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A few years ago we were visiting friends in northern Netherlands. Our friend's father in law was feeling unwell and asked to be taken to the hospital. Apparentl

A few years ago we were visiting friends in northern Netherlands. Our friend's father in law was feeling unwell and asked to be taken to the hospital. Apparently in the Netherlands you can't just go to the hospital (unless it's an emergency I guess), so you need to call them first. You'll be interviewed by a doctor, who'll schedule an appointment. The doctor told the father in law to continue taking his medication and come to the hospital the next morning. I got to accompany him to the hospital and go with him through the whole process. It was like nothing I've ever seen - the hospital was quiet, very few people, the guy for a while room for himself, and the treatment was efficient and on schedule. I thought the whole pre-screening on the phone thing was brilliant.

stefanfisk 4y ago
As a swede I’m confused, how does it work where you are from?
- zinekeller 4y ago
  You'll call 911, gets transported to the hectic emergency room by ambulance and then you'll be triaged and whatever things that needs to be done will be done. Few weeks later, you'll receive a financially-crippling bill in the mailbox because the insurers refuse to reimburse your treatment/you were sent out to a out-of-network hospital/because you don't have health insurance in the first place. Oh, don't forget to pay for the ambulance!
  - madaxe_again 4y ago
    Ooh, you get ambulances? Fancy. In the U.K., you dial 999, and then you die on the kitchen floor. Seriously. Excess deaths due to failure to treat are off the charts.
    - myspy 4y ago
      Isn't that a problem of Brexit? As I read here https://eand.co/britains-finally-figuring-out-brexit-really-was-the-biggest-mistake-in-modern-history-8419a8b940c6 https://eand.co/britains-finally-figuring-out-brexit-really-...
      - Shoue 4y ago
        Yeah, Brexit is a factor, but it's also one of many and it's important we tackle all of them. The private finance initiative (PFI) in the early 00s, is another[0]. Our government's lack of funding is also another ("The UK has spent around 20 per cent less per person on health each year than similar European countries over the past decade")[1]. Privatisation has been linked to not treating otherwise treatable deaths[2], so that's likely another. Then there's unwillingness and delay in many areas, to tackling air quality by reducing local pollution from car wheel breakage (linked to bad health)[3] by building more cycling infrastructure so that people don't have to be afraid of getting hit by a car[4] (and actually end up cycling). And disincentivising unhealthy diets[5] that are linked to hospital admissions, and amusingly urban planning like more cycling lanes can help people exercise without even really thinking about it like people already do in the Netherlands. [0] https://www.theguardian.com/politics/2019/sep/12/nhs-hospital-trusts-to-pay-out-further-55bn-under-pfi-scheme https://www.theguardian.com/politics/2019/sep/12/nhs-hospita... [1] https://archive.ph/UDtZo/again?url=https://www.ft.com/content/f752a1ad-4a23-408f-a549-4909974c6a2c https://archive.ph/UDtZo/again?url=https://www.ft.com/conten... [2] https://www.opendemocracy.net/en/nhs-privatisation-health-social-care-treatable-deaths/ https://www.opendemocracy.net/en/nhs-privatisation-health-so... [3] https://www.gov.uk/government/publications/health-matters-air-pollution/health-matters-air-pollution https://www.gov.uk/government/publications/health-matters-ai... [4] https://usa.streetsblog.org/2019/05/29/protect-yourself-separated-bike-lanes-means-safer-streets-study-says/ https://usa.streetsblog.org/2019/05/29/protect-yourself-sepa... [5] https://digital.nhs.uk/news/2021/one-million-admissions-linked-to-obesity-in-2019-20-new-data-reveals https://digital.nhs.uk/news/2021/one-million-admissions-link...
      - pja 4y ago
        Well, only in as much as Brexit has restricted the availability of people prepared to do social care work for minimum wage from outside the UK. But that’s not the main cause of the current problems the NHS is facing. The problems in the NHS are mostly structural & have been building ever since George Osborne chose austerity in the aftermath of the 2008 financial crash. NHS spending was ringfenced in real terms, but social care wasn’t as that was funded out of local authority expenditure. Social care is now difficult to access & in short supply nearly everywhere as a result. Care homes are closing under the pressure of the difficulties in employing staff & inflation in fuel costs running headlong into the squeeze on LA funding meaning that LAs have been forced to eliminate any/all discretionary expenditures. For the NHS this has led to two issues that have got progressively worse over time: 1) the UK population is aging & old people need more healthcare, meaning that freezing NHS funding in real terms would inevitably result in a steady increase in healthcare need that couldn’t be met and 2) for those people the NHS did manage to treat the collapse in social care has made it impossible to discharge them from hospital safely in a timely manner. Some estimates suggest that currently a third of NHS beds are occupied by people who could go home if a care plan was in place for them, but that care is either unavailable due to LA funding cuts (forced on them by a government which cut LA funding to the bone) and can take weeks to arrange as the staff doing the assessments are themselves in extremely short supply. This bed shortage then has knock on effects that ripple through the rest of the system. Combine with the regular winter flu epidemic & Covid wave spiking demand & you end up with A&E full to the brim with patients dying on the floor whilst every single available ambulance sat queueing outside A&E with patients that cannot be left alone & with no-where for them to go. All of this has been aggravated by Brexit, but we would still have ended up here without Brexit: the root cause is the intersection of the steady decline in healthcare & social care funding with the increase in demand caused by an aging population & two concurrent epidemics. All this has been predicted for years, it was obvious from the data that the system was persistently overloaded: waiting times for NHS treatment were steadily increasing at every level, including A&E. The current collapse was entirely predictable, but our current government was either unwilling or incapable of doing anything about it. Chunks of the left believe that this is a planned collapse - that at least part of the government intended to force the NHS into a state of collapse in order to drive through a US-style privatisation that would enable them to line their own pockets. We know that government ministers have met with representatives of US medical companies numerous times within the last few years, so this isn’t an entirely baseless conspiracy theory sadly. I’m not personally against private companies being part of a national healthcare service - most of the EU provides healthcare on some kind of partially private basis, with many differences in the details. However the US system is the worst of all possible worlds - it’s extremely expensive whilst giving very poor coverage of the population. It’s impossible not to suspect that US healthcare companies are hoping for an opportunity to carve up the UK healthcare market along similar lines in order to line their own pockets - the cost of bribing government ministers with a few well placed post-government directorships would be a small price to pay.
    - makomk 4y ago
      If by "off the charts" you mean about the same as the EU then sure. (Germany is particularly badly affected - which is interesting because the British press has been pointing to their higher levels of healthcare funding and larger number of hospital beds as proof our healthcare system has been catastrophically underfunded. Eurostat doesn't have the December figures, but Germany had a 23% excess mortality rate in October, the most recent month, when England was still at 10%. If it was the other way around the headlines here would be yelling about a catastrophic failure... It looks like other EU members experienced similar spikes earlier in 2022 too.)
  - FabHK 4y ago
    BTW, there are apparently two main concepts for ambulances: “Scoop and Run” (just get the patient into the ambulance and then the hospital as quickly as possible) vs “Stay and Play” (emergency doctor starts treatment on site, then transportation to the hospital). Apparently the former is more associated with the UK and US, the latter with the European continent.
    - closewith 4y ago
      That's a false dichotomy. Scoop & Run vs Stay & Play is just a way of describing whether to treat on scene or not. It's used everywhere (at least everywhere that has a modern ambulance service with paramedics) and the boundaries shift depending on scene, patient, skill level on the ground, distance to definitive care, transport options, etc. The whole world has been migrating over the last ~50 years from a purely Scoop & Run model where ambulance drivers were just that - barely first-aid trained - to a model where more and more care is delivered on-scene, Stay & Play.
    - candiddevmike 4y ago
      In the US, how much treatment you get depends on how EMS triages you over the phone. AEMTs and paramedics, especially in bigger cities, are authorized to perform some crazy shit, vs EMTs who can just give you aspirin.
  - drstewart 4y ago
    So you're arguing there should be more up front blockers between a person and their attempts to get health care, European-style?
    - zinekeller 4y ago
      I simply answered GP's question: > As a swede I’m confused, how does it work where you are from? I simply described it as how would an ordinary American would experience a potential emergency. Between the "designated doctor" versus "let's be cautious", I'm not sure which is the objectively superior one (although unlike your presumption, I actually like this cautious approach), however I cannot underestimate the fact that your insurance company can just declare your situation as not emergency, despite multiple administrations trying to close loopholes (and even some arguing that the liberalness of insurance companies are not enough). Except for the (rather bitter, I'll be honest) tirade about health insurance, I have tried to not evaluate which system is better, and I'm not sure where did you get the impression that I despise the Anglo-American procedure.
- null_object 4y ago
  [dead]
DoingIsLearning 4y ago
As a counter point I also had a not so close friend die of an Aneurysm bleeding because during phone screening with a general practioner's receptionist she was too young to have 'something serious' and was told to wait it out until the next day. Not saying the system does not work but you do have medical zebras falling through the cracks.
- Tade0 4y ago
  Out of the six brain aneurysms(all men - four resulted in deaths) in my extended social circle just one wasn't a person before their 40s. In one case serious consequences were prevented only because the wife of the person, after exhausting all other options, called a special "ambulance on call" service which was part of their healthcare package.
- amrocha 4y ago
  Sure, the system isn't perfect. Did anyone think it was perfect? Misdiagnosis is a problem regardless of whether you're talking to a doctor in person or over the phone.
shellfishgene 4y ago
A Dutch friend says that healthcare in the Netherlands is so much cheaper than in Germany is also because they don't spend huge amounts of money to extend the life of old patients by a few weeks. I don't know to what extent this is true.
- Vinnl 4y ago
  There's more of a culture of balancing quality of life vs. treatment here compared to many other countries, but trying to use that as a singular explanation for most anything is most certainly wrong. For example, as I understand it there's also less slack in the Dutch system, exemplified by Dutch patients needing to be moved to Germany during covid because we had fewer IC beds per capita. Which, of course, also surely isn't enough by itself to explain it. (Though I'm not sure how much cheaper health care is here anyway — we definitely do have a problem with ever-growing health care costs.)

stefanfisk 4y ago

As a swede I’m confused, how does it work where you are from?

zinekeller 4y ago
You'll call 911, gets transported to the hectic emergency room by ambulance and then you'll be triaged and whatever things that needs to be done will be done. Few weeks later, you'll receive a financially-crippling bill in the mailbox because the insurers refuse to reimburse your treatment/you were sent out to a out-of-network hospital/because you don't have health insurance in the first place. Oh, don't forget to pay for the ambulance!
- madaxe_again 4y ago
  Ooh, you get ambulances? Fancy. In the U.K., you dial 999, and then you die on the kitchen floor. Seriously. Excess deaths due to failure to treat are off the charts.
  - myspy 4y ago
    Isn't that a problem of Brexit? As I read here https://eand.co/britains-finally-figuring-out-brexit-really-was-the-biggest-mistake-in-modern-history-8419a8b940c6 https://eand.co/britains-finally-figuring-out-brexit-really-...
    - Shoue 4y ago
      Yeah, Brexit is a factor, but it's also one of many and it's important we tackle all of them. The private finance initiative (PFI) in the early 00s, is another[0]. Our government's lack of funding is also another ("The UK has spent around 20 per cent less per person on health each year than similar European countries over the past decade")[1]. Privatisation has been linked to not treating otherwise treatable deaths[2], so that's likely another. Then there's unwillingness and delay in many areas, to tackling air quality by reducing local pollution from car wheel breakage (linked to bad health)[3] by building more cycling infrastructure so that people don't have to be afraid of getting hit by a car[4] (and actually end up cycling). And disincentivising unhealthy diets[5] that are linked to hospital admissions, and amusingly urban planning like more cycling lanes can help people exercise without even really thinking about it like people already do in the Netherlands. [0] https://www.theguardian.com/politics/2019/sep/12/nhs-hospital-trusts-to-pay-out-further-55bn-under-pfi-scheme https://www.theguardian.com/politics/2019/sep/12/nhs-hospita... [1] https://archive.ph/UDtZo/again?url=https://www.ft.com/content/f752a1ad-4a23-408f-a549-4909974c6a2c https://archive.ph/UDtZo/again?url=https://www.ft.com/conten... [2] https://www.opendemocracy.net/en/nhs-privatisation-health-social-care-treatable-deaths/ https://www.opendemocracy.net/en/nhs-privatisation-health-so... [3] https://www.gov.uk/government/publications/health-matters-air-pollution/health-matters-air-pollution https://www.gov.uk/government/publications/health-matters-ai... [4] https://usa.streetsblog.org/2019/05/29/protect-yourself-separated-bike-lanes-means-safer-streets-study-says/ https://usa.streetsblog.org/2019/05/29/protect-yourself-sepa... [5] https://digital.nhs.uk/news/2021/one-million-admissions-linked-to-obesity-in-2019-20-new-data-reveals https://digital.nhs.uk/news/2021/one-million-admissions-link...
    - pja 4y ago
      Well, only in as much as Brexit has restricted the availability of people prepared to do social care work for minimum wage from outside the UK. But that’s not the main cause of the current problems the NHS is facing. The problems in the NHS are mostly structural & have been building ever since George Osborne chose austerity in the aftermath of the 2008 financial crash. NHS spending was ringfenced in real terms, but social care wasn’t as that was funded out of local authority expenditure. Social care is now difficult to access & in short supply nearly everywhere as a result. Care homes are closing under the pressure of the difficulties in employing staff & inflation in fuel costs running headlong into the squeeze on LA funding meaning that LAs have been forced to eliminate any/all discretionary expenditures. For the NHS this has led to two issues that have got progressively worse over time: 1) the UK population is aging & old people need more healthcare, meaning that freezing NHS funding in real terms would inevitably result in a steady increase in healthcare need that couldn’t be met and 2) for those people the NHS did manage to treat the collapse in social care has made it impossible to discharge them from hospital safely in a timely manner. Some estimates suggest that currently a third of NHS beds are occupied by people who could go home if a care plan was in place for them, but that care is either unavailable due to LA funding cuts (forced on them by a government which cut LA funding to the bone) and can take weeks to arrange as the staff doing the assessments are themselves in extremely short supply. This bed shortage then has knock on effects that ripple through the rest of the system. Combine with the regular winter flu epidemic & Covid wave spiking demand & you end up with A&E full to the brim with patients dying on the floor whilst every single available ambulance sat queueing outside A&E with patients that cannot be left alone & with no-where for them to go. All of this has been aggravated by Brexit, but we would still have ended up here without Brexit: the root cause is the intersection of the steady decline in healthcare & social care funding with the increase in demand caused by an aging population & two concurrent epidemics. All this has been predicted for years, it was obvious from the data that the system was persistently overloaded: waiting times for NHS treatment were steadily increasing at every level, including A&E. The current collapse was entirely predictable, but our current government was either unwilling or incapable of doing anything about it. Chunks of the left believe that this is a planned collapse - that at least part of the government intended to force the NHS into a state of collapse in order to drive through a US-style privatisation that would enable them to line their own pockets. We know that government ministers have met with representatives of US medical companies numerous times within the last few years, so this isn’t an entirely baseless conspiracy theory sadly. I’m not personally against private companies being part of a national healthcare service - most of the EU provides healthcare on some kind of partially private basis, with many differences in the details. However the US system is the worst of all possible worlds - it’s extremely expensive whilst giving very poor coverage of the population. It’s impossible not to suspect that US healthcare companies are hoping for an opportunity to carve up the UK healthcare market along similar lines in order to line their own pockets - the cost of bribing government ministers with a few well placed post-government directorships would be a small price to pay.
  - makomk 4y ago
    If by "off the charts" you mean about the same as the EU then sure. (Germany is particularly badly affected - which is interesting because the British press has been pointing to their higher levels of healthcare funding and larger number of hospital beds as proof our healthcare system has been catastrophically underfunded. Eurostat doesn't have the December figures, but Germany had a 23% excess mortality rate in October, the most recent month, when England was still at 10%. If it was the other way around the headlines here would be yelling about a catastrophic failure... It looks like other EU members experienced similar spikes earlier in 2022 too.)
- FabHK 4y ago
  BTW, there are apparently two main concepts for ambulances: “Scoop and Run” (just get the patient into the ambulance and then the hospital as quickly as possible) vs “Stay and Play” (emergency doctor starts treatment on site, then transportation to the hospital). Apparently the former is more associated with the UK and US, the latter with the European continent.
  - closewith 4y ago
    That's a false dichotomy. Scoop & Run vs Stay & Play is just a way of describing whether to treat on scene or not. It's used everywhere (at least everywhere that has a modern ambulance service with paramedics) and the boundaries shift depending on scene, patient, skill level on the ground, distance to definitive care, transport options, etc. The whole world has been migrating over the last ~50 years from a purely Scoop & Run model where ambulance drivers were just that - barely first-aid trained - to a model where more and more care is delivered on-scene, Stay & Play.
  - candiddevmike 4y ago
    In the US, how much treatment you get depends on how EMS triages you over the phone. AEMTs and paramedics, especially in bigger cities, are authorized to perform some crazy shit, vs EMTs who can just give you aspirin.
- drstewart 4y ago
  So you're arguing there should be more up front blockers between a person and their attempts to get health care, European-style?
  - zinekeller 4y ago
    I simply answered GP's question: > As a swede I’m confused, how does it work where you are from? I simply described it as how would an ordinary American would experience a potential emergency. Between the "designated doctor" versus "let's be cautious", I'm not sure which is the objectively superior one (although unlike your presumption, I actually like this cautious approach), however I cannot underestimate the fact that your insurance company can just declare your situation as not emergency, despite multiple administrations trying to close loopholes (and even some arguing that the liberalness of insurance companies are not enough). Except for the (rather bitter, I'll be honest) tirade about health insurance, I have tried to not evaluate which system is better, and I'm not sure where did you get the impression that I despise the Anglo-American procedure.
null_object 4y ago
[dead]

DoingIsLearning 4y ago

As a counter point I also had a not so close friend die of an Aneurysm bleeding because during phone screening with a general practioner's receptionist she was too young to have 'something serious' and was told to wait it out until the next day. Not saying the system does not work but you do have medical zebras falling through the cracks.

Tade0 4y ago
Out of the six brain aneurysms(all men - four resulted in deaths) in my extended social circle just one wasn't a person before their 40s. In one case serious consequences were prevented only because the wife of the person, after exhausting all other options, called a special "ambulance on call" service which was part of their healthcare package.
amrocha 4y ago
Sure, the system isn't perfect. Did anyone think it was perfect? Misdiagnosis is a problem regardless of whether you're talking to a doctor in person or over the phone.

shellfishgene 4y ago

A Dutch friend says that healthcare in the Netherlands is so much cheaper than in Germany is also because they don't spend huge amounts of money to extend the life of old patients by a few weeks. I don't know to what extent this is true.

Vinnl 4y ago
There's more of a culture of balancing quality of life vs. treatment here compared to many other countries, but trying to use that as a singular explanation for most anything is most certainly wrong. For example, as I understand it there's also less slack in the Dutch system, exemplified by Dutch patients needing to be moved to Germany during covid because we had fewer IC beds per capita. Which, of course, also surely isn't enough by itself to explain it. (Though I'm not sure how much cheaper health care is here anyway — we definitely do have a problem with ever-growing health care costs.)