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How does healthcare affect health?

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Nick Nick | 11:53 UK time, Monday, 23 April 2012

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.

Operating theatre

For free!

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?


  • Comment number 1.


    As I see we have the same problems. Officially all the healthcare is free but normally we have to pay for it. Of course we have the national hospitals, usual outpatient clinics, but If you want treatment yourself you must first of all to have the patience and then a rich wallet.... Lately lacked medicines for cancer, patients must wait for therapy, where everybody knows that time is the most dangerous enemy..., we live in the middle of Europe and such a story, horror! Our lovely politicians have better duties for example brawling about Smolensk's catastrophe.. Ordinary people have a one question "What with living beings".... Parliamentarians should to focus on attention for the mental clinics, I think that some of them in the nearest future can take advantage of their help.

    Best regards,

  • Comment number 2.

    Hi, Nick,

    Thank you for your third long write-up. I love it the most. This few days, I kept open BBC LE’s webpage to see that did you, Neil and Graciela who have post new blogs. Because I couldn’t wait to read and give a comment, even I write it with my below-standard English.
    I like your write-up because everyone must concern about it. Healthcare is one of the important subjects in our lives. Who have never get sick? Who have never get a health problem?
    Here is the same, Hong Kong was one of the Britain’s colonies until 1997, the land was handed over back to China on 1st October this year. I’m not sure but maybe it is one of the reasons why Hong Kong’s healthcare system has been deteriorated. At least, one thing that I’m sure is most of my friends and my colleagues they wish they could live back in the period of Britain’s colony. ha!! Who don’t want to have better lives?
    I can tell that Hong Kong’s healthcare system also is terrible. Our government hospitals (GHs) there lack of a huge of doctors and nurses because most of the government hospital’s doctors and nurse they fled to private hospitals where they can get more salaries and less workloads. Now who are working in GHs where only have two kinds of professions. One are who just graduated in universities they need more experience so they are no choice to work in GHs and the others are senior doctors they’re waiting for a pension after they retired in few years. Turning out the result is that who working in GHs they both lost their enthusiastic in serving their patients. A recent healthcare statistic’s just been released. It said each doctor has to take care of near 200 patients in GH, meanwhile, each nurse also has to serve almost 30 patients. The numbers are extremely higher than the international standard.
    Let me talk about my experience of medical treatment. A few months ago, I went to have an adventure race in a mountain, then I got slippery in a valley and fell down getting a cut on my knee. After then, I rushed to a GH and waited almost 3 hours to get 5 stitches fixing. It’s a nightmare for me. I don’t want to go to any GH again so I bought a healthcare insurance. That guarantees I can get a treatment in private hospital as soon as possible when I need it next time.
    Thanks for your blog once again. Hope my wordy write-up won’t make you yawn. Look forward to reading your next blog.

    Sai-fung (Hong Kong)

  • Comment number 3.

    Hello Nick!
    I must say I am quite impressed by your good -sized and detailed writing about Healthcare in your country and realized that we Azerbaijanis are not the only unpappy bunch in this matter.Private clinics in our country equipped with the latest medical innovations and employed by experienced doctors.You have to pay and get the test results and service in no time,but not everybody can afford this,because you have to have rich pocket.Government Hospitals are officially free,on papers,but actually you have to pay to see a doctor,maybe a little less than you would have payed in private clinics.So nothing is free.Yoy pay doctors,nurses and even cleaners if you stay in.Medicines aren't free,even cotton,syringes,thats used in hospitals, are bought by patients themselves.Doctors are paid around 150-450$ per month,which don't cover their basic needs,so they are not to blame.When you are ill ,you are worried more about the money than your health.People who live below standard suffer from this hugely and seek doctor's help when they are nearly "'dead".
    We are told that it is about to change soon and we going to have insurance based healthcare,which no one really understand how.To be honest ,I am a bit pessimistic about this so-called change,but hope that I will be proved wrong.
    All the best ,Nick
    Seva from Azerbaijan

  • Comment number 4.

    Dear Nick

    It seems to be a thorny issue again to discuss about health care systems in our international forum.
    As a practising general practitioner and paediatrician I am personally involved in this topic. Reading Nick’s essay a lot of details seem very familiar to me and we work in a quite similar structure - maybe this can be originated from our common communist roots.
    As I see those parts of health care systems which are financed by governments work more or less inadequately all over the world; neither the patients nor the health care staff are fully contented. Private sector is more likely to provide its function well but only few people can afford it.
    One of the main problems I see is that great majority of our adult population tend to be inactive to take care of its own health. Waiting for resolutions from others or a nursing system is more comfortable. Improving our own coping mechanisms is one of the hardest tasks in the adulthood. In my daily medical practise I often meet patients whose problems are deeply ensue from their false presence in life in consequence of series of wrong decisions they have already made. Their reactions to any kind of physical disorders are exaggerated and give us a big challenge to examine and treat them correctly.
    Sorry for mentioning of some little philosophical–like sides of the problem but I don’t want to repeat the content of the comments above in which are correctly said about the problems of low salaries and lack of appreciation that can be experienced from time to time at all levels of health providers.

    I don’t know the right way how to rebuilt the national health care systems but I aim to do my best each case whenever someone asks for help.

    Have a nice day for all of you.

    Krisztina from Hungary

  • Comment number 5.

    Hi Maja,

    thanks for your opinion! I see that healthcare is a complicated issue just about everywhere :)


  • Comment number 6.

    Hello Sai-fung and thanks for your detailed comment!

    Well, your problems mostly resemble ours: groups that work in GH-s are really similar, and your experience in our GH with your wound might well have been more or less the same.

    Still, I hear stories like that even from people living in super-mega-developed countries. Free medicine - lines, lack of specialists, etc. Paid medicine - comfort, but for large money, and a lot of medics are really focused not on treatments, but on selling you additional services even if you don`t need them...

    Wish you never visit doctors again (at their workplaces, at least)!

    P.S. You don`t need to worry about your English level - people with "below average" could barely write that sort of well-formed comment. As long as you see notice your problems, it`s fine. Just never stop improving! I`d suggest that you use something like "my English level is constantly improving" - that would be inspiring, optimistic and true :)

  • Comment number 7.

    Hi seva,

    thanks for your comments and please accept my best wishes to you and your country. You`ll be hosting Eurovision soon, the thing that a lot of people in our country are crazy about :)

    But to the point - yes, that`s a pity you have nothing for free, really. I believe it might well be in Belarus, though of course money make healthcare mechanism wheels turn faster.

    Talking about insurance-based medicine, I also do not see it as the ultimate solution. We need to have really strong insurance traditions to implement it right, but I don`t think that post-USSR countries managed to fully adopt it.

    I`m also pessimistic on the issue (because I could see it from both sides) and don`t feel that there are improvements that might solve everything. But, to my mind, state has to pump more money into healthcare, along with implementing stricter control, discouraging patients from "parasitism", providing fair basis for private companies to grow and introducing more "officially paid" services.


  • Comment number 8.

    Hi Krisztina,

    thanks for your comment! It makes us look at the problem from two different sides.

    First, you`re perfectly correct on that: it`s only you who could take proper care of you and make you healthy, not medics. We have also a bunch of problems with it. For our people, one of the most devastating problems is alcohol addiction :( And not a lot of people prefer to lead the healthy way of life.

    Second, you`re ABSOLUTELY right about "doing the best you can". It all starts from us, from you, from me. If I do my work responsively, 100%, than it pays off someday. If people from the state who control healthcare, if patients and doctors would behave responsibly and do 100% of what they could, all the "ecosystem" would gradually become better.

    Let`s hope for the better!

    Best, Nick

  • Comment number 9.

    I am newbie on the blog, and in my very first comment I'd like to touch a different aspect of the health care system.
    I can share the opinion with a group of experts saying, that we can not talk about “ free ” healthcare.
    The healthcare system needs a number of resources working on a successful way e.g. human staff equipments, buildings, drugs etc. The tests, diagnoses, treatments all expensive elements of the network, and somebody have to pay the bill.
    In one case the government collects taxes and distributes the money, in other cases the insurance associations negotiate with the providers, or the patients pay on a direct way. The yearly budget is always a result of a long negotiation process. No matter which method is used, at the and of the chain the patients pay.
    The key question is, whether the providers are able to spend our money on a cost-effective way or not. I strongly believe, that the well educated and deeply motivated management could be the most important factor.
    The write-up starts with the question: How does healthcare affect the health?
    In my opinion the health status is influenced by different factors e.g. way of living, prevention, environment, geographical area, social network and number of others. The healthcare itself is playing a role not more than 30-40 % among the factors.
    Thank you for reading.
    Best wishes
    Imre0382 from Hungary

  • Comment number 10.

    Nick, thanks for your encouragement. Hope to learn more from you all. Also, I hope my English level is constantly improving indeed. ha!! Thanks!!

  • Comment number 11.

    I'd like to tell about healthcare system in Spain. It's very similar to the belorusian system. The basic service is free. Ambulance service and emergencyes are free. Hospitals are full of patients (sometimes whithotu emergencyes cases). The diference is that doctors and nurses are well payed. How I could know, they recive about 2000Euro. But in private hospital they recive more. That is the problem. The health is converted in economy problem.
    But in spite of all problems with the payment, the public system in Spain, I think, is the best in Europe. There is better hi-tech equipment, better specialistes than in private hospitals. If you are an immigrant, you can recive the treatment free at all. Even dental service. People from others countries come to Spain to make some operation. It's named "medical tourism". Because of the low prices. It could be the price of the operation or the insurance. Of course, it is not that the operation really costs.
    It seems "communism".
    But these system has also drawback. It can be called to waste money. The money, wich came from ours (taxpayers) pockets. Because of these, I agree whith fine for falls ambulance calls, whit payment of total invocie in case of help to drunk (it is logical, each one must to be responsable for it self) for example. Also it could be given some advantages to the people who don't smoke or do sport regulary. All of these is aplicated to public health service.
    Nowaday in hard financial times, unofortunately, a lot of free services will be cut off. But if you have a seriosly health problems, doctors save you.
    The spain insurance health service works also. I had my baby in a privat hospital whit the cesarean. It costed me no money at the moment. All of these: the operation, care service, cleaning, the room in the hospital are included in my insurance. Yes, of course I pay about 50 euro pro month. But it nothing comparing whit the real amount of these services.

  • Comment number 12.

    It's great to know the healthcare system in Belarus. I think the healthcare system in your country have to change.
    I am from Taiwan. In my country, everyone have a health insurance. People must pay to government for the health insurance. Therefore, it cost cheap when we need a medical treatment. However, people go to doctor frequently even if they aren't really sick. That is really wasting medical treatments.

  • Comment number 13.

    The American healthcare system is great, not perfect, but we don't live in a vacuum and compared to other countries it's the best and I hope it stays that way.

    Best health

  • Comment number 14.

    The UK private healthcare system is getting bigger every year with patients not willing to wait for the NHS waiting lists, so patients are either paying out of their own pocket or using private health insurance to pay for treatments. There are however a number of doctors and specialists that are working for the NHS and privately [Unsuitable/Broken URL removed by Moderator]

  • Comment number 15.

    And for additional information about my private research which can be found here:




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