We have many folks that are members of our group that are living in other countries that, in many instances, are very different with their medical charges/costs/ and of course service and availability of same. They have given us some background on their own country and will be placing their names on another list for folks to contact them by email if they wish. Naturally, we are also interested in having them become more involved with their own EFFORTS in their country.

You are more then welcomed to add my details to your list. It is Gerard De Vignat., Nivelles, Belgium.

Here we have a Social service system, into which every working person pays into through his taxation. That covers us for the major part of any payments to Doctors, Hospitals, Clinics etc. When I say the major part, I am talking about 90%. In the event of you being out of work, the state pays roughly 70% of your wages in the first year, and then 80% thereafter. Most firms have a group insurance scheme which normally covers the balance, so in theory, you are paid the flat salary. Those schemes also cover you for the Hospital bills. In other words, the National scheme pays 70% and the insurance pays the balance. There are loads of other advantages, especially for young people just getting married, and for young parents having their first baby.

We are allowed to choose our own doctors and if you are not happy you can go and get a second opinion no problem. Normally your doctor recommends a specialist, if needed, but again there is nothing stopping you looking round. But, they are very tight when it comes to prescriptions. Chemist will only give you medication that has been prescribed. You can get alternative medicine.

Hospitals are great. They do everything necessary to make you comfortable, and from my own experience, any tests needed have been done. For me, I have not had to wait longer than three days to get a bed, not more than 48 hours for an appointment. But I cannot say that that is normal. Anyone I have spoken to though, have only said good things.

If you are out of work more than twelve months, you are entitled to extra benefits, but your income must be lower than a set amount. It is not an amount that is absurd. With that, you get extra reductions on your medical bills.

Gerard. BE. gerard.de.vignat@skynet.be

Hi Gary, and anyone else reading this :) (Australia)

We also have a Social Service system (as against America who have I believe a Social Security System). Working people pay a percentage of their gross wage (about 1% I think) into what we also call Medicare.

Working people have to pay a set amount for medical treatment of any kind, although our hospitals are free. We do have private hospitals, but these are usually only in the major cities. People on low incomes, those who are on a medical certificate to be off work for medical reasons for a set time, pensioners, and those on disability don't pay as much for treatment and receive a health care card that entitles them to medication at a greatly reduced cost. We pay $3.80 au per prescription and some Doctor's bulk bill the government so pay nothing for a Doctors visit (not ALL Doctors do this).

Working people usually take out Private health Insurance, this can be extremely expensive.

We choose our own GP's but are referred to specialists.

Some people plan their future by paying into Superannuation funds all their working lives therefore becoming self funded when they retire (you asked about retirement Gary). In doing that they have to ensure they have ENOUGH!!!! Others don't and therefore have to rely on Medicare only.

The quality of medical care in this country is second to none, we are very lucky indeed.

I hope this is what you wanted Gary?

Blessings

Marianne from Australia

Additional information re COPD care in the UK

In the last two years COPD patients living in a fairly large radius of my locality have been given the back up of a Respiratory Nurse. The general idea of this is that should a patient feel something is not quite right, instead of staying home doing nothing and getting sicker or trundling along to the Doctor's waiting room and picking up more infections, he or she can telephone the Respiratory Nurse.

If she feels it is necessary she will come and visit and assess what she thinks to be the necessary treatment. This could vary from just monitoring how you feel over the next couple of days, to starting a course of antibiotics or Prednisone, or going straight to ER. It is so reassuring and takes that fretting feeling out of the equation. It is so easy for us to put off making decisions as soon as we get sick. This nurse has told me that within a year, the service she provides has saved the National Health Service thousands of pounds, entirely due to the fact that her intervention has saved many patients the necessity of being admitted to hospital.

Eventually, I understand that this service is hopefully going to be provided across the country. At the moment it is only sporadic coverage in certain areas..

Ann in England

Gary, The system in the British Isles is a two tier system The National Health Service known as the NHS, and Privately Funded Medical Care.

Everyone that is working pays into the NHS. This covers all medical Treatment in theory.
In general, each person is registered with a medical Practice, (called surgeries) these practices vary from a single doctor (called a General Practitioner), receptionist and possibly a nurse (called a practice nurse) to a multi doctor practice which may carry out minor operations on site.
Some surgeries have other health care professionals on site such as Nurses, physiotherapists and alternative or complementary medicine. The surgery will deal with first referral and most minor ailments where treatment can be carried at home.

We have a system of visiting nurses (district Nurses) who visit and change dressings and the like as well as dealing with some terminal care at home. This is arranged through the General practitioner or hospital.

Our hospitals range from small hospital to large hospitals with 100s of beds and emergency departments.

The GP will see the patient first and if necessary refer him to the local hospital for fuller examination. While at the hospital the patient will be examined and a diagnosis made. Treatment will be carried out either in hospital or at home under the supervision of the family doctor (GP). The patient will also be kept under review by a specialist, in my case6 monthly.

Drugs are paid for by a fixed payment for each item of £6.40. However lots of people are exempt from these charges.

We have recently had a set of Guidelines published which show the minimum standard of treatment a COPD sufferer can expect. These are called the NICE Guidelines and all COPD patients should be given a copy.

In some areas the patient will be referred for a Pulmonary Rehabilitation Course which lasts6-8 weeks and comprises Talks on medication, nutrition etc and Supervised exercise.

We have voluntary agencies as well such as the British Lung Foundation who run BreatheEasy Clubs send out a magazine and fund research ( there is a Breathe Easy club inmost areas).

I think this about covers it. If anybody wants more info I will be happy to try and supply it
Regards Howard UK

Further information from a city-dweller in Australia

Marianne, I think, must live in the country. Australia has a dearth of doctors and most prefer to set up practice in the cities. I will describe the situation in a capital city in Australia.

We pay 3% of our income to something called Medicare. This system ensures that all people are entitled to:

· a bed in a public ward in a public hospital including all costs associated with the treatment, i.e. xrays, blood tests, echo-cardiograms, etc. However you get the doctor the hospital assigns to you and cannot choose to have your own doctor. (By the way, all public hospitals are teaching hospitals here in Australia and the very top doctors are always found at the big public hospitals as well as in their own private practices.)

· $30.00 towards the cost of each of your General Practitioner visits. GPs can charge what they like here in Oz. However, most "bulk-bill" pensioners and children so that the $30.00 covers all your GP costs. As part of the "new Medicare System" which our present Government is organising, many practices also include nurses, physios, to assist with the lack of doctors in some city and country areas)

· Your GP refers you to a specialist he prefers. However, you can go to any specialist you would like to go to (your GP MUST provide a referral!). Specialists' visits are also covered by Medicare, but the gap payment for each visit is sometimes up to $80.00 for ordinary folk. Some specialists will "bulk-bill" pensioners, etc., but there seems to be fewer and fewer of these specialists these days!

· Your GP can also refer you to Community Health centres to obtain help such as Home-help, District Nurse, Meals-on-Wheels, Handicapped Parking, Rehab, Exercise classes, dental work, etc. Our local councils also assist in keeping the citizens healthy!

· When medical costs reach over $500 for families, the government will refund the difference (through tax I think?)

As well as Medicare our Pharmaceutical Benefits Scheme brings us all medications at very low costs:

· for most people who are working the cost is $27.60 per scrip.

· for low income workers, social security pensioners and self-funded senior citizens the cost is $3.80 per scrip

· when you have paid for 50 scrips in one year:

o working people pay $3.80

o pensioners etc. pay nothing.

As well as our public hospital system, we have private insurance and private hospitals. Top cover costs about $4000 per year for a family or $2000 a year for a single, of which the Australian Government pays 30%.

This entitles you to go to a private hospital with the doctor of your choice. Private hospitals are much more luxurious than the public hospitals with private rooms, great menus, telephones, television, newspapers, etc., as standard (rather like a reasonably good hotel!). Medical treatment is fine but if you need something out of the ordinary in terms of treatment, eg really special medical equipment or the like, you will find yourself transferred to a big public hospital.

The disadvantage of going to a private hospital is that there is a huge GAP between the cost of treatment and what the private health insurer will pay for. All private health insurers have special lists of "preferred hospitals" where all hospital and medical treatments are covered by your private insurance and cost you nothing. However, all x-rays, blood tests, etc., etc., as well as medication have to be paid by the patient. The GAP can cost over $1000.00 on occasions. This huge gap of course means that most people with private health insurance who find themselves admitted to hospital through an emergency (as so often happens with COPD!) will not admit to having Private Insurance since all the tests can prove to be very expensive.

It seems to me that in Australia, apart from the very wealthy, Private Health Insurance is taken out in case of an accident. Public hospital waiting lists are very long (up to 2 years for some procedures) and although they always find room for an emergency, people with chronic pain find themselves at the back of the list. Private Health insurance ensures that you can have the hip replaced or the varicose veins done or whatever within a fortnight.

Private insurance can also cover you for optical treatments, physiotherapy, dental work, but these areas are not as well covered: for instance a physotherapy treatment may cost $50.00 per visit, but you will only get $20.00 back. Dental work: a filling may cost $200.00 but you will only get $35.00 back! This area is not well covered in Australia at all!

I agree with Marianne, we are very lucky here in Australia. Medicare is a Universal Health System which means that everyone, rich or poor, is entitled to the same medical and hospital treatment. It is not a two-tiered system, and many of us in Australia are praying that it stays that way if at all possible! Cheers, Peg AU

Philippine Islands

Over here, even our health insurance companies are a far cry from the worst one in the world. Those afflicted here with any disease would most probably die from the lack of medical insurance and facilities. Meaning that if you can't afford it, you probably won't get it. And you would have to rely on donations from civic organizations. Those that can't afford it usually end up being cared for at home and die. While those that can afford will get the best possible care although it would run into the millions of pesos, so it would only be the upper class that could afford. It is a pity here that health care is not a priority. Too much red tape and graft and corruption in all government agencies. While private insurance institutions pay for limited coverage only, more for hospital room, a certain percentage for surgery and a certain percentage for fees, hardly none for medicines. We are really quite unfortunate as compared to the developed countries.
Use of oxygen is not covered, at all here. It is really a pity.
http://www.philhealth.gov.ph/irr1_ra7875.htm
Victor Lopez

Additional information for Australia

In Australia we have a choice of private insurance or Medicare. Private insurance is expensive and so not everyone can afford it. However, for those who can afford it, it will get you into hospital much sooner than if you need to go public (for any number of operations or procedures). Medicare covers the rest of the population. A certain amount is deducted from your weekly wage, I am not sure of the percentage. For those who only have Medicare, you still have your choice of GP's (general practioners). Assuming one is having a problem with their breathing they would ordinarily go to their GP and he may do some tests. If he/she finds a problem, such as copd, he/she will give you a referral (a letter) to take to a specialist. We call them 'Respiratory Specialists' as opposed to Pulmonologists, but it is the same thing. Now the specialists are more expensive than the GP's so if you go to a private specialist you would have to pay the 'gap' which amounts to about $100. Oh I forgot to mention, you can get 'gap' insurance. Assuming one is on a very low income or a pension of some sort and cannot afford the 'gap', there are clinics for Respiratory problems (as well as any other health problems) in the public hospitals. They are just as effective as a private Specialist but the problem is there is a 'waiting list'. You may have to wait up to 3 months to see a Specialist in the hospital. Those who choose to pay the 'gap' or have private insurance would get into a specialist within a week.

Our Pharmaceutical Benefits Scheme provides cheaper rates for some medications but not all. For example Spiriva is on the PBS and I pay $3.80 for a months supply. But those who earn more money would pay approximately $77.00 for one months supply. Regardless of your income, some medications are not available on the PBS and one must pay full price if one needs that particular medication. While I am on the subject of our PBS I might add that although it is very good, it is not perfect, and the government is constantly changing which medications will go on it, taking some off the PBS and adding others on.

As for the oxygen, I am not on oxygen as yet. But I believe the price works along the same lines as above. I know a man who pays around $60 a month for his wife's oxygen because he is a Realtor (Real Estate Agent) who earns too much to qualify for the PBS.

The need for oxygen is determined much the same as it is in the USA. You have to desaturate to a certain level before you can become eligible for oxygen. Then the treatment of copd here in Australia is also much the same as it is in the USA and probably all over the world.

Carol in Australia ccurtin@ecn.net.au

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