How does healthcare affect health?
No doubt that it is better to be healthy and wealthy, than to be sick and penniless. Still health remains one of the core human values that money cannot buy (of course, to some extent). But how does it actually correlate with the power of healthcare system? Does better healthcare actually improve human health or it just helps to "firefight" problems brought there by all the efforts of making the society (and the healthcare) more developed?..
Well, thoughts like these were running through my head the last week, while I was laying in my bed with a terrible cold, with my plans and schedule ruined. The situation also had a silver lining: I got a chance to slow things down a bit and think about health and healthcare. And not just think, but also blog :)
Health is a really immense topic, that`s why I suggest that we today focus on a healthcare system.
Here in Belarus we face a great debate from time to time: whether should we switch to paid-only medicine? How could we save doctors from leaving their workplaces for better-paid occupations? What way we should address the lack of specialists in the small cities? A number of friends/relatives in healthcare & "patient-experience", coupled with curiosity & some international first-hand facts do allow me to share some observations about pros and cons of different healthcare types.
But let me first make an introduction and brief you on what the Belarusian healthcare actually is at the moment.
We have the complimentary medicine. That means that most of the treatments would cost nothing to you. You call an ambulance - you pay nothing. Visiting a polyclinic? Just need to wait in a line, but no money required. Having serious troubles? Your operation would be free to you. Still, some things are not included in the free medicine benefits (say, cosmetic surgery).
So how it really works? If you have a health-related problem, you just go to a polyclinic where you make an appointment with a specialist-physician - say, a cardiology specialist if you have heart problems or an oculist for eye-related diseases. It is free but may take some time to book an appointment (it could be done over the internet for some medical institutions) and wait in a line, sometimes - hours and hours. Then you get your recommendations and prescriptions, if needed. Your case is serious? Then you will be given a "referral note" to visit a hospital. Sometimes hospitals may be overcrowded for weeks and months (for not an emergency cases), but all the treatment is still free. In case you need an emergency aid, just call an ambulance. It will arrive swiftly and again with no payments required.
Drugs are usually bought by the patient, but some categories may apply for a subsidy. We have some really talented and skillful doctors along with quite modern equipment to successfully perform even serious surgical operations - such as heart transplantations. Dental care is of high quality and low prices - you need to pay if you are not facing an emergency tooth problem.
Sounds good, huh? Now let me add some "flies" to the "ointment".
Free medicine = problems for free?
Well, we do have free medicine, but if you go into detail you may find out that it`s quite a controversial story. Free medicine does not mean free drugs. And they are really expensive sometimes. Of course, if you managed to get into a hospital, you`ll be generally treated by complimentary drugs, but they most likely would be locally produced. Those are "not always good", so doctors from time to time do strongly recommend patients to buy a really high quality drugs for themselves.
Situation in healthcare is tightly connected with "everyday bribery" - when patients bring doctors chocolates, cognac or even money to express their gratitude or to grab an appointment, to get an additional treatment without papers and lines. That is not a surprise, really: doctors have ridiculously tiny salaries (around $150-700).
A lot of things (like tests, dental services), especially when you are not "that ill", in most cases would still be done at the commercial centers or in the state healthcare institutions on a paid basis. Why? Lines in the polyclinics are just hellish: imagine dozens of patients waiting, lack of doctors, closed spaces - a lot of people prefer to pay (fees are reasonable).
Immense number of patients plus limited (and declining) number of physicians lead to shorter appointment times (what can you do in a 5 minutes? only your paperwork!), social tension (God prevent you to jump the queue!) and a vast number of other drawbacks.
Could paid medicine be the universal option?
Maybe we all should just shift to the paid (or insurance-based) medicine, will it be a cure-all?
Not sure. Of course, total comfort level, provision of hi-tech equipment and total quality of service are usually better, but... but it all costs money! Huge money. For the people, for the state. And it would be extremely hard for the nation to switch at once. Even timid appeals of ambulance workers to charge false emergency calls face massive repulse from the society! Once a suggestion arise to impose minimal fees ($0,5) for entering polyclinics in order to cut off those "false patients" coming there to socialize and battle boredom. But soon the guy who suggested it faced intense opposition from the society and government.
Despite transition problems, I see (according to my friends` experience) that insurance-based medicine has its own drawbacks. For instance, your appointments may be booked not less than a few months from now. Ambulance calls? No problem, but you`ll need to pay or to cover it with your insurance. And my experience of working with insurers say that they are willing to pay less or not to pay at all, which means additional stress for you.
Awaiting baby? Not a problem, go find few thousand dollars for medics to take care. Want to buy some relatively harmless drug (not talking about antibiotics or something really powerful)? Go visit your "family doctor" (it may also take weeks), get a prescription (we have them only for the most powerful medications)...
And well, not having an insurance policy covering all (which are really costly) means you still need to pay from time to time. Correct me if I am wrong, but those sums might be frightening if you caught something serious.
However, as I observe it, we definitely need to alter the attitude of our society to the doctors. They must not be treated by "servants" - people should get it once and for all these medical services are expensive and extremely difficult services (even if Government pays). Everyone will have to care about their health. For instance, a lot of alcohol addicts don`t care at all - maybe having less help for free could make them think of the consequences next time.
The main issue that if we don`t do anything, our medicine would be ruined quickly. Old and skilled workers pass away or retire on a pension, and young physicians are not willing to stay in the profession if the salary could not even cover their basic needs! And they leave country, or become traders, businessmen, housewives...
Less doctors plus the aging society equals severe problems in the nearest future.
P.S. Request for comments
What about your country? What healthcare system do you have? What challenges does it face?