Tuesday, November 25, 2014

Socialized healthcare – a nightmare?

I regularly watch political shows, and often in US media the term “socialized healthcare” is used to refer to something negative and something that US consumers should be afraid of.  Remember the "Death panel" discussions that Sarah Palin started several years back in the US? Having lived in Finland for more than 3 years with my family, I now have some experiences within a socialized healthcare system and perhaps it is time to address the big question – is it a nightmare?  In my experience, not so.  Once we moved to Finland, everyone in my family received a Finnish social security card (Kela), which entitles us to the benefits in the public healthcare system.  Of importance, the Finnish system is not entirely reliant on the public system, as there are several large private health providers, who are typically sponsored by employers.  Both me and my wife have the supplemental employer sponsored private health care, so we have also used that for our healthcare needs, especially for quick health check-ups, e.g. for cold and flu symptoms etc.  In essence, we have a choice between the private and the public system, however, the private system does have limitations so that e.g. all surgeries are referred by the private doctors to the public system.

How does the system work?  Our kids are school-aged so they receive regular health check-ups either by a nurse or a doctor through their school.  The cost for regular check-ups for kids?  None.  :)  Recently one of my kid had a regular check-up and during the visit we discussed the need to have her tested for certain allergies.  The original appointment with the doctor at the school premises was on Tuesday afternoon and on Friday we received a letter in the mail indicating that she had been scheduled for an allergy test at a hospital approx. three weeks later.  We did not get to choose the date and time for the test as in the Finnish system typically the providers will do the scheduling without input from you (yes, I can see how that would be considered inconvenient to many), but this was certainly quick and efficient. 

Dental care is free for all until age 23.  Our kids receive letters in the mail for their dental check-ups.  Again, we do not get to choose the time and date, but the system makes sure every child gets their appointments at certain grades/ages.  Cost for kids’ dental care?  None.  Adults pay for dental services, however, the Finnish social security administration (Kela) still subsidizes a portion of the costs.  I have done e.g. dental cleanings via the public system.  Perhaps a bit inconvenient is that it usually will take about 2 months for an appointment, but then again dental cleanings can be planned ahead of time.  Dental care in the public side in our experience has been just fine.  Of course, Finns in general are not very emphatic, or at least they do not hold your hand at every juncture, so I don’t have a warm or close relationship with my dentist, but rather I receive the care and they provide it.  Cost for adult dental care?  Yes, there is some depending on what you need.  Dental cleaning at the public side costs about 30 euros.   My wife has done dental cleanings as well as other procedures at the private providers and paid a bit as well, again with partial Kela subsidies.  Nevertheless, to our surprise the cost of dental care even with private providers in Finland is no more expensive than dental care in US with (good) employer sponsored dental plans. 

Surgeries in Finland are typically handled by the public side.  Even if you visit a private doctor who determines the need for a surgery they will give you a referral to the public hospitals for the actual surgery.  I know some friends who have had surgeries in Finland and my wife recently had one as well.  As far as I have been told, all of them have been happy about the quality of the care they received.  Again, they did not get to pick the date for the surgery, although certainly if the original date does not work you can reschedule it, in which case it will be rescheduled for the next available time the hospital has.  For my wife, the wait time for the surgery, which was not time-sensitive, was approx. 2-3 months.  Cost for surgeries?  Yes, there is some, but they are ridiculously low.  Surgeries involve a day-charge for the use of hospital beds, and that is all that is charged from the patient.  So, if your surgery requires you to stay overnight in the hospital, you would pay 2 x approx. 30 euros ($40, i.e. $80 in total).  For my wife, she did not get to choose the surgeon (or the date), but she had a meeting with one of the two operating surgeons prior to the surgery and as a result had no concerns about not knowing the surgeon or what would happen during the surgery.   Another friend we know had cancer while in Finland, and many of her friends asked if she would have rather been in US to receive care there.  My impression was that she felt that she received timely and appropriate care, and most importantly, she fully recovered from cancer.  So, from our experiences, there are no delays, long lines or other inefficiencies, at least not with respect to serious illnesses or procedures. 

The idea of having to wait for long lines is often portrayed as something that certainly happens in socialized healthcare systems.  We tested this recently as well.  Few weeks ago on a Saturday afternoon my wife suddenly lost hearing in one of her ears (due to what turned out to be an ear infection).  With no private health care providers open late on weekends, she went to the on-call (päivystys) at a local hospital.  She provided her social security card and explained her issue at the front desk.  They logged her in and told her to go to the waiting room to be called.  This is where the long wait times come in, right?  It was a large room with lots of chairs, tables, magazines and TV-screens, and it was after all Saturday evening almost 9 pm.  The patients are called in to see the doctor based on priority.  So, the more urgent your matter the quicker you are seen.  Given that her symptom was merely inability to hear and pain in her ear, she pulled out a bunch of magazines and prepared for the wait.  Long?  No, in about 10 minutes she was called to see a doctor, and within another 10 minutes she was done equipped with an antibiotic prescription.  Since pharmacies were not open, she was given the first two antibiotic pills free of charge by the doctor to get going before the pharmacies would open the next morning.  Cost for urgent on-call appointment?  Yes, approx. 30 euros ($40).   This was certainly just one experience and I am sure there are more busier times than others when patients with less urgent matters have to wait. 

We have had few urgent check-up needs (for our kids) over the years as well.  In each case, we have received an appointment for the same day.  With an appointment we are seen when the appointment is scheduled for, so there are no lines or extensive wait times.  Cost for urgent or same day appointments for children?  None.   My son recently fell at school at recess at approx. 11:15 am.  The teacher called us when my son complained about his teeth hurting.  My wife called the urgent same-day (public) dental care, and received an appointment for 1 pm, which really was the earliest she could do after picking him up from school and driving to the dentist.  Efficient and no waiting.

Filling out form after form.  That is one thing I recall from US health care visits.  Most every time you visit a doctor’s office you have to fill out few forms about your health history and few disclosures as well.  The amount of paperwork required at doctor’s offices in Finland seems to be quite minimal in comparison.  I think the reason for that is a centralized system where all of one’s health information is stored.  Typical doctor’s examination rooms in Finland include a computer, and the doctor always enters some information into the computer during the visit.   Prescriptions are entered by the doctor into the computer system as well and during the visit they will print a copy to you which you can present at the pharmacy.  However, only on few occasions have we been asked to fill out extensive forms about health history. 

Medicine and pharmacies are closely related to health care.  Medicine costs are subsidized by the social security administration.  The costs vary depending on the medication, and the cost is often described particularly by the elderly as being expensive.  Finland in general is an expensive country.  By way of an example, we have seen e.g. antibiotic prescriptions cost anywhere from 10-25 euros (13-35 USD).  I am sure there are more expensive medicines in Finland, but our experiences are quite limited.  Getting a prescription filled in a pharmacy in Finland is in itself one of the most efficient operations I have seen.  Some prescriptions nowadays are electronic, but regardless of the format, you show up at the pharmacy and wait few minutes to be seen by the next available pharmacist.  You proceed to the counter, present your prescription and social security card.  The pharmacist types in the information on the computer and while she/he is still typing, the medicine you need is either dropped off at the counter by another clerk or dropped from an automatic tubing system (think of those systems used e.g. in Costco by cashiers to send a stack of bills via the tubing system into some office).  I have never seen them handling individual pills and counting how many to place in a bottle to be prepared for the patient.  Instead the clerk finds the packaged drug from behind-the-counter shelves etc., and it is brought to you.  I remember having to wait in US in Safeway or Longs for 10-15 minutes even without anyone else being there so that they can confirm the prescription and then prepare it by getting the actual pills, sorting the quantity etc.  The total process for getting medicine in a pharmacy in Finland is finished within few minutes. 

So, in response to the overall question – is socialized healthcare something to be afraid of and would it be the end of the world?  Based on our experiences of over 3 years in the Finnish health care system, I think the words socialized healthcare and nightmare should be used in the same sentence only in late night entertainment shows.  Regardless of the system, some people will always complain.  I know some Finns who complain about the Finnish system as well.  However, based on the experiences we have had, I think (Finnish) socialized health care system works quite efficiently and well, especially considering that it is universal and almost free.  And those Finns who complain, have not really given me any specifics as to what in particular is worth complaining about.  Seems like those who I know who have needed care have received it in a timely manner and with sufficient quality.

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