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I wish we could have it both ways somehow: a baseline level of widely available cheap care and an expensive tier for people who'd pay anything to get quick care

I wish we could have it both ways somehow: a baseline level of widely available cheap care and an expensive tier for people who'd pay anything to get quick care. I'm not a policy expert so I won't pretend to understand all the problems involved or the potential solutions. But as a patient I have a disability that makes it so the state covers 100% of my health expanses. I've been needing to see a physiotherapist for 3 years but can't find a single one that does home visits. Because of the dwindling number of physiotherapists even those that receive patients in their office sometimes have to see 5 patients at a time. So I have great coverage for terrible or no care at all. I was so desperate I called every physio in my region and told them I'd pay them any amount to come see me, but they can't take my money because the price of their service is regulated and they'd lose their license. Same thing for public hospitals, I came in Friday with three broken bones they wanted me out by Saturday, they didn't have a single available bed in their orthopedic unit and they needed the E.R bed back as soon as possible. All that because we decided to regulate the maximum number of doctors so now everyone has to go get care at the hospital instead of at home care by their local doctor. We do have some pretty stellar private hospitals though but it doesn't help because you don't choose where you get sent to when you call an ambulance. It's a mess.

moonchrome 3y ago
>a baseline level of widely available cheap care and an expensive tier for people who'd pay anything to get quick care We sort of have this in Croatia, public care and a lot of private options. It's not that great because : - There is a tension with public system where doctors from public care move to private system, you hear about doctors working at a private clinics while they are on shift in public hospital, or referring you to their private clinic if you want to get treatment in reasonable amount of time - Private clinics usually don't cover everything, they focus on the profitable stuff. Like we had two smaller earthquakes (~5) around the time my wife was pregnant and both times they were evacuating pregnant women out in the street because the public hospital buildings are >100 years old. Private option was expensive and in case of complications they would still need to ambulance you to a general hospital - Medical tourism eats up private capacity - this is kind of a mixed thing because medical tourism also keeps the field growing/investing much more than domestic demand alone would
- naasking 3y ago
  There's another consideration too: the wealthy people stop caring about funding the public tier because they can afford not to care about it, lobby for policies to cut public funding to lower taxes. Two tier systems typically degrade the public tier over time.
  - moonchrome 3y ago
    I'd say wealthy people don't use the public option anyway/get top tier institutions.
    - naasking 3y ago
      Depends. There is rarely a private ER, and as you say, private care will often focus on the higher margin items so the lower margin stuff might be left to the public option. Some countries forbid two tier systems entirely for this reason, like here in Canada.
audunw 3y ago
> I wish we could have it both ways somehow: a baseline level of widely available cheap care and an expensive tier for people who'd pay anything to get quick care. I think that's quite common? There are both public and private clinics in Norway, but public health care only covers the public ones. My wife and I visited a private clinic in Denmark to get NIPT test even though it was covered in Norway, because the process was longer in the public system (not too bad, but wasn't too expensive to just pay to have it done fast and we wanted to take a trip to Denmark anyway). I know there's kind of a mix in Taiwan too. The argument against having policies that encourages private clinics is that wealthy individuals with a lot of political influence might try to push for funding cuts for public clinics if they don't depend on them. And the best doctors might prefer to work for private clinics if the pay is better. All-in-all I think a mix is best though.
vidarh 3y ago
> I wish we could have it both ways somehow: a baseline level of widely available cheap care and an expensive tier for people who'd pay anything to get quick care. That is the case in most countries with universal healthcare. Very few countries restrict your ability to pay extra for "top up" insurances and services. E.g. in the UK about 10% have private insurance. These tend to be cheap because they basically expect you to use NHS for emergencies, and to try to go to your NHS doctor first, but ask for private referrals if there are waits on the NHS, or for "extras" like regular comprehensive checkups. The NHS itself is also allowed to offer some extras. E.g. many NHS trusts runs private clinics to maximize utilisation.
rjmunro 3y ago
So rich people deserve better healthcare? We have an expensive tier here in the UK. Not many people use it. When they do it takes doctors and nurses away from treating more urgent needs in the NHS system.

moonchrome 3y ago

>a baseline level of widely available cheap care and an expensive tier for people who'd pay anything to get quick care We sort of have this in Croatia, public care and a lot of private options. It's not that great because : - There is a tension with public system where doctors from public care move to private system, you hear about doctors working at a private clinics while they are on shift in public hospital, or referring you to their private clinic if you want to get treatment in reasonable amount of time - Private clinics usually don't cover everything, they focus on the profitable stuff. Like we had two smaller earthquakes (~5) around the time my wife was pregnant and both times they were evacuating pregnant women out in the street because the public hospital buildings are >100 years old. Private option was expensive and in case of complications they would still need to ambulance you to a general hospital - Medical tourism eats up private capacity - this is kind of a mixed thing because medical tourism also keeps the field growing/investing much more than domestic demand alone would

naasking 3y ago
There's another consideration too: the wealthy people stop caring about funding the public tier because they can afford not to care about it, lobby for policies to cut public funding to lower taxes. Two tier systems typically degrade the public tier over time.
- moonchrome 3y ago
  I'd say wealthy people don't use the public option anyway/get top tier institutions.
  - naasking 3y ago
    Depends. There is rarely a private ER, and as you say, private care will often focus on the higher margin items so the lower margin stuff might be left to the public option. Some countries forbid two tier systems entirely for this reason, like here in Canada.

audunw 3y ago

> I wish we could have it both ways somehow: a baseline level of widely available cheap care and an expensive tier for people who'd pay anything to get quick care. I think that's quite common? There are both public and private clinics in Norway, but public health care only covers the public ones. My wife and I visited a private clinic in Denmark to get NIPT test even though it was covered in Norway, because the process was longer in the public system (not too bad, but wasn't too expensive to just pay to have it done fast and we wanted to take a trip to Denmark anyway). I know there's kind of a mix in Taiwan too. The argument against having policies that encourages private clinics is that wealthy individuals with a lot of political influence might try to push for funding cuts for public clinics if they don't depend on them. And the best doctors might prefer to work for private clinics if the pay is better. All-in-all I think a mix is best though.

vidarh 3y ago

> I wish we could have it both ways somehow: a baseline level of widely available cheap care and an expensive tier for people who'd pay anything to get quick care. That is the case in most countries with universal healthcare. Very few countries restrict your ability to pay extra for "top up" insurances and services. E.g. in the UK about 10% have private insurance. These tend to be cheap because they basically expect you to use NHS for emergencies, and to try to go to your NHS doctor first, but ask for private referrals if there are waits on the NHS, or for "extras" like regular comprehensive checkups. The NHS itself is also allowed to offer some extras. E.g. many NHS trusts runs private clinics to maximize utilisation.

rjmunro 3y ago

So rich people deserve better healthcare? We have an expensive tier here in the UK. Not many people use it. When they do it takes doctors and nurses away from treating more urgent needs in the NHS system.