American wants to practice in the EU

[f_w]

I guess we have finally found someone with first hand knowledge in the spanish healthcare system...

Although, reading it a second time I start to wonder. A lot of the stuff has quite a political tone to it, and some of it is just plain nonsense. Particularly the broad generalizations regarding 'anywhere else in europe' show that the author has either never been to the rest of europe, or has a very skewed view of his surroundings.

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[deleted21609]

I grew up in Madrid until I was 21, now I am in medical school here and would *never* chose to go back and practice medicine in Spain. The whole Spanish system is in terrible need of some major revamp and "most" doctors that "can" (note: you may want to have your own private practice but this is easier said than done) will work long hours into the night to make some $$ because they make peanuts under the "socialized" umbrella. Until you have lived there for a substantial amount of time you have NO clue of what living in Spain or any other European country is. I know that when you visit it is great but the whole way of life is totally different and not that glamorous as you may thing. Folks here say the quality of life is better and I ask what do you mean by quality of life? if you mean tons of bars/restaurants/night clubs/etc.. at every corner then sure it is better but if you mean opportunities to excel in whatever, nice highways, homes, etc...then hell no! Spain (and many other European countries) have tiny tiny apartments that is very difficult to get used to once you have experienced the massive homes here..same with vehicles. If you think that you will be living la vida loca and having tons of time off as a physician think again! they tend to work a lot there for nothing *and* again there are many many unemployed physicians there so beware! the medical care is awful and it *is* discriminatory, do not assume that socialized healthcare mean healthcare for all this is a huge misconception. If you are elderly (over 55 or so) or the very young...there are tons of procedures and options that WILL NOT be available for you. Again think that this is a government run system so somewhere the line is drawn. Please do yourself a favor and go there for a year or more and see for yourself what it is like before you embark on this. The hospitals for the most part are subpar (think a la communist style) and most folks that can opt for private insurance...

Miklos
antoniost wants to stay in spain or the UK, he wouldn't be doing any US rotations then.

Except for CA which has their minimum hour requirements for different specialties, there is no medical board that puts up particular hurdles for FMG's who did their training entirely abroad. (NY requires US citizenship or permanent residency for full licensure: not a problem for antoniost. TX used to require proof of legal status. LA requires proof of legal status.)

It would be prudent to go ahead and prepare for or at least consider the highly probable case that he will want to return home at some stage.

 

[efex101]

You obviously have no clue about my intentions or what you say is my political undertone. If you go back and do a search for some of my posts you will realize that I am not trying to bring politics into this because I could give a rats arse about politics. I care and replied to this thread to try to explain some of the misconceptions that folks have about nationalized or socialized healthcare. I know of how ****ed up the system is because my father yes my father died due to some of the "policies" in effect in Spain. I also lived for six years in Germany...so I am *not* making things up about other contries or like you said my view is narrow regarding other European countries. I have tons of relatives to include my mother that still live in Spain and I also have family in Italy, France, and Germany. Please, do not say that there is a "political" undertone because there is none. It is amazing to see that when someone that has "actually" lived there tries to explain to others the misconceptions that foks have (and to boot these folks have NEVER set foot there) someone starts to "assume" that there is political undertone...I have been exposed to this system since I was an infant and because it is so "great" my mother had me on a private insurance..this was not the case for my father and now we obviously regret this tremendoulsy but you see, it is expensive to have private insurance for the whole family..If you love the system in Europe and you think that it so great how come many folks (those that can) come here for healthcare? why are there so many seniors that are NOT being treated? why does it take YEARS for a simple x-ray or other tests? again please go there and see for yourself. Go and see the great hospitals that are so poorly run and maintained and understaffed...go talk to the many Spaniards that have lost loved ones *waiting* for tests, or they were not offered alternative treatments, go see and you will then understand. My father died waiting for an oncologist at one of the biggest hospitals in Madrid. There were ZERO oncologists on call from Friday night until early Monday morning. This is not a podunk hospital in the middle of BFE either..this is in the capital of Spain! So please before you try to assume that what I say is nonsense your happy arse and go see for yourself. There is NO perfect system but to assume that socialized healthcare *is* the answer is ludicrous. Here anyone is treated at the ER regardless of insurance status and yes our system is not perfect but neither are other systems. The grass always looks greener from the other side but when you actually go to the other side you realize that there are weeds there as well.

 

[antoniost]

Thanks for your comments efex101. They will not be weighed lightly.

 

[f_w]

Get a hold of yourself.


Say, have you ever worked in the spanish healthcare system ?

 

[Miklos]

efex101 mentions what I consider one very valid point: Living in a country is radically different than simply visiting it.

Anyone considering permanent relocation would be well advised to consider this.

 

[tlew12778]

I don't think that efex has any political motivation behind his posts. I think he's just raising a few good points. But I think that one particular issue that needs to be addressed, is that there is a big difference in being the caretaker vs the receiver as was mentioned in another post.

I think efex that you would need to experience healthcare as a practicing physician in Spain in order to have such a strong opinion of it (versus basing your opinion on your family's past experience(s)). It is one thing to be a layman getting the short end of the stick and another to be a physician or related to one. As sad as that is, it's the truth. It's amazing what 'knowing someone' can do for you here (I'm making a broad generalization... I acknowledge this).

Regardless, I think that antoniost is on the right track. He seems to be covering his bases in ensuring that he goes to a school that would allow him to transfer back as an FMG should he decide to return to the US. I do think that 6 years of medical school in any country that he chooses will give him a good insight into what life in that country will be like should he choose to stay.

antoniost - You will find many posts on both the Europe thread as well as the Intl thread about the ECFMG certification process.

 

[efex101]

I completely agree that it does matter on what end you are but see, I have spoken with many physicians in Spain. No, I do not know ALL physicians in Spain but ALL the ones I have spoken to have mentioned the many pits and downfalls of the current system...but to say that just because I have experienced it as a patient or family member of one does not mean that I cannot have strong opinions of it..that *is* how you get strong opinions of something by going through it. I have friends and family members that are physicians, also I get to meet many physicians that come here to Mayo for training so I do get some first hand exposure via them. The general consensus is that the Spanish system is in shambles right now. Sure it *is* great for preventive measures and regular checkups as long as you are young and healthy. The problems arise when you are getting "older" and have a serious illness or chronic disease. I can tell you of many many cases of people that did not make it waiting for procedures, folks that had MI's went to a local suburban hospital (this hospital lacked basic life support equipment/medications/staff) and patients not making it to *the* hospital not far away (a few kilometers) that had what was needed..btw this was someone in their 40's, stories of severly underfunded hospitals and very disgruntled physicians that do not care about anything because they are "just" punching a clock from 8-5. There are many stories like this and I get these stories on every phone call from my mother and every visit to Spain. I am not trying to dissuade anyone wanting from practicing in Spain or Europe but trying to make sure that you have some "facts" before you decide to go there. One thing, there are many unemployed doctors in Spain there are too many graduating every year for a country that size. The physicians there "know" how bad the system is and when they candidly tell you about it then it gives me another perspective. I have also seen how rude many of them are to patients of the "socialized" healthcare hospitals. They have yelled and demeaned patients (yes I was there and heard it) saying to the patients in the ER that "hey you are not paying for this so shut up and wait your turn" this is no lie. These docs (really young during residency for they start medical school straight out of high school) could give a rats arse about a lot...this was amazing to me. I know that here physicians are by no means perfect but they usually do not yell at patients in the ER although they may talk among themselves about patients...so again just one perspective but something to ponder. I would also urge anyone that goes to Europe and understands the language to just go sit at an ER and listen to the patients see what they are saying and observe the docs to get a feel for the system. BTW I am a she not a he..

 

[tlew12778]

but to say that just because I have experienced it as a patient or family member of one does not mean that I cannot have strong opinions of it..that *is* how you get strong opinions of something by going through it.

You're right but I also think it's one-sided.

BTW I am a she not a he..

Sorry [blush]

 

[efex101]

Agreed that it is one sided..

 

[brightblueeyes]

...I know of how ****ed up the system is because my father yes my father died due to some of the "policies" in effect in Spain....

I'm sorry to hear about your father. Some of us disagree with some of what you write but this is not intended to be disrespectful.

...Please, do not say that there is a "political" undertone because there is none. It is amazing to see that when someone that has "actually" lived there tries to explain to others the misconceptions that foks have (and to boot these folks have NEVER set foot there) someone starts to "assume" that there is political undertone.

I think you misunderstood. I've read a number of your posts and it sounds like you had a very painful experience. But even though you might be posting in good faith, some of what you write is fairly one-sided and polemical. I think this is what f_w meant by political.
BTW, many of us have lived in the regions we describe.

Sure it *is* great for preventive measures and regular checkups as long as you are young and healthy. The problems arise when you are getting "older" and have a serious illness or chronic disease.

I won't comment on Spain but if you're contrasting systems in France and Canada with the US then you have this backwards. A number of my (middle-class) relatives have left the US as they got older, primarily because of concern for healthcare costs. Unlike what you imply, the US is not a good country to be in for anyone with prolonged medical problems. Though it is good for someone who is young and healthy.

why does it take YEARS for a simple x-ray or other tests

I don't know what things are like in Spain, but this isn't the case in France or Canada.

again please go there and see for yourself. Go and see the great hospitals that are so poorly run and maintained and understaffed

I agree with you that European hospitals are usually run on much tigher budgets than American hospitals (some are clearly underfunded)...but the two most modern and best equipped hospitals I've ever seen just happened to be European. So you might not want to generalize quite so much.

So please before you try to assume that what I say is nonsense your happy arse and go see for yourself. There is NO perfect system but to assume that socialized healthcare *is* the answer is ludicrous. Here anyone is treated at the ER regardless of insurance status and yes our system is not perfect but neither are other systems. The grass always looks greener from the other side but when you actually go to the other side you realize that there are weeds there as well.

It's misleading to lump together all the varied non-American approaches to healthcare the way you seem to be doing. I agree there's no perfect system but did you ever stop to consider what some of these other countries would be like if they were prepared to spend as much of their taxpayers' dollars on healthcare as the US? (American taxpayers have already spent more than 1.5 times as much of their per capita GDP on healthcare even before they plonk down any money for private insurance.)

 

[f_w]

Actually, I did mean 'political'. Her use of descriptors for everything 'socialized medicine' (or what she believes to recognize as such) shows a deep hatred and contempt for any involvement of the goverment in the provision of medical care. And as it so happens, this matches well with the political agenda of certain groups in the US. Now from the subsequent posts, it seems as if these feelings are more rooted in an unfortunate event that happened to her family, but I did mean 'political' when I wrote it.

If anybody remembers. At the top of this thread I cautinoned antoniost that to the best of my knowledge things are not perfect in the spanish healthcare system and that some immersion into the system would be of benefit before he decides to leave for far away shores.


(btw. I grew up in a 'big house' with my dad driving a 'big car'. When anyone in my family needed medical care, it was readily available, with the wait for diagnostic testing e.g. radiology or lab services in the hours rather than months scale. And no, it was not in the US. But in your blind hatred you will probably lump my home into the countries with 'socialized medicine' (whatever that means). Maybe things in 'mayoland' are perfect. For the rest of us struggling with crappy HMO healthcare, a system offering healthcare as a 'right' sometimes doesn't sound all so bad. )

 

[efex101]

I am not really sure why you say deep hatred? why because I give you one point of view and my reasoning behind it? I do not think that I "lumped" all socialized healthcare countries together and if I did sorry...for that was not my intention. I am speaking about my first hand experience with the Spanish system and why it is really not all that great. It seems that you may have some issues with anyone trying to give their opinion..for you sure are quick to attack and label me with the "deep hatred" and my "political" agenda which does not exist. BTW was it not France where thousands of seniors died during the terrible heat wave a couple of years ago? if I remember correctly and I brought this up in some other thread some of it was blamed on the current healthcare delivery that exists in France...many docs were out of town and hence the high mortality rate...

 

[brightblueeyes]

...BTW was it not France where thousands of seniors died during the terrible heat wave a couple of years ago? if I remember correctly and I brought this up in some other thread some of it was blamed on the current healthcare delivery that exists in France...many docs were out of town and hence the high mortality rate...

Yes, it was France. France has a problem in that a huge chunk of its population goes on holiday in August. It's no mystery...it's just a longstanding tradition that has to change.

But to use this as a means of discrediting their entire healthcare system is just silly.

 

[f_w]

The generous use of expletives and lack of factual information regarding the spanish healthcare system in your posts somewhat reduces their informational value. All I could take away from it so far is that there is one VERY angry patient/family member who made it from spain to medschool at mayo.

But maybe you can help me out in my curiosity:

- how is residency training organized in Spain ?
- is there a nationwide/provincial salary scale for physicians in training ? Or are the salaries determined for each hospital in the collective bargaining process ?
- is it possible for a non-EU citizen to obtain the right to practice at the end of medical school/residency ?
- how 'real' is the problem of of physician unemployment ? (or is it a function of generous unemployment benefits which reduce the incentive to look for a new position for a while after your old contract ends ?)
- how high is the proportion of goverment provided healthcare relative to the private sector ?
- where do you see the specific shortcomings in the spanish medical sector ('everything is bad' is not a very satisfying answer) ?

 

[efex101]

I was not trying to discredit the entire health system in France just giving one example of how the system (any system) can fail...just like there are examples of the inadequacies (sp?) of our system here. To fw sure I do not have 1000's of examples/facts/figures but neither does anyone else that usually posts their ideas on these forums. Most of the posts come from either personal experience or data/info we dig up on the internet. I will try to get the info you need from one of my Spanish doc family members...hold tight.

 

[efex101]

How is residency training organized in Spain?

you take an exam MIR (like the USMLE) and depending on score will let you gain access to X or Y residencies from family practice to surgery. The higher the score the more likely you will the more "competitive" ones. The pay is pretty much set with an R1 (first year resident) making about 1200 euros (net monthly) with about "five guardias" overnight call. Family practice doc working for the government run hospital/outpatient center is about 2400 euros monthly with four guardias.

 

[f_w]

Now we are talking. 2400 Euros/month, that is after graduation from residency I guess. How long do people stick with these jobs, is there a way to move up to some private practice gig ?

 

[efex101]

Yeah the 2400 euros is after residency and then sure you can get your own private practice but the market is so saturated and remember to get private insurance in Spain is not cheap so there are not tons of Spaniards doing it..so again it is easier said than done (private practice that is). Although those docs that *can* go into private practice for sure go for it...for the mula is better. I think that one of the huge groans about the current system from the patient side is that they go see X doctor at the socialized hospital/outpatient clinic and the doctor is an arse...then they go see the same doc at their private practice and he/she is wonderful. This really ticks them off (patients)...I am talking to some of my cousins, and there is also a Spanish medical student/resident forum if you guys are interested. I posted a question there to get more input.

 

[f_w]

he patient side is that they go see X doctor at the socialized hospital/outpatient clinic and the doctor is an arse...then they go see the same doc at their private practice and he/she is wonderful.

Sounds like the stories I used to hear from the UK. At the NHS hospital, the consultant breezes in and out of the room in split-seconds. At the private hospital were the consultant makes 50% of his income in 10% of his hours worked, there is time for a long h&p.

 

[antoniost]

there is also a Spanish medical student/resident forum if you guys are interested. I posted a question there to get more input.

Can you post the address of this forum. Thanks.

 

[tlew12778]

How is residency training organized in Spain?

you take an exam MIR (like the USMLE) and depending on score will let you gain access to X or Y residencies from family practice to surgery. The higher the score the more likely you will the more "competitive" ones. The pay is pretty much set with an R1 (first year resident) making about 1200 euros (net monthly) with about "five guardias" overnight call. Family practice doc working for the government run hospital/outpatient center is about 2400 euros monthly with four guardias.

I know that the concept is absurd by US standards but you can live in Spain for 1200 euro a month. I know this bc I could live in Italy on 1200 euro a month and Spain has a lower cost of living than Italy. In Italy, residents get 800 euro a month!

I think that one of the huge groans about the current system from the patient side is that they go see X doctor at the socialized hospital/outpatient clinic and the doctor is an arse...then they go see the same doc at their private practice and he/she is wonderful. This really ticks them off (patients)...

I totally agree with this from the Italian perspective. This is why I bitch and moan about the fact that I pay 3 times more than my American friends pay for healthcare coverage (their companies subsidize it for them I guess, whereas here, it's just a tax that employees pay) while I rarely actually use the national healthcare system for specialist visits (dentist, OB/Gyn, etc... I pay 100% out of pocket for them). But it's still comforting to know that should I get into some major car accident, the hospital's first question to me will not be "Do you have insurance?".

...BTW was it not France where thousands of seniors died during the terrible heat wave a couple of years ago? if I remember correctly and I brought this up in some other thread some of it was blamed on the current healthcare delivery that exists in France...many docs were out of town and hence the high mortality rate...

I don't agree with this. It had nothing to do with the fact that drs were out of town and everything to do with the fact that it was over 100F here in Europe for about 3 months straight. It's not like the hospitals were abandoned. It's my impression that a lot of old people here do not like to 'bother' drs with what they think is a trivial problem and hence do not seek care. I cannot tell you the number of amputations my fiance has done bc diabetics let their limbs succumb to gangreen. Maybe it's just inexperience, but I don't think this is that common in the US. Point being, you can't blame an entire healthcare system if patients don't actively take advantage of it.

 

[Miklos]

I don't agree with this. It had nothing to do with the fact that drs were out of town and everything to do with the fact that it was over 100F here in Europe for about 3 months straight. It's not like the hospitals were abandoned. It's my impression that a lot of old people here do not like to 'bother' drs with what they think is a trivial problem and hence do not seek care. I cannot tell you the number of amputations my fiance has done bc diabetics let their limbs succumb to gangreen. Maybe it's just inexperience, but I don't think this is that common in the US. Point being, you can't blame an entire healthcare system if patients don't actively take advantage of it.

Well, then call it a breakdown of the socialist system.

Regardless, in "heartless" America, after a much smaller incident in 1995, the city of Chicago (among others) implemented plans to prevent that sort of a disaster.

There's no guarantee that it won't happen again in France. Note the response of the French people when Raffarin decided to scrap the Pentecost public holiday (May 16th) as a gesture of solidarity for the elderly. The money to be raised -- Euro 2 billion was intended to prevent a repeat of 2003.

Lo and behold, look at what took place in the land of Fraternité...

The workers went on strike.

Who's "heartless"?

 

[efex101]

I just asked my mom (she is here visiting) about the 1200 euros/month is nowhere near enough nowdays...to pay for apt/food/daycare/gas/car payment/clothes/having fun etc...things have gone up a lot in Spain since the euro was implemented. If you go to the forum and read a variety of threads you will get the feeling that this is not enough unless you have an apartment that is very cheap or paid for, same for car, etc..rent in Spain can be exepensive in Madrid or a major capital..if you live in some podunk area then yes the 1200 will get you somewhere..

 

[efex101]

Here is the forum link.

http://foros.recoletos.es/foros-diariomedico/forum.jspa?forumID=83

 

[efex101]

BTW the bit about the French incidence that I wrote regarding some of it due to lack of healthcare workers...was an excerpt from comments of a French official...go can google the story and read it yourself. Again, my intention is *not* to discredit but to shed light on how EVERY system is not perfect.

 

[tlew12778]

I didn't say the US was "heartless". Who said that?

I just asked my mom (she is here visiting) about the 1200 euros/month is nowhere near enough nowdays...to pay for apt/food/daycare/gas/car payment/clothes/having fun etc...things have gone up a lot in Spain since the euro was implemented. If you go to the forum and read a variety of threads you will get the feeling that this is not enough unless you have an apartment that is very cheap or paid for, same for car, etc..rent in Spain can be exepensive in Madrid or a major capital..if you live in some podunk area then yes the 1200 will get you somewhere..

OK well if I asked my FMIL the same thing about Milan she would say it's not enough either. But then again, people who are 50 are generally much better settled and have become accustomed to certain comforts in life. I didn't say it was easy living on 1200 euro a month. I just said it was possible. My secretary actually earns that each month and she gets by fine. And Milan is the most expensive city in Italy. She shares a 3-BR apt with 2 other girls and she pays like 375 euro a month rent I think. She vacations every year (has something like 36 days off), has retirement savings, saves on a regular basis just for rainy days, eats like it's going out of style, and is always going out to the theatre, cinema, bars, etc. My opinion is based on the presumption that the person is single and not supporting a family. Clearly one will not be paying daycare on 1200 euro a month. Besides, I don't know how it is in Spain, but people in Italy rarely use daycare. Daycare is called grandparents here. Anything else is considered offensive almost (not saying I agree with this). And yes, the introduction of the euro has overhauled most EU countries. It sucks. Prices doubled here. I don't know about Spain but I know that Italy is considered to have had one of the worst inflation rates (of the euro-nations) since January 2002. Another important point to remember is that Europe in general is not a credit society. People are not swamped in CC debt like in the US. Nor do they have student loans to pay back.

Point being, the OP knows that by moving to the EU you are giving up certain American comforts. But they're just that... comforts... not necessities of life. Both the US and Europe will offer their own advantages and disadvantages.

 

[efex101]

Agreed that the euro has seriously brought prices up for most European countries...yeah if you share apartment costs then 1200 euros is more than enough for all other expenses. Italy from my understanding is pretty expensive more than Spain...I also heard that France is pretty high.

 

[deleted21609]

But it's still comforting to know that should I get into some major car accident, the hospital's first question to me will not be "Do you have insurance?".

If you are trying to claim that they ask that in American ER's then it's a g...n lie. The funny thing is that you probably even know it's a lie and say it anyway to continue the misinformation that's so comforting to the brainwashed europeans. I just finished working in one of the biggest poorest ER's in America. NO ONE was ever turned away whether they had a headache or a GSW. Also, the hospital received 2% of the money that they billed for from the ER (barely enough to pay for the billing paperwork). They know they won't get paid and provide care anyway, so stop the lies.

 

[f_w]

If you are trying to claim that they ask that in American ER's then it's a g...n lie. The funny thing is that you probably even know it's a lie and say it anyway to continue the misinformation that's so comforting to the brainwashed europeans. I just finished working in one of the biggest poorest ER's in America.

If it was 'one of the biggest poorest ER's' it was probably some sort of inner city public hospital. They have indeed all but given up on the concept of getting paid for ED services.

If you go to a regular community hospital ED, you see the triage nurse first, and if you are not a level1 type case, you are sent to 'registration' (sounds so much better than 'insurance verification'). The friendly clerical employee there gives you stacks of paperwork to sign (HIPAA release, living will, declaration that they are an EEO employer and other federal and state mandated BS). And yes, at this point you are asked for your insurance card or a 'guarantor' for the ED/hospital bill.
While the classic 'wallet biopsy' (request for a deposit) has been outlawed with EMTALA, the question of how you are going to pay comes up before you see a physician. And while you are correct that (mainly for liability reasons) nobody is turned back at the ED door anymore, many hospitals still have subtle and not so subtle ways of diverting undesired patients to the next county hospital.

 

[brightblueeyes]

BTW the bit about the French incidence that I wrote regarding some of it due to lack of healthcare workers...was an excerpt from comments of a French official...go can google the story and read it yourself. Again, my intention is *not* to discredit but to shed light on how EVERY system is not perfect.

efex101 is right about the deaths caused by the heatwave in France. I think the same heatwave hit Italy and Spain but the death toll was highest in France because so many people were on holiday. Note, it wasn't just that doctors were on holiday. An even bigger problem was that sons and daughters who would normally see their elderly parents regularly were away travelling. Miklos might be right about the possibility of this reoccuring too. I recall reading that there had been some modest reforms, but nothing that could completely rule out this happening again.

You're right about every system being imperfect. Simply stating that one healthcare system is "better" than another is often misleading. The healthcare systems in Canada, France, the US, the UK, Germany, Sweden, and Australia each have certain advantages but they each have their own problems too.

Italy from my understanding is pretty expensive more than Spain...I also heard that France is pretty high.

Most of France is affordable but Paris is quite expensive. Residents' compensation seems to be okay though.

 

[tlew12778]

If you are trying to claim that they ask that in American ER's then it's a g...n lie. The funny thing is that you probably even know it's a lie and say it anyway to continue the misinformation that's so comforting to the brainwashed europeans. I just finished working in one of the biggest poorest ER's in America. NO ONE was ever turned away whether they had a headache or a GSW. Also, the hospital received 2% of the money that they billed for from the ER (barely enough to pay for the billing paperwork). They know they won't get paid and provide care anyway, so stop the lies.

Excuse me but that is just not true. My sister just brought her friend's kid to the ER bc he got in a pretty bad scooter accident (went flying down a hill, hit his head, no helmet, dislocated shoulder and scraped off half his face) and that was the first question they asked. She had to get the kids mother on the phone (who was away at some gala in DC) to prove to the nurse that they did indeed have insurance and ask if they could please treat her son. They live in the suburbs of Boston.

 

[Miklos]

Excuse me but that is just not true. My sister just brought her friend's kid to the ER bc he got in a pretty bad scooter accident (went flying down a hill, hit his head, no helmet, dislocated shoulder and scraped off half his face) and that was the first question they asked. She had to get the kids mother on the phone (who was away at some gala in DC) to prove to the nurse that they did indeed have insurance and ask if they could please treat her son. They live in the suburbs of Boston.

Well, something quite similar happend to an American friend of mine vacationing in Germany. He broke his ankle, and before they'd do his surgery, he had to charge his credit card a couple thousand Euros. After that, the staff's demeanor changed considerably.

BTW, you'll find this all over Europe. If you don't have health coverage as a foreigner, you'll receive minimum treatment until you can show that have the means to pay. The same applies in Canada.

Miklos

 

[Miklos]

You're right about every system being imperfect. Simply stating that one healthcare system is "better" than another is often misleading. The healthcare systems in Canada, France, the US, the UK, Germany, Sweden, and Australia each have certain advantages but they each have their own problems too.

Agreed.

 

[efex101]

It would be so nice to do an amalgamation (sp?) of all the best traits of each of those systems...

 

[Miklos]

Excuse me but that is just not true. My sister just brought her friend's kid to the ER bc he got in a pretty bad scooter accident (went flying down a hill, hit his head, no helmet, dislocated shoulder and scraped off half his face) and that was the first question they asked. She had to get the kids mother on the phone (who was away at some gala in DC) to prove to the nurse that they did indeed have insurance and ask if they could please treat her son. They live in the suburbs of Boston.

Someone correct me if I'm wrong, but there might be another legal issue here. Since your sister is presumably not the legal guardian of the child, consent to treatment must be obtained from someone who is. In addition, that person is going to be footing the bill...

 

[brightblueeyes]

Well, something quite similar happend to an American friend of mine vacationing in Germany. He broke his ankle, and before they'd do his surgery, he had to charge his credit card a couple thousand Euros. After that, the staff's demeanor changed considerably.

BTW, you'll find this all over Europe. If you don't have health coverage as a foreigner, you'll receive minimum treatment until you can show that have the means to pay. The same applies in Canada.

Miklos

You're probably right but I wish I knew more about this. I'm especially curious about France. (I'm pretty sure this doesn't apply to refugees but it probably applies to visitors like your friend.)

BTW, I wonder what percentage of North Americans abroad aren't covered by some sort of travel insurance. (This isn't a sarcastic question--I really have no idea. I also don't know what's usually covered by such insurance.)

It might also be worth pointing out that these two stories aren't exactly the same. In the first example, the boy was a local citizen and in the second, your friend was a foreign visitor. In countries like France, there's not much point in checking a French patient for insurance coverage since they all seem to be covered.

Heck, they don't even seem to check on me because everyone assumes I have coverage too.

 

[john182]

Well, something quite similar happend to an American friend of mine vacationing in Germany. He broke his ankle, and before they'd do his surgery, he had to charge his credit card a couple thousand Euros. After that, the staff's demeanor changed considerably.

BTW, you'll find this all over Europe. If you don't have health coverage as a foreigner, you'll receive minimum treatment until you can show that have the means to pay. The same applies in Canada.

Miklos

Perhaps it has something to do with the fact that your US citizen friend is not a citizen of the EEA?

http://www.oasis.gov.ie/moving_country/moving_abroad/e111.html

The EEA countries have an agreement to provide transnational health coverage to travellers who need care outside of their own country. Your friend pays no taxes to any of the "evil" public health care systems in any EEA country. Furthermore, his country of origin does not have an agreement with any EEA country to provide health coverage.

This may have something to do with the fact that there is no way an EEA citizen will get care provided for free in the US if they need it there. Perhaps when the US joins in the rest of the world, things might change.

So, of course your friend didn't get health care for "free". It's not free you know, it's paid by taxes and we are now approaching tax harmonisation, etc., . If he was a resident he would have got it. WHy should we provide "free" cover for non EEA citizens and there be no reciprocation?

 

[antoniost]

When I was in Valencia, Spain a couple years back, my friend (US citizen visiting) dislocated his shoulder. And I was impressed by how quickly he was seen and treated (within 30 minutes) and when he asked how much he owed them, they said no charge. From what I'm reading on this thread, is this efficiency of service and free treatment to non-EU residents a rarity?

 

[f_w]

There is a treaty on the provision of medical care to non-citizens. If your country is party to that treaty , you can get a standardized form E111 from your health insurance provider (or provincial goverment, depending how your healthcare system is organized) which allows you to obtain free medical care in another participant country (limited to conditions arising during the trip).

The treaty includes most of the EU countries and a couple more. In addition, there are bilateral treaties between countries who do a lot of trade/tourism with each other giving their citizens access to healthcare abroad.

But it's kind of like the metric system and soccer, the US is not part of it.

 

[Miklos]

It might also be worth pointing out that these two stories aren't exactly the same. In the first example, the boy was a local citizen and in the second, your friend was a foreign visitor. In countries like France, there's not much point in checking a French patient for insurance coverage since they all seem to be covered.

So, of course your friend didn't get health care for "free". It's not free you know, it's paid by taxes and we are now approaching tax harmonisation, etc., . If he was a resident he would have got it. WHy should we provide "free" cover for non EEA citizens and there be no reciprocation?

Precisely my point. Medical care must be financed by someone.

Why should it be unreasonable to ask for payment in either instance?

 

[deleted21609]

But it's kind of like the metric system and soccer, the US is not part of it.

American travellers aren't typically required to have insurance because the federal government guarantees payment for emergency care abroad. The US isn't part of these agreements because foreign nations don't necessarily guarantee payment for their citizens' treatment in the US. That's my understanding based on my widespread travel & interactions with embassies etc. anyway.

 

[antoniost]

there is also a Spanish medical student/resident forum if you guys are interested. I posted a question there to get more input.

I read your post and the reponses on that forum. Thank you for doing that for me, and for considering me an amigo.

So if I got this correct from Turol Jones' reponse, a resident makes about 35,000€/year and works only 38 hrs/week. If that's true, then that's 2900€/month which is much different from the 1200€/month you stated before. Clearly 35,000€/year and 38 hrs/week in Spain is better than $37,000/year and 80 hrs/week in the US.

 

[f_w]

American travellers aren't typically required to have insurance because the federal government guarantees payment for emergency care abroad.


Lol. Under what program do you propose that this happens ? What a shame that DOS doesn't seem to know about this.

This is just the first paragraph on medical care abroad from the DOS website:

http://travel.state.gov/travel/tips/health/health_1185.html

Medical Information for Americans Traveling Abroad

If an American citizen becomes seriously ill or injured abroad, a U. S. consular officer can assist in locating appropriate medical services and informing family or friends. If necessary, a consular officer can also assist in the transfer of funds from the United States. However, payment of hospital and other expenses is the responsibility of the traveler.
.............

http://travel.state.gov/travel/living/residing/residing_1235.html

Once you obtain health insurance, remember to carry your policys identity card and to keep a supply of insurance claim forms handy. The U.S. government cannot pay for hospital or medical services for Americans overseas and cannot pay to evacuate you for treatment in the United States.
...............

 

[tlew12778]

Well, something quite similar happend to an American friend of mine vacationing in Germany. He broke his ankle, and before they'd do his surgery, he had to charge his credit card a couple thousand Euros. After that, the staff's demeanor changed considerably.

BTW, you'll find this all over Europe. If you don't have health coverage as a foreigner, you'll receive minimum treatment until you can show that have the means to pay. The same applies in Canada.

Miklos

But that's surgery which I assume was needed beyond initial treatment. I also thinks it makes a difference if he was in the ER of a public hospital vs a private hospital. Private hospitals, anywhere in the world I think, are not required to treat you unless you can pay them.

Someone correct me if I'm wrong, but there might be another legal issue here. Since your sister is presumably not the legal guardian of the child, consent to treatment must be obtained from someone who is. In addition, that person is going to be footing the bill...

You're right. But the reason my sister was there was bc the kid's grandparents did not speak English and the kid didn't speak Creole so couldn't even help with translating. The hospital asked for authorization from the parents but only once they could prove they were insured.

I wonder what percentage of North Americans abroad aren't covered by some sort of travel insurance.

I would guess a lot actually. I have never bought travel insurance. I think my credit card might have some on it but it's probably only for repatriation of remains. Also, I think basic travel insurance covers your *trip* not your health while on your trip. You would need intl coverage by your own American insurance company for that.

Why should it be unreasonable to ask for payment in either instance?

It's not wrong to ask for payment in these instances. It's a matter of establishing whether either patient has *already* paid (ie. into the insurance system whether that be private in the US or socialised in Europe).

 

[whoam]

My sister just brought her friend's kid to the ER bc he got in a pretty bad scooter accident (went flying down a hill, hit his head, no helmet, dislocated shoulder and scraped off half his face) and that was the first question they asked. She had to get the kids mother on the phone (who was away at some gala in DC) to prove to the nurse that they did indeed have insurance and ask if they could please treat her son. They live in the suburbs of Boston.

I'm not American but I thought all children under a certain age in the states had free medical care?

 

[efex101]

No, I am pretty sure that the pay for residents is 1200 euros..I also received one e-mail from another Spanish resident...do you read Spanish? I can post it here...or PM it to you..she answered all the questions that fw? asked...

 

[efex101]

I went back and saw the post..you need to work on reading your Spanish he he...he said that Spaniards make nowhere what make 35,000...so their pay is way lower *but* their hours are very manageable. There is a LOT of dissent among most of the physicians/residents posting there this tells you how the working conditions/pay are in this system..Most highly suggest to NOT even think of setting foot in Spain to work just fyi.

 

[tlew12778]

I'm not American but I thought all children under a certain age in the states had free medical care?

Hahaha. Ideally yes, but realistically, no.
Coverage varies by state. NY state offers:
Well-child care
Physical exams
Immunizations
Diagnosis and treatment of illness and injury
X-ray and lab tests
Outpatient surgery
Emergency care
Prescription and non-prescription drugs if ordered
Inpatient hospital medical or surgical care
Short-term therapeutic outpatient services (chemotherapy, hemodialysis)
Limited inpatient and outpatient treatment for alcoholism and substance abuse, and mental health
Dental care
Vision care
Speech and hearing
Durable medical equipment
Emergency ambulance transportation to a hospital
Hospice

This is what the Medicaid website said:

Although Medicaid has made great strides in enrolling low-income children, significant numbers of children remain uninsured. From 1988 to 1998, the proportion of children insured through Medicaid increased from 15.6% to 19.8%. At the same time, however, the percentage of children without health insurance increased from 13.1% to 15.4%. The increase in uninsured children is mostly the result of fewer children being covered by employer-sponsored health insurance.

The key to all this is that you actually have to be *enrolled* in the program. And you have to earn little enough to be enrolled. If you're not, too bad basically.

 

[f_w]

The key to all this is that you actually have to be *enrolled* in the program. And you have to earn little enough to be enrolled. If you're not, too bad basically.

Actually, to qualify for medicaid (or child health plus and its incarnations) in NYS you just have to be a kid. The reason that there are still uninsured kids in NYS is that their parent(s) are not organized enough to gather their phonebill and W2 and to move their b(#* to the medicaid office. You can't fault the department of health for this, they even offer on-the spot enrollment in the city hospital clinics. Unfortunately, for half of the uncovered kids they sign up, the parent (more often grandparent), never bothers to come back with the necessary paperwork and coverage lapses after a month.

If the parents make 0 money, the program is free for the kids. If the parents make somewhere around FPL, the have to pay a monthly fee, somewhere in the $25 range. The people who are really screwed are the parents who have a job with a small corporation that only offers coverage for the employee, not the dependents. They might have to pay substantially more to get their kids into CHP.

Unfortunately, the only place in the US you have an unequivocal right to healthcare is in prison (There is one guy who knocks over old ladies for their purse and turns himself in, just so he can get another 2-3 year conviction with state paid healthcare. He is a heroine dependent hemophiliac who burns through about $1.1mio worth of factor 7A every year.)