Not on a theoretical level, but how would you practically have to pay costs, access specialist doctors?
I’ll start with the German system. Here you are either automatically insured in one of the public insurances (there are many), which marginally differ in their cost (think single digit euro differences) and have to cover basically the same procedures. If one reaches a certain income level, being privately insured is possible.
If you are publicly insured, you wont see most costs, as these are directly handled between your insurer and the doctor/hospital. For some medications and procedures there are co-pays that are flat fees (5 Eur for Medications, …).
Access to specialists mostly need a referral from your family doctor.
In private insurance, often you yourself will be billed and you will need to hand this to your insurance company.
The good side is that in most common situations I have never needed to worry about cost in public insurance, wait times for referrals can be very long and understanding what you need to get certain care can be very difficult. Private insurance often has better payment schemes for providers and less artificial limits on number of patients or which doctor is able to provide services, so access to most care is faster and more widely available.
Access to specialists mostly need a referral from your family doctor.
That hasn’t been the case in many years now, you can just make an appointment without a referral.
Well, for most specialist. There are still a few cases were it is required, e.g. radiologist.
Also with public insurance you might have to wait longer for your appointment with a specialist - but if you have a referral from your family doctor, they can add a urgency note (Dringlichkeitsvermerk) on it and you will get an appointment faster. With that you can also call the health service hotline (116117) and they have to find an appointment for you.
That is not correct anymore - they are absolutely insured as long as they are entitled to Bürgergeld,even if they don’t actually get it or have the three month block in it. The problem is more that the insurance works retroactively in that situation and they often are billed privately by health care providers (which is somewhat illegal) and some of these claims “stick”, especially if you don’t have the resources to fight it.
Sweden: Healthcare is mostly tax-funded. There is a small fee (for adults between 20-85 ) for each appointment. This fee lies between 150-330 SEK (~15-33 €), depending on which region you’re in. Emergency care is usually about 10 € more (40€), and an ambulance trip double (so ~60€). If you’re admitted to a hospital the fee is 120 SEK/day (in my region). Total fees paid for appointments during a year is capped at 1300 SEK (130 €), after that they’re cost-free.
The above is regarding “necessary” care, so things like cosmetic surgery, vasectomies, etc. you’ll have to pay more.
Access to specialist doctors varies, some you can contact directly (usually private practice), and others you’ll have to first make an appointment with a general practitioner at a health center, then get a referall if they deem it necessary. In my region there’s quite a long wait time for many specialists (I had to wait 6 months for a head MRI), and sometimes you’ll have to travel quite far because the care is only offered in one hospital in the region (My wife had to drive 200 km for a surgery).
UK here. Everything is free at point of use (paid via taxes) except prescriptions. It’s around £10 per item. But they are free if you have certain long term health conditions, are pregnant etc.
To see a specialist your doctor writes a letter and they contact you.
Australia here.
For most medical services, the govt will reimburse you a set rate. The GP or specialist can charge you whatever, sometimes the same as the govt reimbursement, sometimes quite a lot extra. You don’t pay anything at public hospitals (which are nice).
I recently had some great problems, I stayed overnight in hospital twice, for a total of 3 nights in private rooms, had an internal scaffold inserted in my artery. i also had numerous consults with specialists and drs.
The whole thing cost me about $500, a few days work on average wage.
U.S.A., I have a “high deductible PPO” plan, more or less what my parents would have called “Major Medical”.
It covers only some preventative care, for $0 out of pocket, whatever is mandated by the government basically so annual wellness, annual woman-care, birth control, one dermatologist visit.
Then nothing, until we spend some ridiculous amount in one year, I think it’s $7,000? At which point it starts paying 80% until we have paid an even bigger $, then it pays 100%.
So we don’t have healthcare, exactly, we have limited liability for healthcare cost.
Specialist I can just schedule, do not need to be referred by GP. Prescriptions are subject to that same high deductible.
This plan costs, out of my paycheck, kind of a lot for family coverage, and employer puts back some of it onto a “health savings account” that can be used to pay towards the cost. Not anywhere near that $7k but some, and what is not used stays in there. I also put money in that account out of my paycheck to build it up so that when we do eventually have a bad year again, the money will hopefully be there to use.
Yes it’s complicated.
This is the plan the vast majority of people in the US have. It’s dogshit.
Yes it is. And besides the premium and other costs, we also pay taxes for care for the sickest and the oldest. These private insurers are cherry-picking the group they insure and still charging the outrageous fees, raking in profit and outsourcing the more expensive groups to the rest of us to pay for. So I get about half of my paycheck as netpay after medical, tax, HSA and 401k; same as someone in a socialized nation, but without the assurance of healthcare or a pension.
