US versus UK Health Care
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.