned to a different hospital for oncology, and reassigned to a new oncologist who I only saw once, instead mostly seeing junior oncologists/researchers/registrars. Appointment times were down into the 8 to 5 minute range and every new oncologist meant they had no idea who I was or my concerns. It drove me nuts so I switched to private care, where I was able to choose my oncologist and hospital and I see JUST HER every month, so she know me as a person and I feel much more at ease opening up to her.

3. Are tests and results scheduled in a timely manner, like two weeks?

Depends - my scans were moved from 3 to 4 months right away, mostly due to Covid pressures. Results were hit or miss, I once waited almost a month for the outcome of some scans. At diagnostics it took two weeks to find out I had cancer (for sure), then another two weeks to find out it was terminal, and then another 8 weeks before I started treatment. Under private treatment I use the same facilities but am "bumped to the head of the line" - my scans are now scheduled when they are convenient for my schedule (end of day), I can make changes, and my results are done within 24 hours. The same doctors work in the NHS and private systems as I don't think they can have hospital privileges without agreeing to see a certain percentage of NHS patients.

4. Do people generally agree that the higher income tax rates are a fair trade for the medical benefits? (I only ask this because I can't see how it would be possible to provide it without raising taxes)

The NHS is essentially a state religion in the UK and the link between tax payments and affording the health service has been broken. There is very much a sense of entitlement to "our NHS" - you get a lot of stories of timewasters who are drunks in the ER at 3 am every Saturday, or people going to the GP because their toe hurt, that sort of thing. Similarly you get people who "don't want to waste the NHS time, its just a little thing" when it actually is something that SHOULD be checked out, but there is this perception that the all-holy NHS can't cope year after year after year so we must all support it by... not using it?!

It is free at point of access so people push that to the limit. I am in a high tax bracket and pay over 40% of my salary on taxes, a lot of which goes to supporting the NHS. That is before you account for the local services monthly tax and the 20% VAT tax on everything else. My workplace 100% funds my medical insurance and I have no other deductibles and maybe a small copay (I had to pay the difference for my genetic testing - a whole £14). As a cancer patient, any medicine prescribed for me is free - so my letrozole or amoxicillan or whatever the GP may prescribe is always free, as are my Ibrance and other drugs. You can access other drugs in the private system as there are certain equations used to determine if a drug is useful to offer to the wider population.

Is it a fair trade? I think a small form of personal contribution to access services (say £10 for a GP visit, or £100 if you are using the ER as a drunk tank on the weekend) would help encourage people to take care of themselves better, fund improved services and access, and get people to realize that health care isn't free and no, the NHS can't just always patch you up and off you go. Many people in this country don't pay any form of income/contributory tax, so if you are stuck in the higher tax bracket, but below the super rich, you are paying a lot of money in contributions to the health system for others who won't take care of themselves (not everyone is like this, but you see the disincentive).

A small fee could also help fund better preventative care - mammograms dont start here until 50 (even then is every 2 years), its every 3 years for a PAP (which doesn't include breast/pelvic exam). The GP system acts as a gatekeeper into the NHS services so if you are "too young" for cancer they are more likely to put you off rather than refer to get something checked out. It took me almost four weeks to get my initial appointment to be seen for my breast lump. GP offices are not great - usually somewhat shabby with older equipment and I have never EVER had a single GP actually touch me. I had one diagnose my back problem from sitting behind a desk.

Feb 10, 2021 01:41PM - edited Feb 10, 2021 01:42PM by exbrnxgrl

I am American and wanted to share my perspective. Countries that have national healthcare systems are usually happy but most I know freely acknowledge that it is not perfect. In the US, we have a tangled patchwork of ways to get medical coverage. Wait times for appointments, tests and results are all over the place and the reality is that if you have a very good insurance plan, you are often served more quickly and given more options. If you don't have insurance or have a plan that doesn't cover much, you're in for many more delays and fewer, if any, choices. Bottom line? If you have the money you can get great care, if not your care choices become limited. I have been fortunate to have very good insurance but would gladly “give up" some of the conveniences I've enjoyed sothat everyone can get decent medical care. So many other nations have figured this out. Why can't we?

Feb 10, 2021 02:47PM illimae wrote:

exbrnxgrl and olma, I agree and I’m not excluding the American perspective but want to encourage real, first hand experience by those who have national healthcare. There’s lots of talk about us doing what other countries do but I, like most people, don’t actually know the details of how other systems work, not enough to have an honest opinion of it anyway.

I appreciate all participation here, it’s very helpful.

Feb 11, 2021 10:14AM illimae wrote:

flashlight, I agree. I had a government job with great insurance and am now on Medicare with a Medicare advantage plan through my retirement plan. My costs are almost nothing, which I am extremely grateful for but being 45, it wouldn’t be available to me if I wasn’t stage IV. I see many young people struggle with the system we have now and I’m hoping there’s an affordable compromise somehow.