Feb 8, 2018
About That "Really Bad and Non-Personal Medical Care"
I’m an American citizen living in London as a permanent UK resident. When I go to my local health clinic’s website or call to book an appointment, I have the option of requesting a standard doctor’s appointment (same-day if I need it) or a home visit. Home visits are for the elderly and others who are too weak or ill to travel.
A few weeks ago we had an unexpected home visit by a doctor in the middle of the night. At around 2:30 a.m., the doorbell awoke us with a loud buzz. Startled, I went to the intercom to ask who was there. Figuring this would deflect any burglar or drunkard on the street, I didn’t expect a reply. “Hello, this is Doctor ___ [I can’t recall his name]. I’m here to see Mr. David ___.”
My husband David was now by my side. “That’s weird,” I said. “Is this normal?” He is British and more accustomed to common practices and peculiarities over here. "No, definitely not," he replied. We crept down the stairs and spoke through the bolted front door. “Do you have an I.D. of some kind?” I asked. “Because we didn’t call for a doctor.”
The Royal Free Hospital had sent him, he explained. “Your blood test results were flagged at the lab. We’ve been trying to call to check on you but got no answer. Are you alright?"
It’s true: David, who had been hit hard with a flu-type thing, had been at the hospital earlier that day and had blood tests done. We knew the results were due that night. I opened the door and saw a large man holding a doctor bag patched with duct tape. Though we shook hands I still didn’t invite him in because the whole thing was so surreal and we were still half asleep. David answered the doctor’s questions, shivering near the doorstep in his boxer shorts.
It turns out he was severely dehydrated and his kidney function results were dangerously low. After a week-long viral infection that had landed him in the ER in Singapore (another story for another day), he was weak and required urgent care. Plus he has an underlying health problem which puts him at higher risk for complications from flu. Sleeping it off for one more day could have been dangerous.
Knowing that the flu season has been especially brutal this year, I spent the next day googling worst-case scenarios. I’ve since read news stories about people in the US dying from flu-related complications like sepsis and dehydration resulting in organ failure. It’s scary stuff.
I wish I could recall the mystery doctor’s name so I could thank him for the wakeup call that night. Count me among the millions of UK residents who take pride in the National Health Service. I am grateful for the professional — and yes, personalized — care my husband has received from NHS doctors, specialists, nurses and paramedics over the past 18 months. On several occasions, they have literally saved his life.
Feb 12, 2018
It's been a week since Trump posted that tweet and I'm still fuming. I'm not the only one. Even the Health Minister, a loyal conservative, got his back up:
Within just two hours of Trump's ill-informed tweet there were more than 10,000 responses on Twitter. As everyone was quick to point out, the marchers were protesting funding cuts to the NHS, not the NHS itself. Banners, signs and t-shirts emblazened with "SAVE the NHS" and big red hearts made this obvious. (See Gallery: NHS in Crisis March from the IndependentUK)
Then there was this:
"In a Twitter poll set up by Financial Times journalist Jim Pickard pitting the two countries’ health-care systems against each other, 90 percent of those who voted preferred the British system."
[Source: Bloomberg: Trump’s NHS Tweet Angers Brits Fearful of U.S.-Style Health Care]The row (argument) is still ongoing.
Feb 15, 2018
Individualized Treatment Under Universal Care
My husband has a rare lung condition called “severe refractory eosinophilic asthma,” which was diagnosed shortly after moving to London from Boston last year. He ended up in the A&E (that’s what they call the ER here) nine times in 2017. Three of those times he was admitted for longer stays. So far in 2018 it’s been two A&E visits and counting. He has never waited longer than an hour to be seen, but that’s partly because his condition makes him a high-priority patient. I’ve read about others waiting for up to four hours, especially during this year's flu season.Specialists and targeted therapies
Just like in the States, we have access to both general practitioners (GPs) and specialists. Just like in the TV show House, specialists conduct tests, analyze data and collaborate with their teams to diagnose, treat and monitor patients. GPs make the referral, and then the specialist contacts the patient. You have to wait for an NHS letter to arrive by mail informing you of the date and time. There’s no picking up the phone and scheduling at your convenience. But for that, you can pay for private supplemental insurance, which many with means choose to do.Respiratory specialists now recognize several different phenotypes of asthma, as I’ve learned, and so much time and care went into testing and finding the right diagnosis. Only about 5 percent of people with asthma have "severe asthma," from there it's broken down into two types: allergic and eosinophilic (having to do with white blood cells). So through the diagnosis period, which requires much trial and error, and the ongoing treatment, which requires tweaks and testing, he's received personalized medical care. Just like in the US, but with no co-pays, premiums or paperwork required.
Fortunately, since receiving his diagnosis, my husband has qualified for a new biological adjunct treatment, which is administered monthly at the hospital. The cost to the hospital is £840 ($1,150) per injection, but it is free to the patient. The cost in the US is roughly $3,000 per injection, and the different guidelines for different insurance and prescription plans are so confusing that I have no idea how much it would cost us. The wholesale cost of $2,700/month or $32,500/year does not include the fees for doctors to administer the treatment in a clinical setting.
Prescription Costs (or lack thereof)
This type of asthma leaves the patient more prone to picking up viruses and infections, as does the high doses of steroids needed to keep breathing stabilized. With this double whammy, my husband frequently comes down with viruses and respiratory infections. Thus he frequently needs antibiotics and extra steroids on top of the regular cocktail of more than a dozen different drugs. For this, we go to our local chemist (pharmacist), who provides another personal touch point in the circle of care. He knows every patient by name and advises on holistic care and natural remedies in addition to dispensing medications.Early last fall, he told me he had just received the first batch of flu vaccine and was able to give the shot to at-risk groups (over 65 and those with chronic conditions) before serving the general public. He urged me to get David in for the shot (which I did), but first he suggested I get it too (which I did, on the spot), to minimize risk in our household.
I left, as I always do, with a large bag of prescription medications, virtually for free. Even the inhalers. David pre-pays £104 ($145) at the beginning of the year to cover all the prescriptions he needs. In his case, that’s at least one shopping bag’s worth each month.
For myself, I started by paying the standard rate of £8.60 ($12) per prescription, then switched to a Prescription Prepayment Certificate (PPC) to save money. A three-month PPC is £29.10 ($40.50) upfront or available by 10 monthly direct debit installment payments, allowing anyone to obtain all the prescriptions they need for £2 ($2.75) a week. There are exemptions for those who are unemployed or disabled, and certain types of drugs and categories of patients.
Contraceptives are free. So are prescriptions for STDs, tuberculosis and other communicable diseases. All medicines administered in hospitals are free, as are prescriptions written upon discharge and dispensed by the hospital pharmacy.
Prescriptions are free for the following groups, no strings attached: Cancer patients. Pregnant women. New mothers within 12 months of giving birth. Children under 16. Full-time students age 16–18. People age 60 and older.
US vs UK Health Care
Friends ask me why we don’t just move back to Boston. You’ve got the best hospitals in the world here, they say. And they’re right, but it’s not so simple. It would involve looking for new jobs, shopping for new medical insurance, paying exorbitant premiums for pre-existing conditions. It's true that it's currently illegal for insurers to deny coverage for pre-existing conditions, but that doesn't prevent them from making the cost too prohibitive to buy. What if we somehow got reasonable insurance, and then the terms changed? So many what ifs in a country with a threadbare safety net.Prior to moving to London, I spent the last five years helping my elderly mother navigate Medicare, supplemental health insurance, prescription insurance, “donut holes,” pharmacy bills, mandatory rehab center bills following hospital stays that didn’t meet the three-overnight-admitted-patient status (don’t get me started), home health aide bills and assisted living bills. I am still reeling from it.
For now we’re content to stay put. We’re in good hands—in some cases excellent hands, in others, plenty good enough—and take comfort in knowing that though an illness may force us to the hospital, it won't leave us bankrupt.
Interesting Reads:
The Guardian: Here’s what Americans need to know about the UK’s health systemBusiness Insider: Americans! This is what it's like to use the NHS, Britain's universal healthcare system
The Independent: Having experienced the US and the UK healthcare systems, here's the truth about the differences – and no, Donald Trump isn't right
"Both the American and British healthcare systems are fragmented and broken, sure. But at least the NHS is founded upon rock-hard principles of compassion and equality." - @NashRiggins, The Independent
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