Dental Service: UK and USA

[Ceicei]

This is an article from CNN regarding dental services in UK.

LONDON, England (CNN) -- Some English people have resorted to pulling out their own teeth because they cannot find -- or cannot afford -- a dentist, a major study has revealed. Six percent of those questioned in a survey of 5,000 patients admitted they had resorted to self-treatment using pliers and glue, the UK's Press Association reported.

I'm sure that there are some people in USA who try to treat their own dental problems. While 6% out of 5000 people is not a very big number, if extrapolated to the general UK population, this can be a major problem. Correct me if I'm wrong, doesn't UK provide socialized dental services, while the majority of USA dental services are "fee-for-service" or with dental coverage provided by employers?

What I'd like to discuss is the difference in how two countries approach medical and dental services, and the pros and cons. What works for UK? What works for USA? What is lacking and what can be improved? How much of the difference could be attributed to the culture of the two societies? How much could be from the political philosophies that help establish social policies?


- Ceicei

 

[Tez3]

What happened was the government! It's actually far worse than that article makes out. Most dentists now don't take national Health Service patients so you can spend years yes years looking for one or you take out a bank loan and pay privately. Even if you do find a dentist that will take NHS patients it still costs an arm and a leg.There is insurance of course but you still have to find a dentist! Quite frankly I'm saving either to go to Poland to have my teeth fixed or wait until I come over for the Meet and Greet next year! I'm not joking I'm afraid.The situation is totally disgraceful and it makes me very angry!

http://news.independent.co.uk/health/article3061227.ece

 

[CoryKS]

What happened was the government! It's actually far worse than that article makes out. Most dentists now don't take national Health Service patients so you can spend years yes years looking for one or you take out a bank loan and pay privately. Even if you do find a dentist that will take NHS patients it still costs an arm and a leg.There is insurance of course but you still have to find a dentist! Quite frankly I'm saving either to go to Poland to have my teeth fixed or wait until I come over for the Meet and Greet next year! I'm not joking I'm afraid.The situation is totally disgraceful and it makes me very angry!

http://news.independent.co.uk/health/article3061227.ece

Why do the dentists not take the NHS patients? Does the NHS subsidize the work or do they expect the dentists to do the same work at a lower cost? Or are there additional procedures involved which make it more costly or time-consuming to them?

 

[Tez3]

We now have National Healthcare Trusts for each area, these trusts are given money from the government for all our healthcare needs,dental, medicines, hospitals etc. The trusts decide how much goes where and there simply isn't the money available for dentists to be paid so they refuse to take NHS patients on as they won't get paid for treating them. doctors can only prescibe certain medications which are cost effective, some life prolonging drugs are refused. The trusts also spend huge amounts of money on admin and buildings instead of medical care and we have a huge medical problem with infections in hospitals because they trusts won't pay for enough cleaners or even good enough ones.

http://news.bbc.co.uk/1/hi/health/6364253.stm

http://news.bbc.co.uk/1/hi/health/6364253.stm

 

[Blotan Hunka]

What is your opinion on government healthcare? And what about the USA's quest to start our own program? I dont think its a great idea. Ive been saying "if you think its bad now, imagine going to the DMV (Department of Motor Vehicles: American Bureaucratic "Hell on Earth")to get your health care." Thats what gvt run programs become.

 

[Steel Tiger]

What is your opinion on government healthcare? And what about the USA's quest to start our own program? I dont think its a great idea. Ive been saying "if you think its bad now, imagine going to the DMV (Department of Motor Vehicles: American Bureaucratic "Hell on Earth")to get your health care." Thats what gvt run programs become.

I don't know that it will get that bad. It might though, you have a lot more people than we do.

We have government run healthcare here in Australia called Medicare. Its a little strange but it works well (except for dental). Medicare will reimbuse 85% of a medical bill that you have payed yourself (you can get private insurance to cover the gap). If, on the other hand, you go to a doctor who bulk bills you don't pay anything, the doctor claims his fee from the government. Some years ago we had a problem with doctors not bulk billing but that has changed and many, especially GPs, do. The problem the government has is getting doctors to work in public hospitals. But that seems to be a problem everywhere.

Dental is not covered by Medicare and you need to get private health cover for that. The public dental service is a disaster, unlike the majority of the health system. Dentists just won't work in the public system so we have waiting lists years long. I have never really understood why dental is not covered by Medicare.

Of course, in both cases, you can go private and spend a fortune. Its faster, but not necessarily better.

 

[Flying Crane]

I think the biggest problem with medical care in the USA is the HMOs and other insurance plans. They have basically wedged themselves between the patient and the medical provider, they take a huge huge profit, and they really do nothing for anybody. And because they have gotten such a strong hold on the system, it has become really impossible to afford medical care beyond something very basic without some kind of coverage. I think the fees charged by providers could be much more affordable if the HMOs were just removed from the equation.

I have medical coverage thru my employer, and every year our paycheck deductions go up and our coverage goes down. I just received notice of the changes that will take place for 2008. Basically, every out of pocket cost to me is increasing about 30%, including my copay and paycheck deductions, and in most cases what I would need to pay for certain types of procedures is going up as well, by about as much. And it seems to jump by about this much each and every year. Pretty soon, I wonder if it will be worth it to have insurance at all. We spend all this money to reserve the right to see a doctor, then rarely need to do it, and if we do, we still have to pay for part of it, and the HMOs just rake in the money.

But for the big things, if you don't have it, it can leave you in financial ruin. My aunt died of cancer a couple years ago, and spent several months getting various treatments and whatnot up until the end. I believe the medical bills topped $300,000. Without insurance, she would have been out on the street prior to her death.

A co-worker confided that the birth of his child ran up a hospital bill of about $30,000.

I believe that if the HMOs and the huge profits that they take were simply removed, many of these huge expenses could be brought back to a reasonable range. Possibly some sort of government controlled insurance plan that wasn't focused on profit, could perhaps do the job. I know there is a tendency to feel that the govt just screws up everything it touches, and often that is true. But the medical system is pretty bad as it is and I might be willing to try something different and see how it goes.

If it meant an extra tax, well, I guess I already pay that in the form of payroll deductions to my HMO plan. Just shift those kinds of payments over into a tax to fund the program, or something.

I dunno, it's very frustrating as it is.

 

[Blotan Hunka]

I agree HMO's are bloodsuckers with all the politicians in their pockets. Making profit off of peoples suffering is despicable. But I fear the gvt option will be worse. It may be anecdotal, but my wife heard from a Canadian that her elderly father, who had heart disease, was told that he was "too old to treat" and "past their parameters for treatment because of his age". He wasnt worth the $$ so he was told to go die basically. I DONT want that!

 

[Flying Crane]

well, I have a coworker who is from Canada and has maintained dual citizenship. We were discussing this just a few days ago, and she indicated that for critical issues you will get in quickly, but for non-critical issues there is a waiting list and it can take a while to get in, but you will definitely get treatment. Actually, she recently went back to visit her family, and was able to get in to see a doctor and get a prescription for some ailment while she was there. It was quick and easy and cost her very little compared to what it would cost here.

Some people who don't want to wait will come to the US to get quicker treatment, and they just pay for it out of pocket. But the thing is, the people who can afford to do that are the wealthy. Sure, if you are sitting on a pile of money, you can get top notch medical care of any kind, in a hurry. But this is not the reality for most people.

I cannot speak to what happened with your wife's friend's father. But from what my coworker says, it sounds like for the most part, Canadians are pretty happy with their system, even tho not all parts are perfect.

Dental is another issue, however. Seems like dental is not covered in Canadian system, so people tend to have messed up teeth. That is one thing I will say for my own coverage thru my employer: my paycheck deductions for dental coverage is quite cheap. But there are weird DMO issues involve as well, it's not exactly smooth sailing for anything other than routine cleanings.

 

[Ceicei]

Interesting. If I or anyone in my family needs medical services (non-emergency), depending upon severity, I can usually book an appointment for a doctor the same day. If it is not urgent and can wait, then the appointment is usually booked the same week.

Of course, being seen by a specialist is a different matter and do require advance booking, anywhere from a couple of weeks to a month. The time may be shortened considerably if the referral to a specialist comes from the doctor. It also depends upon the availability of the specialist.

Typical dental services (such as teeth cleaning) for my family do have to be booked in advance, anywhere from two weeks up to a couple months. If it is a dental emergency, the dentist will see the same day. If it is something that needs to be worked but is not "urgent", it is generally scheduled the same week.

Medical hospitals are another story--I avoid whenever possible, but recognize hospitals are necessary. If I am referred to a medical hospital by the doctor (as I was once), I am admitted almost immediately with very little wait time. If I get hurt in a car accident or a sport-related injury (if no major injuries are obvious), then the wait time for service can be up to four hours. When I was pregnant and went to the hospital for delivery, they have learned to admit me quickly; I always wait the last possible second before the baby is born before I go--my labors are very swift and short.

I'm not sure if my experiences are typical for those who have health/dental insurance, or dependent upon geographical area, socio-economic range, and type of coverage. I've lived in three different states and have received services in four additional states while on vacations/trips and the services I get are generally consistent.

- Ceicei

 

[Sukerkin]

The core problem with medical care has become that the price of treatment has escalated through the stratosphere due to the greed of those involved in the means of it's provision. The action of 'medical insurance' or 'private care' has also had a very deleterious effect on the price/treatment equation.

I do not exempt doctors or dentists from that broad brush - they are in many cases less qualified in their field than I am in mine but command salaries three times higher or more. I do accede tho' that the demands made on them can be correspondingly high, so I cut those at the bleeding edge a little slack.

In Britain, until very recently, we had a wonderful Health Service that was an example to the world of what could be achieved with socialised medicine. Then the aforementioned providers of equipment and medicine started to reap astronomical profit from their services and the tax burden became unendurable.

That need not have happened - it was a simple outcome of unadulterated greed. No excuses will gainsay that. Health Trusts are a travesty and I could not believe what had happened to the NHS in the intervening years between my bike accident and my father going through heart surgery in a hospital that I vocally deemed "Third World" when I went to visit him. For there not to be enough blankets for patients is a scathing indictment of the system as it has become.

On the dentistry front, until a year or so ago, my dentist was NHS and very good too. Now he's 'private' and my costs have skyrocketed and, sadly, much as I like him personally, treatment has degraded. I've been under the drill for a root canal and crown for more hours than I care to remember this year and it's still not right. I have to go again tomorrow for another go to sort it out and I'm currently £2500 out of pocket. No wonder people are resorting to just pulling the darned things out themselves!

 

[Flying Crane]

The core problem with medical care has become that the price of treatment has escalated through the stratosphere due to the greed of those involved in the means of it's provision. The action of 'medical insurance' or 'private care' has also had a very deleterious effect on the price/treatment equation.

I do not exempt doctors or dentists from that broad brush - they are in many cases less qualified in their field than I am in mine but command salaries three times higher or more.

I agree with much of what you are saying here. While I think anyone's salary and level of profit should fall within some bounds of reason, I guess I am more willing to accept the doctors earning a high salary, and the hospitals earning a profit if that profit is used to improve their capabilities and develop cutting-edge medical technology. What I really resent, however, is the profits that the HMOs are making. That is pure and absolute waste, in my opinion. At least the doctors and hospitals are actually providing a service. The HMOs are just creating beaurocracy and have become a hurdle between the patient and the provider.

 

[Ceicei]

So can this problem with spiraling costs be fixed or is it too late? What could be done? It is easy enough to sit back and complain, but harder to think up a solution and get others to go along to take action.

- Ceicei

 

[Flying Crane]

So can this problem with spiraling costs be fixed or is it too late? What could be done? It is easy enough to sit back and complain, but harder to think up a solution and get others to go along to take action.

- Ceicei

I wish I had an answer for that. It's a real mess, and I don't know how to approach it.

The City of San Francisco is experimenting with a health program offered to residents. It is still in its infant stages, but has been showing some promise. It is only for city residents, and coverage doesn't travel with you outside the city. You are only covered if you get your treatment in the city. In the beginning, it has only been for low-income people, and only at one or two locations in the city. But they are starting to expand it so that there will be many more locations within the city where you can get treatment, and the goal is that it will ultimately be available for anyone who is a city resident. This could be very promising for people like self-employed who don't have the leverage of a big corporation to help defray the costs of insurance plans. It's not a perfect solution but it seems to be a good step, and I believe a lot of other cities are watching this to see how it turns out. It might become a model for other cities to follow, and maybe a whole new network will eventually grow up and even replace the current HMOs and traditional insurances.

I don't have a lot of actual details, I was even unaware of it until about a month ago when I saw an article in the local paper about it. I don't know how it is being funded, but the article I read made it sound like it has a lot of promise. Very interesting...

 

[Cryozombie]

I have dental insurance... and even with that I have to pay almost 800 bucks out of my pocket for a root canal/crown for a molar I cracked eating popcorn. And they want it all up front.

So now I get to choose... live in pain, with the potential for infection,

Or live without gas, electricity and running water.

Hmmm...

 

[CanuckMA]

I agree HMO's are bloodsuckers with all the politicians in their pockets. Making profit off of peoples suffering is despicable. But I fear the gvt option will be worse. It may be anecdotal, but my wife heard from a Canadian that her elderly father, who had heart disease, was told that he was "too old to treat" and "past their parameters for treatment because of his age". He wasnt worth the $$ so he was told to go die basically. I DONT want that!

Definetely anecdotal. There is a point at which it becomes medically pointless to do surgery, but never just 'too old to treat'.

Dental is another issue, however. Seems like dental is not covered in Canadian system, so people tend to have messed up teeth. That is one thing I will say for my own coverage thru my employer: my paycheck deductions for dental coverage is quite cheap. But there are weird DMO issues involve as well, it's not exactly smooth sailing for anything other than routine cleanings.

Most dental is not covered in Canada. However, dental is usually covered by your work insurance. It's a lot cheaper than US medical insurance.

Yes there is wait time for some procedures. Our system is not perfect, but it beats not having any health coverage at all.

 

[Phoenix44]

IMO, the best plan for the US would not be to start a new national health plan, but simply to expand Medicare to cover all Americans, not just senior citizens.

Medicare is not a health service--it doesn't have its own staff of doctors or hospitals to treat patients. It's just an efficient means to pay for the health services that people use. Medicare recipients choose their own doctors and hospitals--the same doctors that everyone else uses, so there's no difference in the waiting periods for appointments. There's a reasonable monthly premium, and fees are set by Medicare so that the co-payments the patients pay are relatively low. The administrative costs of Medicare are a fraction of the costs of HMOs and corporate health insurers, and since Medicare is not for profit, unlike insurance companies, no money is siphoned off for shareholders or CEOs. And almost all doctors participate in Medicare (there are strong disincentives not to), so you never hear of a patient complaining that their doctor went off their plan.

Private insurers cherry-pick the youngest and the healthiest patients, so if their patients (and the money they pay for insurance) suddenly transferred to Medicare, it would give Medicare the resources to expand care to everyone, and probably pay for prescription drugs--at lower volume discounts--as well.

And unlike patients with HMOs, most seniors absolutely LOVE their Medicare. It allows for FAR more choice than HMOs and PPOs. I'd like to see it expanded. In fact, I'd like to have Medicare myself!

 

[Cryozombie]

IMO, the best plan for the US would not be to start a new national health plan, but simply to expand Medicare to cover all Americans, not just senior citizens.

Ya know, this is somthing I have often thought about myself... at least I see commericals on TV for medicare covering "this" or "that" and thought "Damn I need Medicare".

Thats a good idea.

 

[Sorros]

Definetely anecdotal. There is a point at which it becomes medically pointless to do surgery, but never just 'too old to treat'.




Most dental is not covered in Canada. However, dental is usually covered by your work insurance. It's a lot cheaper than US medical insurance.

Yes there is wait time for some procedures. Our system is not perfect, but it beats not having any health coverage at all.

Your absolutly right is is cheaper. You just wait for ever for treatment.
I don't know your family members condition, but a lot of times recovery from treatment is worse on the patient than the treatment itself.
One third of the doctors in this country are east indian now. The rural hospital in this country are flooded with Philipino nurses, because of the nursing shortage. (many speak lousy english and under stand less)
Medical schools in this country are the best in the world. Residencys and internships are getting longer, with more training. That is why foreiners are flooding to this country for treatment. A lot of them Canadians with money, who can afford to leave there system for better care.

 

[CanuckMA]

Your absolutly right is is cheaper. You just wait for ever for treatment.
I don't know your family members condition, but a lot of times recovery from treatment is worse on the patient than the treatment itself.
One third of the doctors in this country are east indian now. The rural hospital in this country are flooded with Philipino nurses, because of the nursing shortage. (many speak lousy english and under stand less)
Medical schools in this country are the best in the world. Residencys and internships are getting longer, with more training. That is why foreiners are flooding to this country for treatment. A lot of them Canadians with money, who can afford to leave there system for better care.

4 years ago I had a herniated disc. Yeah, it took 5 weeks to get te CT scan done. 3 days before I went to see my GP for the result, my rigt leg loat most of it's mobility. I asked the GP to refer me to the head of neurosurgery at the top neurosurgical unit in Ontario. That was Monday evening. The neurosurgeon's nurse called me on Tuesday PM to set an appointment for Wednesday morning. I was on the table the following Tuesday. No cost.

2 years ago I was visiting family in NYC. Hot August. Lots of walking. My knee selled up. I went to emerg late at night. took 3 hours to get seen. They suspected an infection. I was there for 2 nights. Got some antibiotic IV. Saw a Dr. twice for a total 15 minutes. My insurance company paid $12.5K above what the Ontario plan paid.

I much prefer Canada.