4 ms·

As a resident of the UK and a former resident of Switzerland, I can't understand how they came to this conclusion. Don't get me wrong, the NHS is great and the

As a resident of the UK and a former resident of Switzerland, I can't understand how they came to this conclusion. Don't get me wrong, the NHS is great and the system works much better than in the US, but health care in Switzerland is just on another level. Before you say "but in the UK it's free" - considering what I paid for (private, mandatory) insurance in Switzerland, and the National Insurance contribution that gets deducted from my paycheck in the UK, I'm not so sure...

guelo 9y ago
You could read the report. Basically UK spends less overall, 9.9% of GDP vs SWIZ's 11.1%. While UK ranks higher than SWIZ on the report's definitions of Care Process, Access, Efficiency and Equity. SWIZ ranks higher on Health Care Outcomes.
JamesMcMinn 9y ago
I don't think anyone, in the UK at least, thinks the NHS is free. Most people in the UK who describe it as "free" really mean "free at the point of use" (i.e. no invoice after treatment), but that's a bit of a mouth full.
- mjevans 9y ago
  It removes an entire department and source of variable from a 'company' that doesn't need it. Ultimately you aren't going to deny someone coverage based on cost*, they're going to end up in an ER and 'written off' which will then be billed in to everyone else's costs. Worse, the outcome for the individual is often less good and frequently means they will be, overall, more of a burden on society than if they had received proper treatment in an early stage. Instead, the 'cost' of billing that is 'outsourced' to the government's tax collectors, which are going to be the /very/ last thing removed if ever.
  - HarryHirsch 9y ago
    Ultimately you aren't going to deny someone coverage based on cost For acute conditions, yes, but in the American ER they do not treat chronic conditions, like cancer, depression and substance addiction. That's a public health issue.
    - deepsun 9y ago
      And even for sub-acute thing, for example if you've broken ankle, it needs a surgery to bring your bones together and put a metallic screws and a plate. But the only thing they'll do in ER is put a cast on your leg (for ~$7,000 bill to your insurance). For the surgery you'll need to look for a surgeon yourself (and, there's HUGE shortage of surgeons everywhere in US, seems like the system wants it that way). Then your surgeon's hospital will pre-agree on the surgery cost with your insurance. If you don't have insurance or money -- welcome to limpers.
- mikeash 9y ago
  Nothing is truly free. TANSTAAFL and all that. We all know this, and we use the word anyway because it gets the point across. But for some reason any time it's used in the context of health care, people just have to point out that it's not really free.
_delirium 9y ago
There's some more detail in the online summary on their own website: http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/ http://www.commonwealthfund.org/interactives/2017/july/mirro... On cost (which is under the Access category), Swiss seem to self-report having at least somewhat more problems even with the health insurance. For example: 22% of Swiss self-report having had a "cost-related access problem to health care in the past year" (UK 7%, US 33%), and 21% of Swiss report skipping dental care or check up in the past year because of cost (UK 11%, US 32%). Also, 46% of Swiss report having paid more than US$1000 for out-of-pocket medical expenses in the past year, which was the highest of any country in the study (UK 4%, US 36%).
jseliger 9y ago
the NHS is great and the system works much better than in the US, I'm not so sure about that: https://news.ycombinator.com/item?id=14774718 https://news.ycombinator.com/item?id=14774718
- DanBC 9y ago
  You know the rapid access to multiple forms of scanning is something that causes harm and death in the US, right? Over testing, over diagnosis, and over treatment are not good things.
bboreham 9y ago
> the National Insurance contribution that gets deducted from my paycheck in the UK National Insurance nominally covers state pension and unemployment benefits, not the health service. Of course, it all goes into one pot of money, but your entitlement to the above goes up the more years of NI you have paid in, whereas your entitlement to NHS does not change.

guelo 9y ago

You could read the report. Basically UK spends less overall, 9.9% of GDP vs SWIZ's 11.1%. While UK ranks higher than SWIZ on the report's definitions of Care Process, Access, Efficiency and Equity. SWIZ ranks higher on Health Care Outcomes.

JamesMcMinn 9y ago

I don't think anyone, in the UK at least, thinks the NHS is free. Most people in the UK who describe it as "free" really mean "free at the point of use" (i.e. no invoice after treatment), but that's a bit of a mouth full.

mjevans 9y ago
It removes an entire department and source of variable from a 'company' that doesn't need it. Ultimately you aren't going to deny someone coverage based on cost*, they're going to end up in an ER and 'written off' which will then be billed in to everyone else's costs. Worse, the outcome for the individual is often less good and frequently means they will be, overall, more of a burden on society than if they had received proper treatment in an early stage. Instead, the 'cost' of billing that is 'outsourced' to the government's tax collectors, which are going to be the /very/ last thing removed if ever.
- HarryHirsch 9y ago
  Ultimately you aren't going to deny someone coverage based on cost For acute conditions, yes, but in the American ER they do not treat chronic conditions, like cancer, depression and substance addiction. That's a public health issue.
  - deepsun 9y ago
    And even for sub-acute thing, for example if you've broken ankle, it needs a surgery to bring your bones together and put a metallic screws and a plate. But the only thing they'll do in ER is put a cast on your leg (for ~$7,000 bill to your insurance). For the surgery you'll need to look for a surgeon yourself (and, there's HUGE shortage of surgeons everywhere in US, seems like the system wants it that way). Then your surgeon's hospital will pre-agree on the surgery cost with your insurance. If you don't have insurance or money -- welcome to limpers.
mikeash 9y ago
Nothing is truly free. TANSTAAFL and all that. We all know this, and we use the word anyway because it gets the point across. But for some reason any time it's used in the context of health care, people just have to point out that it's not really free.

_delirium 9y ago

There's some more detail in the online summary on their own website: http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/ http://www.commonwealthfund.org/interactives/2017/july/mirro... On cost (which is under the Access category), Swiss seem to self-report having at least somewhat more problems even with the health insurance. For example: 22% of Swiss self-report having had a "cost-related access problem to health care in the past year" (UK 7%, US 33%), and 21% of Swiss report skipping dental care or check up in the past year because of cost (UK 11%, US 32%). Also, 46% of Swiss report having paid more than US$1000 for out-of-pocket medical expenses in the past year, which was the highest of any country in the study (UK 4%, US 36%).

jseliger 9y ago

the NHS is great and the system works much better than in the US, I'm not so sure about that: https://news.ycombinator.com/item?id=14774718 https://news.ycombinator.com/item?id=14774718

DanBC 9y ago
You know the rapid access to multiple forms of scanning is something that causes harm and death in the US, right? Over testing, over diagnosis, and over treatment are not good things.

bboreham 9y ago

> the National Insurance contribution that gets deducted from my paycheck in the UK National Insurance nominally covers state pension and unemployment benefits, not the health service. Of course, it all goes into one pot of money, but your entitlement to the above goes up the more years of NI you have paid in, whereas your entitlement to NHS does not change.