My experiences in the UK have been pretty good.

Bashed my ribs a few months ago, went in and got a check-up. I suspect a difference with the US is that I would probably have got an X-ray since they test a lot more. I was told that since the "treatment is the same for bruising as fractures" (i.e. there's bugger all they can do) there was no point to an X-ray.

My father has a lot of health problems, the worst of which are Parkinson's and prostate cancer. His treatment for those has been excellent: he's got a lot of attention from specialists.

The problems with waiting lists tend to be for the less serious problems: he had a months-long wait to get a hearing aid. But people who can afford it tend to "go private" for things like that.

I have private insurance through my job, so, by using that, I can free up a space for a patient in the NHS. The biggest issues with my local hospital (Whipps Cross) are cleanliness (it used to have one of the worst rates of death from MRSA and other bacteria-related infections) and the large (25-30 bed) mixed-sex wards, where you're side by side with strangers, men and women mixed, and only a curtain to separate you, sharing toilets and bathrooms. No privacy, no dignity.

I can only use my private insurance if I see my NHS GP for a referral. To get an appointment you feel as if you're having to complete some arcane and complex series of tasks set by the receptionists, who will only grant an audience with a doctor if you get every single thing right.

"I'd like to make an appointment to see Doctor _____"

"What about?"

"About my health?"

"What, specifically?"

"I'll discuss that with the doctor"

"I can't give you an appointment unless you tell me what you want to see him about."

"I don't have to tell you that. It's private."

"But I need to know"

"Why?"

"For the records."

"But the doctor will record it when I've discussed it with him in confidence, and not standing here in the reception area in front of fifteen patients, one of whom is a neighbour of mine, and all the other office staff."

"Well you can't see the doctor then."

"Oh, okay then, it's about my ... er... male pattern baldness." Heh.

"Wednesday morning at 9.40."

Can't you just phone the receptionists for an appointment Jan?

The hospital I was talking about, btw, is the local NHS one. The local private one has single-occupancy rooms with their own bathrooms, a 4-1 patient-nurse ratio, hotel-quality food, your own free TV and phone (in the NHS they have pay to view TVs which cost about £3 per day, telephone calls cost 10p per minute to make and 49p a minute to receive). I had major surgery at my local private hospital in 2003 and I think it made a huge difference to be in surroundings where I didn't feel my dignity was compromised.

A friend of mine who had the same operation in an NHS hospital said that, as soon as a patient was ambulent, they were coerced into taking other patients to the toilet and helping serve meals and drinks.

I think they're trying to change things at my NHS hospital, but it's an enormous old Victorian hospital and there just isn't the money available to give NHS patients a high standard of care all the time.

I'm in Germany and I have the normal public insurance. I can only speak of my own experience.

A few years ago I was in the hospital due to a heart related emergency. Within a half hour of my arrival, I was getting a heart catheter. I ended staying in the hospital for one week and had physical therapy/rehabilitation for 3 weeks after that. It was at a facility not far from here. The rooms were clean. The hospital staff were polite and professional. I had 3 square meals a day and a private room. All together I think I paid about 250 EUR.

When the first doctor told me that I was going to stay there for a week, I worriedly asked how the hell am I supposed to pay for it. He said to me in English, "You're in Germany, you have insurance. Relax."

I like not having to worry about going to the doctor, when I am sick. I have to pay 10EUR every quarter if I go to my doctor. If I don't go, I don't pay. Past the age of 35, everyone is entitled to 1 free checkup every year.

If I don't like my doctor, I can go to another one, any one I choose. Prescription medication is also much cheaper than in the US.

I pay 14% of my monthly salary for health insurance. I pay about another 16% for other forms of taxes, so about 30% total of my salary. If I were to pay for the same quality of healthcare in the US, I would be broke. The money I pay in taxes more than makes up for what I would have to pay if I lived in America.

There is private insurance, like my GF has, and it might mean that you get private rooms in the hospital and more time with your doctor. The paperwork with private insurance is more of a headache though because the bills get sent to you and then you have to submit them to your insurer and things might get lost or misplaced...

It is such a relief not having to worry about it. Is the system perfect? No. All complex systems developed by humans have inefficiencies. There is bureaucracy that can be frustrating but it is usually encountered after treatment or when you have referral from your family doctor to a specialist. It's nothing that a few stern words and a few telephone calls can't clear up. The main thing is, if I need care, I can get it.

Although there are things like my career and my girlfriend keeping me here right now, I would like to someday live in the US again. The state of US healthcare prevents that. I would not be able to find a job that would offer me a benefits package that would provide me with the same care I am used to getting here. Also, due to my pre-existing condition, I doubt I could get any reasonable coverage. But more importantly, I wouldn't want to give up the quality, security and freedom I have when it comes to making my own decisions about my health.

Can't you just phone the receptionists for an appointment Jan?

No, they don't take appointments over the phone. You get a recorded message telling you that you (or someone on your behalf) has to call into the surgery to make an appointment. There's no facility to leave a message. Instead, if it's urgent, you have to call another number (that they tell you about in the recorded message). But if you call that number and it's not urgent, and you do it more than three or four times, they'll take you off their patient list.

The only other option is the first-come, first-served system they operate where you show up at 8am and hope there's a spare slot for you at 10.15. And you have to wait, or you lose your place - you can't leave and come back. If they can't fit you in in the morning, you have to come back at 2pm, and see if there's a space any time between 2pm and 6pm.

It's sucky beyond belief, but all the local GPs in this area operate the same system and say it works very well (for them, probably).

I'm staying away from this thread: I work for a private health insurance company here in the UK, and am tired of thinking about it. Heh.

Specklet, if I direct my next claim to you, will you also authorise a boob lift, tummy tuck and some liposuction at the same time? You know, just check those boxes on screen, nobody will ever know ...

I: Indonesia

When I was living in Bandung, the issue of public insurance never even came up; I'm not sure it exists. The school where I was working paid for some catastrophic-care stuff - like evacuation to Jakarta or Singapore if you were in a head-on collision or something (though now Bandung has a few fantastic hospitals) - and would pay for whatever you needed locally, up to a certain (really high) limit, so if you got some random endemic tropical disease like dengue fever or typhoid, you were covered, because even a week or two in a private room in the hospital was something under $100. (One of my colleagues had both at the same time!)

Amazingly, though, this never happened to me - I credit my mom's meticulous food-prep education, eating at super-crowded food stalls with high turnover, and window screens to keep the bugs out - but the few times I needed a prescription for antibiotics or something, I'd just call the English-speaking, Singapore-educated doctor down the road and see if he was free later in the week or that day - I'd head over there, discuss my symptoms, and then we'd gab about whatever was happening in town, my classes, his kids. The guy's clinic was really convenient, and both labwork and prescriptions were under $1 each. He'd often just have samples lying around. Easily the best doctor I've ever had, and once I clued in the rest of the office and their families, he stopped letting me pay for appointments (already only, like, $5) because I'd brought in so many other patients! :)

I think, over the course of the entire year, I spent a grand total of $25 on everything related to my health, with an excellent standard of care in a country where even just a tiny amount of cash can make a huge difference. Outside of Java and Bali, it would have been tricky, perhaps, to find such a perfect set-up, but I doubt it would have been impossible. Medicine cost very little, though belief in folk medicine was still very strong, especially among those who were less-educated.

II: Morocco

While on vacation in Marrakesh this past February, I was struck with a stomach bug in the middle of a bus station - without going into detail, the results were, uh, unflattering - and I was rushed to the hospital in the back of a taxi. The first triage unit I was in was clean, well-run, and with my baaaaad French, mostly navigable. But in the middle of the night, I was moved to a new ward, with no explanation and nowhere to hang up my IV bag until morning, leading the vein to become mildly thrombosed.

Not until the morning, when I was chatting with the students from the local medical-vocation high school (who made me feel as if I was, in fact, the most exciting thing to ever happen there), did I know where I was. I saw a doctor for about three minutes, and though after the first full day he said I'd be able to leave, he changed his mind and kept me another night. I left in the morning with a bill for about $80 (they had to let me leave the hospital to get enough cash to pay it as they didn't take bank cards - I was wandering the streets unshowered after three days and asking random Marrakesh residents where to find a cashpoint, quite a sight...) and about $20 in prescriptions, most of which were, I later found out, unnecessary.

An aside - I noticed that the hospital food (which was actually pretty good, but was totally inappropriate for what I had been diagnosed with!) appeared to be free, but as the youngest person in the all-male ward and the only person not being visited by family three times a day, I can't be sure what it would be like to be there for weeks. There was no entertainment, either - my suitcase had vanished somewhere along the way, and I later found out it was still at the bus station, where the employees welcomed me back and offered me a big glass to tea! :)

Overall, I'd much rather be sick in Indonesia than Morocco, counter-intuitive as that seems.

I have no complaints about the Canadian system. I see my family doctor easily (same day even) and do not feel rushed (I've had appointments lasting two hours). The one time I used the Emergency room I was seen immediately after the triage appointment which took only a minute (my nurse MIL insisted I bring my daughter to the Dr when I knew she just had a bad cold). We were probably there all of five minutes. My dad had double bypass very quickly after his heart attack, my mum had her hip replaced two hours after she fell but my sister waited three hours for her surgery when she broke her ankle. My sister also is an entrepreneur single mom who would never had been able to afford US style health insurance. My husband has a chronic health condition that prevented him from working. After his health was stabilised, he had gone back to work without any health-related debts. When I had major complications with my second child's birth I had top notch care and the choice of hospitals/doctors to go to despite only working part-time. The genetic counselling for the next two pregnancies was free of course, if I had had to pay for all those tests (not to mention paying to give birth) I would have stopped at just the one child. My last baby is such a cutie too, it would have been a shame to miss out on her. FOr some reason there has been a spate of breast cancers amount people I know and not one person has complained of waiting for biopsy/surgery/chemo/other treatment.

I pay 14% of my monthly salary for health insurance.

Funny, I paid more than that for private insurance when I was working.

I'm in British Columbia, Canada. I say that because each province operates in different ways.

I can usually get an appointment with my doctor the same week I call. If not, it's the next week. I have to see him every three months for prescription renewals.

Doctor visits are covered - no co-pay. We've never received a hospital bill. The mister pays for extended medical through his employer. It covers extra stuff, but I'm not sure what all except for prescriptions. Prescriptions start each year at 80% paid by insurance and goes down from there. We're usually at 100% insurance paid sometime in May. It covers only two hours of mental health counselling per year - that sucks as I think I'd benefit from it.

My doc really pushes the Diabetic Care Centre at the hospital. They hold classes for various things (diet, how to inject, etc) as well as one-on-one counselling - all free. Other than that, he's not very proactive on the diabetes stuff. I should probably ask for a referral to an endocrinologist but I'm pretty ambivalent about the whole diabetic thing right now.

The heart stuff for the mister was handled pretty well except that our family doctor initially referred the mister to an internist. What a waste of time. The internist was ready to have the mister just go on maintenance drugs and get a check-up in a year. We pushed family doc for a referral to a heart specialist and the mister saw him within three to four weeks. The heart jump-start stuff was all done in a timely manner.

Speaking of specialists - you do have to get a referral from you family doc. And they seem to be few and far between. My eye doc is always over-booked - crazy over-booked. I try to make sure to get the earliest appointment possible in a day. It's the only way not to get pushed back an hour or two.

Not counting the internist, we've always had caring personnel - doctors, nurses, techs, etc. Even if in a hurry, they'll slow down and explain things.

One complaint is lack of follow-up, meaning we don't get called with test results and such. I don't think that's so much a general health care problem as lazy or overworked individuals.

I think I've covered the basics, but feel free to ask questions.

Great thread.

All complex systems developed by humans have inefficiencies.

Amen to that; it's a mature understanding that we would all do well to retain in mind.

A few random experiences here in Australia, speaking as someone who does not have private health insurance, but will likely be getting it VERY soon:

I had my daughter here 15 years ago. (I fell pregnant in the UK, had a few pre natal appts there, all free, but with looooong waits). Not having private insurance, I went public and had excellent care from my GP, the hospital (some longish waits, not as long as in London), and the maternal & child health nurse. I gave birth on a Friday morning & couldn't get out til the Monday morning as there were no doctors around to disharge me (the doctors what were on duty had other priorities) so I spent 3 nights in a 4 bed ward. Cost? $0.

GP appointments are usually free, some doctors charge a gap payment (usually around $20) but most bulk bill. I can usually swing a same day appointment, never had to wait longer than a day unless it's not urgent and I'm trying to find a convenient time for myself.

I've had MS for 10 years. In September 1999 I had optic neuritis & was admitted to (public) hospital (4 patients to a room & bathroom). They sent me home the following day as part of Hospital At Home program. I was still considered an inpatient, but was at home. For the next 5 days a district nurse came over once a day & administered IV steroids. I also had 1.5 lumbar punctures (the first one, the dr was unable to get thru so I was rebooked to have the procedure done under X-Ray) and the first of several MRIs. Cost? $0.

I've had maybe another 4 MRIs since then. Cost? $0

I'm on a medication that costs $1092.60 per month. After government subsidies, the cost to me is $30 per month. Most prescriptions (those approved on the NHS list of approved medications anyway) cost a maximum $30 per month, many are a lot cheaper. Low income earners pay about $5 for prescritions

I've recently opted to switch from going to an MS clinic at a public hospital to see a priavte neurologist, mainly due to location. The clinic was free, the private neuro costs me $140 a visit, and I get back about $80 from Medicare. The out of pocket expense is worth it to me, as it means I don't have to take so long off work to get to an appointment & get back to work.

A few years ago I had some elective surgery. The wait list under the public system was a bit stupid, I would have waited a couple of years, so I opted to have the surgery privately and pay for it all out of my own pocket. I still got about 50% of the costs (surgeon, anaesthesiologist, night in hospital in a 2 bed ward) back from Medicare leaving me about $1,500 out of pocket.

My daughter has had a few trips to casuality for various issues - high fevers with vomiting, broken wrist (twice) - all of this cost $0.

If your out of pocket medical (including dental, prescriptions, physio, imaging, etc) costs exceed $1500 a year, you can claim 20% of everything over the first $1500 back as a tax rebate. Dental work isn't covered until the public system, but there is talk about introducing public dental care.

The system isn't perfect, wait times to see a specialist under the public system can be long as are elective surgery waiting lists. You can be pretty sure that if it's urgent you will be seen and looked after and not go bankrupt in the process.

My last GP practice in London was a big group practice, which had a stupid system like essexjan's, whereby you could make an actual appointment a week in advance, or you could turn up on the day and wait. I spent three hours sitting on the floor with a high fever and kidney infection under this system.

Now I'm in the Midlands I'm with a smaller 2-doctor practice, with a much saner system - just ring up and make an appointment, no questions asked. I can usually be seen the same day if I need to, though I don't take same-day appointments if I don't really need them (I wouldn't want to deprive someone else who might need help more urgently).

My experience with the NHS has been limited - decent GP attention with antibiotics at £7.20 per course when I have needed them, which hasn't been often. I needed an operation last year and at the time we had private insurance, so I went to the local private hospital which was very nice. Never been an NHS inpatient so can't compare there.

Before I realised the contraceptive pill is a Bad Thing for me, I received it at no cost. Contraceptives are free to everyone (other prescriptions are charged at £7.20 each, regardless of the cost of the drug, and you're exempt from paying if you are under 19, over a certain age, or pregnant, and other categories I don't recall).

I pay approximately 15-20% of my income in tax and national insurance. Cost of the above: £100 excess for the private treatment, £7.20 per prescription, otherwise £0.