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US versus UK Health Care

September 5, 2010

Now I have experienced hip replacement in both English and American hospitals, friends have asked me to compare and contrast them. I will try to, but remember that my UK experience was 10 years ago, and also that it was in a private hospital in Chelsea, not a huge University hospital in Philadelphia.

And that is the first thing I have learned about the US health system. For all its boast of a range of choice – denied, they say, to Europeans, suffering under “Socialized Medicine” – I have discovered that America has no easy access to private hospitals. You see, if all the hospitals are private, none of them is.

I had my first hip replaced when I was Dean of Gibraltar; the second a year later when I was Archdeacon of Italy & Malta. The Diocese in Europe had a group policy for private health care in the UK for all its priests. Some of them were ministering in much less salubrious places than I was, places (in Eastern Europe, for example) where health care was less than satisfactory. So with our private policy we could come to the UK at any time and get whatever we needed immediately.

So I went to the Lister Hospital in Chelsea Bridge Road in London which I found quite similar to a five star hotel! There were only a dozen or two patients on each floor, mostly ordinary Brits like me, but some more exotic ones like the Saudi diplomat in the next suite who was visited by a stream of ladies (wives?) who had clearly whiled away the time by shopping in some of the most expensive shops in the world. They were uniformly clad in black sacks from head to toe (and rather alarming leather face and nose masks in some cases).

But the Lister took everyone in its stride and got on with its business, which was to assist its patients in getting better from their operations. That is what Pennsylvania Hospital was doing too this week with me and many others. But their methods were very different. And the atmosphere is very different. Most of this difference is about money.

In Britain (and I have been in National Health Service hospitals as well as private ones) money is never mentioned. In the NHS, everything is “free”, operations, treatment, medicines, food, equipment. Of course it is not free, but has been paid for over the years by one’s National Health Contribution coming out of one’s wages month by month ( and not a great amount). The rich and middle classes who choose to have additional private health insurance all have to pay for the NHS as well. There is no opting out.

But in the USA, all the talk is about money and payments. I was horrified to be asked if I wanted to pay a fee for having the television activated in my room, and took delight in refusing, on the grounds that hospital was harrowing enough without the noise and inanities of television. And at every level of pain, people would bustle into the room and ask me to sign piles of papers about responsibilities and payments.

Eventually, it came to me that the whole business (and I choose the word advisedly) was being run for the benefit of the insurance companies, drug companies, and the medical staff. The patient’s needs and benefits were way down on the list of priorities. In the UK I had had tests before and after the operation, but nothing like the vast number I had here. And I was seen here by a great many doctors and nurses and therapists and social workers, each of which checked off their lists and no doubt then submitted their bills to the insurance.

I expected, in this day and age, that my vital statistics and medical history would be carefully recorded on a computer, and that would be available to any subsequent care givers who needed it. But No! I had to recite my date of birth, address etc literally dozens of times, and also (more worryingly) the medicines I was taking before I came in, allergies, previous illnesses etc. And for all this repetition, sometimes they got it wrong and asked me how my knees were recovering! There is a vast lack of communication between staff.

Ten years ago in England, everything was recorded on paper (too early for computers) and this one file was used by all medical staff, whose number was tiny in comparison, probably because there was not the same terror of being sued for mistakes as there is in the USA. Last week, one doctor frankly told me that my visit to him (when out came all the old questions yet again) was only for insurance protection. However, I believe that malpractice suits are growing commoner in the UK too.

One other great difference was the noise level. In the UK hospital, noise was kept to a minimum; visitors were told to speak quietly, since other patients were sicker than the friend they were visiting and needed peace. But in hospital last week, I was grateful for a thick door to my room, though even that could not keep our the manic laughter and shouting that seemed to go on at almost all times between the staff. There was such a racket from the room next to mine that I thought someone was being murdered but it was “just” a dozen or two family members whooping it up, screeching over the television which was on at top volume. I was sorry for myself but even sorrier for the poor lady who was lying exhausted in the midst of a raucous family.

All of this, I am aware, is very subjective, and I would be interested to hear from others who have had experience of both UK and US medical systems.

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6 Comments leave one →
  1. September 5, 2010 8:44 pm

    Hi Father!
    I think your comments are absolutely correct. I see now why you waited for the quiet neutrality of the Rectory to make them!
    My sister spent several years in the UK and Denmark. She reported that the systems there were so much better than here. The systems there were for the benefit of the patients.

    I enjoyed your comments and especially the following:.

    <>

    Thanks so much for sharing. I am glad to know you are on the mend! Dominus nobiscum!

    Most cordially,

    Rudy Masciantonio

    Dr. Rudolph Masciantonio
    Chairman, Philadelphia Chapter, Latin Liturgy Association, Inc.
    429 S. 20th St., # A
    Philadelphia, PA 19146
    e-mail: Rudolphus9@aol.com
    telephone: 215 732 6431
    website: http://www.LatinLiturgy.org

  2. September 8, 2010 2:19 pm

    I have worked in the field of healthcare for a long time and I cannot agree with you more on your feelings about healthcare being a “business” in the USA. The continuing greed of the insurance companies have made a severe impact on both patients and the way patient care is hnadled. And like you said, the USA being the “sue happy” country it is, hasn’t made things easier.
    I thank you for sharing your experiences in the UK, these experiences need to be vocalized more often. Too many people say they “don’t want socialized medicine” without knowing what “socialized medicine” IS.
    About the TV- yes, they charge for TV in hospitals, it is $4 a day where I work- not a big fee but I understand your point. I’d venture to guess nowadays people bring their own video entertainment- portable DVDs and such.
    I have worked in a hospital for many years and agree that any excessive noise or disorganization by the staff was inappropriate. Each hospital has a Patient Relations Department ( a kind of “complaint dept”) and if I were you I’d contact them and let them know how you feel.

    • Bromartin permalink
      September 8, 2010 5:25 pm

      We came home from a family vacation on June 27. There were 12 of us there. Included was my father-in-law, 86 years old, and quite lively and independent, as usual.
      Early on June 29, he checked himself into hospital, complaining of short breath. After two days of tests, and our insistence that we meet w/the cardiologist, he ruled out heart problems, suggesting that it may be esophogial. Without checking with us, they ran some “snake” down his throat and said they found three gall stones (!) On the evening after this Dad experienced blood and pain coming from his throat.
      (Damage?)
      Hospital patients are often assigned a “hospitalist”

  3. Bromartin permalink
    September 8, 2010 5:49 pm

    !! who is assigned to coordinate and communicate with patient and family (almost like your GP, is is NOT ALLOWED on the premisis).
    Anyway, Dad was realeased a day later, but then returned to hospital on advice from a visiting nurse, just one day later. More tests, no communication, and all of the indifference that made your stay difficult, Father. We were told of a patient “advocate,” who would help with our communications (like in opposition to the medical staff, as if in an adversarial courtroom). Dad was released on July 11. We got him home at noon, and at 2PM he collapsed into my wife’s arms. He “moved on” almost immediately. My wife was screaming in agony and frustration, as attempts to revive him were futile.
    Later, in a hospital waiting room, a pleasant gentlemen dropped in to listen to us. After about a 10 minute discussion, he surrendered his ID as the hospital chaplain, explaining that he generally comes on as simply a social worker, until he senses that he may be dealing with people of faith.

  4. claire permalink
    September 12, 2010 9:50 pm

    First of all, I do hope that you are now recovering well.
    I’m writing as a palliative care nurse in an acute NHS hospital in the UK.
    I have to tell you that the noise levels would be far worse in many NHS hospitals; staff, patients and visitors have no sense of decorum, and the situation is made far worse for so many patients because unless you have an infection, you will be in a main ward, or at best a bay with 3 others, not in a single room. So distressing for seriously ill people.

  5. Paul Emmons permalink
    September 18, 2010 10:45 pm

    Thank you, Father, for sharing your experiences. And let me add to the prayers and good wishes for a quick and full recovery that others have expressed. You have provided one more testimonial as to why http://www.anglocatholicsocialism.org is one of my favorite Web sites. While one may still doubt that thoroughgoing socialism were a viable model for society in practice, the church at least counsels our saying this with a sigh of regret and an ever-open mind.

    Regarding medical care, it seems that the powers-that-be in the U.S. have been very successful in disinforming the public about programs in most of the remainder of the “first world”. It is a common opinion that the sick must stand in queues for hours, days, or weeks; and that as to new technology, they are backwards and utterly dependent, even parasitic, upon research done by American big pharma.

    We’re not often told, of course, that more than thirty countries, including Cuba, have better infant mortality rates than we do; that Americans no longer excel in overall life expectancy; or that (height statistically correlating with overall health) on average we must now literally look up to the Dutch.

    Some twenty years ago, my septuagenarian mother, during her one and only visit to Europe, somehow overexerted herself on an Alp, suffered a mild heart attack, and needed to spend a day or two in a Swiss hospital. (When she opened her eyes, smiled at the doctor standing over her, and told him that he was cute, Dad knew that she was going to be all right.) I don’t know who paid the bills, but gather the Swiss never said a word on the subject. There was certainly no red tape.

    On the other hand, I am happy to report that after an old friend, former Clementine in fact, had a stroke in June, he has received first-rate care ever since, first at Paoli Hospital, then at Bryn Mawr Rehab, then at Manorcare in King of Prussia. Medicare has covered it all. God willing, he will return home any day now if he hasn’t already been released. What a pity that this is yet only a privilege of age. He’s as poor as a church mouse, which is why he hadn’t seen a doctor in years. He was found with blood pressure almost as high as S. Clement’s masses, as well as diabetes. Had these problems been addressed earlier, the crisis would probably have been prevented.

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