mousetail: Sleeping mouse with a pink box (imho)
[personal profile] mousetail
Dear [livejournal.com profile] evilvillan_1 suggested I write about healthcare. Somehow she could tell it would be a rant ;), and she was head on. But first of all, a bit of explanation/disclaimer:

I have an opinion on US healthcare reform, but I also have a very strong opinion about not speaking up where totally incompetent. I have about 0.0001 experience with US healthcare system, so I won't write about that. Neither will I write about Ukrainian healthcare, because, due to my family's totally negative experience with it, I have huge phobia towards Ukrainian doctors, hospitals, and overall medical system. In fact, it took me a lot of growing up to learn to trust any doctor. I'm not totally there yet, in fact. Nevertheless, I will talk about German healthcare, since I do have some experience with it, in fact since the birth of my daugter quite hands-on. But bear in mind that all opinions provided are those of doctor-hating hospitalphobiac with innate distrust for everything medical :)


So, the doctors. They are just like everywhere here - good, bad, and mediocre. I have learned to seek out good & avoid the rest, that is why my daughter is seeing a neurologist an hour drive away - doesn't sound bad for US, but there were plenty of them a lot closer. Sometimes you're stuck with the doctor you're dealt (for example, in the hospital - here, a specialist you're seeing in an outside practice won't work with you in the hospital, but will simply refer you there & await your return ;)), and this is a kink of the system that often angers me, even though we were lucky with those cases so far. There are some distinct features specifically pertaining to German doctors though:

- unaccesibility;
If you're seeing a doctor in private practice, this simply means your appointment will be much later than you need - unless you're having an emergency - and the doctor will be rushed and pressed for time when talking to you in 70% of visits. In the hospital settings, this means you will spend hours on end in your room, wondering what the heck is going on, because doctor is only possible to see during rounds, unless you stake them out in a hallway, pouncing on them every time to pass the floor (and be prepared to be told that they have nothing new to tell you until tomorrow's rounds). This becomes especially annoying when all you want is to be discharged ;) If you're seeing a hospital doctor during cloning hours, he will be both late for appointment and pressed for time in about 80% of cases. And you will not, under any circumstances, talk to the doctor on the phone personally -unless you call during pre-arranged, usually uncomfortable & very limited hours.

- terrifying bedside manner;
I could talk about this one forever, but will just say this: if you have a condition with several possible prognoses, they will make sure you're aware of the worst possible one, sometimes stressing it so much that this is the only one you'll be aware of. Scary diagnoses such as cancer are announced with little hesitation at the time they're merely suspected, and patients refusing to get every single test/treatment covered by insurance are treated as slightly mad :) Which is good, since they stop assuming things at this point and start to check with you - another thing that doesn't happen often enough...

- secrecy :)
No matter how urgent your diagnostic test is, unless it's an ultrasound that is interpreted right there, the procedure is set up in order to make sure the patient has as little access to test results as possible. It goes like this: you go get the test, and weeks later not even you, but the doctor who referred you for it, will receive written results. Which he may or may not share with you in detail or not at the next appointment.. Or not; you may have to call the doctor's office yourself, only to find out that they never got it, at which point you start going back down the line to find out which link of chain failed to send out the letter.
Some places are weirder than others; for example, my daughter's early intervention center had done an EEG on her. I was told to call three weeks later, to the doctor who's only available for phone calls 4 days a week 30 minutes a day early in the morning (needless to say the number is busy that entire time). The kicker is, I'm there in person several times a week - but all I could get from the reception is the damned phone number with times :)

The hospitals: apart from ever-missing doctors they are quite ok. What makes German hospitals stand out is:
- desire to keep you;
They won't discharge you a day earlier than number of days they usually bill the insurance for, and if there is a reason for you to stay any longer, checking out will become extremely tricky.
- lack of privacy;
Whereas in the States you get a private room or curtains to separate you from the roommates, and in Ukraine you can pay for a private room, here it's simply not available too often. So we're easily talking 4 kids plus 4 parents in the same room, add to that very relaxed visitation policy and you get the idea. I'm not the type to make best friends/socialize in hospitals, I'm the type to leave as soon as I can crawl out of there, and all this picnic atmosphere is really not my cup of tea. With that said, it's not that bad for patients I assume.

On a good note, the policy is a parent can always get a bed to stay with their child, unless it's ICU, and even then a bed can usually be arranged elsewhere. I love this, I don't think I'd be able to let Sophia spend a night by herself even in the best of hospitals. Some places even feed you for just a bit extra cash.

Insurance system: well, they are stingy with money, and getting something extra out of them (like my parodontal treatment or Sophia's special needs chair) can be nerve-wrecking, time consuming and sometimes unsuccessful. But they have to be like this, considering they get money from the government, which are always short, and have to carry all the people who are entitled to free coverage. Bein on maternity leave, I am, and I really appreciate that. Some things they deny make no logical sense (my friend couldn't get a biopsy paid for until it was confirmed she had cancer), some things they do pay for make no logical sense either - a paid 6-week vacation for mother and child in a special resort with childcare to preserve mom's sanity and wellbeing?? - but I appreciate not having to go broke because I have a child with high medical needs. In other places, in fact US and Ukraine both, I'd be so far in debt that wouldn't even be funny. So thank God for German insurance.

They also offer many fitness classes, cooking seminars, smoking cessation sessions for free; right now I'm taking Tai Chi class, it's once a week for eight weeks - at no cost whatsoever.

If you're healthy and working, like I used to be, income-based premiums are going to stink, no doubt. But when you're really sick, the system is there to support you (unlike in some other countries, but shhh about those ;)) - you will never be denied coverage under government plan, all the conventional treatments you need will be covered, and even in a room with a bunch other folks you will be attended to by caring stuff. Plus, no surprises: if something is covered, it's universally covered no matter which doctor or hospital you choose to use. If it's not covered or subject to approval, it's also universal and well-known to doctors, so they always warn you beforehand. No surprise bills is good, right? Plus, while you're healthy, you can take advantage of many prevention measures that are covered (like fitness classes mentioned above), to make you feel like you're getting some of your money back anyway :)

Date: 2009-11-07 01:23 am (UTC)
From: [identity profile] evilvillan-1.livejournal.com
I'm disappointed there's no rant. :P (KIDDING!)

I want free classes to take at will, even at university you need to shell out money to take classes through the athletics department!!

Insurance makes me barf a bit inside. I'm glad that I don't have to pay for much healthcare related stuff in Canada. Well, except I have a disability and not a chronic condition and they are notorious for not paying for some procedures/conditions for no apparent good reason.

Discharging experiences make me wonder what you've gone through... I've volunteered on an inpatient wing of a children's hospital here, and if you need to be discharged they try to get rid of you by Friday afternoon because the weekends are DEAD (and very few doctors actually work then).

Thanks for the post!

Date: 2009-11-11 03:16 pm (UTC)
From: [identity profile] mousetail.livejournal.com
This one was a big chore to write :) I usually master up to somethinglike that only if I write about Sophia...

As for discharging experience: this might be particular to the hospital in the nearest city here, since another one we've been to (really busy major university hospital) seemed very efficient and had no interest in keeping us any longer than necessary. They blew me away when we got done with several major tests with just one overnight stay - we stayed two nights for one in the local hospital here. And these unreasonable timeframes drive me nuts. When Sophia was born, they kept her for 2 weeks instead of one (the first one, granted, she really needed - for hydrocephalus observation), because her MRI was scheduled next week and the dr didn;'t want her to leave and come back... Yeah, right. Instead, he wanted me to live in their tiny waiting room/kitchen for a week longer (and I literally lived there, for I still tried to breastfeed at that point). And later I found out they could have sent her up to a regular room, for me to stay with her, but no, they kept her in NICU - I'm sure that cost our insurance an arm and a leg. Really can't blame them for being stingy if they get milked like that :-/

Date: 2011-05-08 11:02 pm (UTC)
From: [identity profile] lbwthwpph.livejournal.com
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