It was 19:00 when I received a call from a personal friend.
He had a three day history of central chest pain with intermittent numbness in his left arm. It was not exertional and he hadn’t had any respiratory symptoms but was worried enough to have given me a call. I asked about his family history which revealed a significant history of myocardial infarction.
I advised him to go to A&E to which he remarked “I don’t want to go there and wait 12 hours.” I pleaded with him to go but he was visiting an unwell relative and wanted to spend most of his time with her. I found myself in a difficult position and in the end could only advise him to try some ibuprofen (as his pain got better with leaning towards) to see if that helped.
He’s fine by the way as I caught up with him a few days later but it really got me thinking about a number of things...
I’m quite proud to be an NHS doctor. The idea of universal access to healthcare and free at the point of access certainly define an altruistic model of healthcare. However, I do often wonder what the experience is like elsewhere and the US healthcare system often becomes a natural comparison.
I’ve grown up watching Scrubs and Hollywood movies so I’ve always been exposed to the US system. This article by Arwa Mahdawi got me thinking. It’s a detailed account of a patient with appendicitis who delayed going to the hospital. Why the delay? Well here are the reasons:
In the US, you are billed for absolutely everything - from the medical condition, medication, hospital stay and even the choice of surgeon.
Surgical conditions with complications are charged twice the going rate. For example, an appendix that has burst would be charged up to four times a standard appendectomy.
Sometimes the rate is not declared until after the surgery. This means that non-experts are made to pay a bill that they don’t fundamentally understand.
Some emergency conditions may be billed as elective procedures. For example, there are numerous cases of acute cholangitis (with no history of gallstone disease) being billed as an “elective procedure” and billed much higher by insurance companies.
What does all this do? It means that currently four in ten US adults delay or do not go hospital due to high costs.
We in the UK should certainly consider ourselves lucky as the NHS doesn’t have as much as a financial motive as the US system. In the UK it is not cost that deters people from accessing healthcare but waiting times. GPs are rammed and emergency departments are full. I have been on the phone to countless friends and family encouraging them to seek urgent help but it is the wait that deters them. In the USA, the average time to see an ER (A&E equivalent) clinician is approximately 2.5 hourswhilst in the UK it increases year on year.
I guess this is more of a reflective piece. Whilst it is easy to feel at peace that cost is not a huge concern for us, long waiting times can have the same effect. Really, the standard of care should be what is described as “universal” i.e. making care as accessible as possible. Waiting times have been compounded by COVID19 with referrals taking much longer. We just hope things improve on our side here in the UK.