Feeling Healthy?

I grew up with the NHS - its what I was used to. I knew that going to the doctor meant waiting ages and an appointment in the morning usually meant I'd be taking the whole day off of school. I suffered from recurrent throat infections (pharyngitis for my medical followers) and was told I needed to have my tonsils out. I was put on the waiting list and it took approximately 3 years for my tonsillectomy to take place. I waited 5-10 years to have skin graft surgery for my arm. Well of course, some would say (and I would agree), these weren't life-threatening operations (surgeries), were they?

The NHS was really all I knew until I moved to America 12 years ago. In America you had to have health insurance unless you wanted to pay exorbitant amounts of money to see a doctor, get an x-ray, blood work etc. You can purchase health insurance on your own which can cost approximately $200 a month (about 150 pounds) but that doesn't always include co-existing conditions that a person may already have at the time of purchasing this insurance, such as diabetes, asthma etc. So basically - group insurance is the best way to go. You pay a small fee monthly and you get good benefits (usually) but you have to either be employed, in school, or somehow get a group insurance. Does it sound easy? Not to me, it doesn't.

Anyway by having health insurance in America - it doesn't guarantee anything. You still have to pay a co-pay to see the doctor and a higher co-pay to see specialists. Also, you pay co-pays on medication. You better hope the medication you are prescribed is a generic, or else either the insurance won't cover it, or you'll be responsible for paying over $200 for a medication monthly.

Health insurance is very complicated because it depends on the type you have etc. I did a whole certification class on it but I won't bore you with the details. Which is better - the NHS or having this health insurance? I don't know.

People in America who are employed but not fortunate enough to have health insurance sometimes cannot get health insurance on their own and therefore they are left with little choices. Do they go to the doctor and risk the huge fees? Or do they risk not going and having something really wrong with them? During my clinicals at the ER, we saw plenty of patients without insurance who came to the ER with minimal issues because they didn't have health insurance and its easier for them to go to the emergency room then to a regular doctor because they can just refuse to pay the hospital and let the bills pile up. But what about those people who have chest pain but don't want to go to the ER because they are worried about the cost involved? What about these people? Its tough. Health care providers cannot be there to assess the risk before the patients even come to the hospital or clinic. We cannot force people to come in if we don't know what is going on. Its a hard battle.

But is the NHS so pretty. Not always. I know many people who don't get the testing they need, or the care they deserve because they are receiving NHS care. True - they have a choice, they can go private - but not everyone can do that. A friend I know has diabetes. She is being prescribed Metformin which is one of the cheapest medications available. Unfortunately, she is not doing too good with the medication due to the common GI side effects experienced with this medication. She has been told by her doctor that this is the only medication available to her. Why is this? There are many many medications available for diabetes. Does she have other risk factors, kidney disease, blood disorders etc. No. The reason she is being told this is because metformin is the cheapest drug available and therefore NHS are pushing this medication as being the only drug available because it is cost effective. But is this fair. I don't think so. I don't think a patient who is obviously having side effects which are very common to this particular medication should have to continue this medication and not get a choice to change.

I know that in my experience when patients taking Metformin experienced a side effect we would recommend another because pts who have side effects are usually left likely to be compliant with the medication anyway. So -we switch to another class of medication. But then the patient makes up the cost involved. The patient is responsible for it. So what's the difference? What is better?

I don't know. I can't judge what is better until I have lived a life of both and experienced much more than I have. The way I see it is that both have their own issues and both have their pros and cons. The primary goal of health care regardless should still be to serve the sick and help those that need it and I think that goal needs to be recognized and be more aware of. I just hope that I can adopt that goal when I start working as a PA.