An American doctor experiences an NHS emergency room

Just wondered if the US government are worried about unemployment from nationalised care? Years ago read an article (I’m an accountant, sorry) that said as much money was spent on the administration of the US health system as the entire NHS….
Agree with others, hospitals should bill overseas visitors, but cost of chasing unpaid invoices and belief of medical staff in free service means they rarely are. Donations are welcome.

Myself and my son have had plenty trips to the ER nothin city and rural and I have never waited more than about 40mins to be seen. And to be fair, that was more minor injuries so nothing emergent.

I am very proud to now work for NHS Scotland. All our goal ever is or has been; patient care.

People like to denigrate my fellow colleagues but let me tell you, if you had to put up with half the nonsense they did; you wouldn’t last two minutes in the job.

Is it perfect? No. Healthcare can never be perfected. It changes too quickly, too often.

My colleagues don’t live to make you wait for hours in and A&E but people need to realise; you have been triaged for a reason. That reason is to determine whether, if something emergent comes in, you can wait without it impacting on your health. One of the biggest problems in A&Es is people attending with no emergent conditions, when they should attend a minor ailments centre or the GP.

We have an outstanding service, whatever may be said, and we have patients not clients. People are not frightened to come to hospital or GP for fear of the bill. People can safely be treated and medicated without wondering how long it will take them to pay it off. People should no be slave to healthcare. Healthcare is a universal right. With a little taken off my wages every month I know that if I break my leg, am in a car accident, fall down the stairs; I can get and ambulance, be triaged, seen by a doctor, go through a battery of tests, be given medication, stay overnight in hospital and be discharged without ever seeing a bill. I can go home in the knowledge that I have nothing to worry about.

I wish more countries would adopt this system. People shouldn’t be avoiding their health over money. People should die because they cannnot afford medication. It simply should never happen.

I am English and well used to the mostly-wonderful NHS (it has its problems as does any country’s healthcare) and also lived in the US for 17 years so have experienced the US system which is excellent (again, not without some problems) but you do have to pay.
Anyway, my son was visiting from the US and within 24 hours of arriving had chest pains. We took him to the Accident and Emergency (A&E ot ER) in Worcester. The nurse said there was no way he was having heart problems because he was a fit 17 year old. They did a test and I have never seen such quick action once they diagnosed a potential heart attack (very quickly assessed).
He was quickly wheeled into a trauma room and assessed as well as being given initial medication. The doctors decided they did not have the right facilities so he was to be transferred to Queen Elizabeth in Birmingham.
I went with him in a white knuckle ride in an ambulance (I was in the front and am sure they never got my fingernail grip marks from the dashboard) to transfer him.
He then spent three days in a Coronary Care Unit and was given the all clear – turns out it was an infection giving false heart attack symptoms.
When my ex-wife (a nurse in the US) asked what the bill was, expecting a new mortgage to be required, was amazed when the doctor scoffed and said “his Dad is English so he is too, no bill”.
Wonderful care from the doctors and nurses throughout the process and Andrew was treated wonderfully.
Here is hoping we never get rid of it.
Oh, and as for the US, I had great care when I had my knee repaired from a rugby injury at the Hospital for Special Surgery in Mew York but thankfully had 100% coverage or would probably still be paying for it.
The NHS is not free (as some people misguidedly think) but it is, in my opinion, worth every penny of tax we pay!

Touch wood, I’ve never had to visit a hospital in the UK. But I did end up in an ER in Washington State, just outside of Seattle, about 11 years ago. Nothing at all to complain about regarding the facility or quality of care (I was in and out in about 40 mins), but that near-midnight panic attack cost me nearly US$800.

Compare that to an ER visit I had in Taipei eight or so years ago for a broken rib. With no insurance, I paid a measly $1,200-some Taiwan dollars (about US$40), including X-rays and four days’ pain meds. After returning a few days later with my National Health Insurance card, I was refunded all of that save for NT$300 odd.

I can’t speak for NHS, but after more than a decade in a country where affordable, high-quality health care is given to everyone, I have little desire to put my family through moving back to and living in the very broken United States.

Americans are constantly told that the NHS doesn’t work, the doctors aren’t paid enough, the service is bad, the treatments ineffective. It’s all propaganda and an outright lie.

I’m part of a support group for people with a debilitating illness. The American users are all in serious financial problems due to the American system and yet they still insist they wouldn’t want an equivalent of the NHS . They told me it wouldn’t be fair to doctors to be paid so little – I told them they’re not, GPs tend to earn around £100k. They said that’s not enough when they have hundreds of thousands in student loads – I had to explain that, in the UK, they don’t.

The thing is, as someone with a chronic illness, I’ve had serious issues with the NHS – it’s not the waiting, it’s the attitude of doctors I’ve had issues with. It took me 10 years to get diagnosed with a condition that affects 1 in 10 women and has pretty obvious symptoms. Then I found out that the average diagnosis time in the US is just as long. Turns out your care isn’t better just because you’re paying for it.

My husband and I are 26 years old with a 3 year old daughter. AFTER taxes, we barely bring home 40k. “Obamacare” forces us to have insurance, says we fall under the poverty line, but make too much money for any government help. If we get private insurance (neither of our jobs offer insurance), it will cost over $800 per month to be on a plan that doesn’t have a rediculous deductible. We are better off paying the fine and crossing our fingers everyone stays healthy! I don’t care what anyone says, there is no such thing as free health care.

Had a slightly different experience. Got an infected toe with diabetes didn’t want to mess around . antibiotics are not OTC med in the UK. So had to see M D. However I was absolutely vehement I was going to pay. The hard part was finding out where to go. Fortunately the neighbor to the house we were sitting was a RN and got me a phone number for a private clinic. 50 GBP including the RX later I was out the door. I had a similar accident 6 months later. My out of pocket costs WITH health insurance were close to the same $ with co pays, lab costs( seriously?!?!) And deductibles. The UK is trying desperately to recoup foreign tourist medical costs but the NHS is fighting it. They don’t want the hassles.

Hi, nice article. Yes waits can sometimes. Es get long, but kids and frail are usually prioritised, and triage also gives impression of activity while waiting, most industries do it.

But a wee bit of a wait is no big deal considering from splinter removal to heart transplant it only costs me 200 sterling a month, some pay more some less based on income.

I have had 3 ops, 2 sinus and one knee probably about 18000 sterling, no Co pay or extras and it was carried out in a private hospital under contract to the NEW.

Waitingood sometimes is annoying, but which of your readers would love a wee wait for reduced payments, no exclusions for pre existing.

Also on the question of billing. ER treatment is usually not billed. Immediate and necessary is offered to everyone, and as a tax payer I have no issue with helping those in distress.

However after stable and crises is over, any further standard treatment, repeat visits may be billed If the cost of chasing it isn’t more than the bill.

I think this post is lovely, and Jen’s comments and opinions of the NHS made me smile. I received medical attention for a mosquito bite that had got infected in France. The treatment was painful, I was very young and it took a number of nurses and my parents to hold me down. After several days it continued to get worse so the hospital told me to go home immediately and seek medical attention at home. We did. Straight away the Royal United Hospital in Bath (my local hospital) diagnosed the infection as Impetigo and treated it accordingly. The treatment I had received in France had aggravated the infection even more, and by this time it had spread right across my body and around my back. The infection quickly healed and I was left with no scarring at all! This was the worst case the RUH had ever seen. But I will be forever greatful for the NHS as I’ve been to A&European more times than I can count. The bad reputation is more on a personal level. I have myself been let down and angered by some things that have happened (or not happened) to me but that is down to the doctors and nurses and paramedics involved rather than the NHS itself.

You won’t be getting a bill. Even if the trust (organisation in-charge) of St. Thomas has the facility to create and send you a bill, I doubt any of the staff are aware of it.

The NHS can issue charges for certain things, such as getting a lift home in one when you’re too drunk a few too many times. Or for medical procedures which aren’t free. And essentially, it is meant to be free for the British taxpayer. However, for a number of reasons, one being responsibility to the hypicratic oath, the NHS cannot refuse anyone but diesn’t bother with the complications of who will pay.

I lived in the UK for 10 years and am hardly a fan out of the NHS. The author declares that the only break downs in care come from clerical or human errors, not systemic failures. In my experience it was the system itself to blame for the poor care we received. At the top of the list was the fact that children in the UK are only treated by pediatricians if they are admitted to the hospital. This can be incredibly dangerous if your children have special needs, which both my children do. Within six months of returning to the US from England, my daughter was diagnosed with cancer. The diagnosis came after her pediatrician ordered a serious of tests because she wasn’t meeting certain developmental milestones. No one was tracking her development in the UK. Similarly, within a year of our return my son was diagnosed with autism. He has received a rigorous course of physical, speech and occupational therapies — all covered by our insurance — and as a result of the doctors catching it when they did, he is expected to be very high functioning. For obvious reasons, I prefer the US system. Much lower down on the list of complaints were cost — we spent more on taxes for the NHS in one year than we spent for a year being self-insured in the US — waiting lists for care and incredibly long wait times for set appointments. I know not everyone has such a good experience with their health care in the US. I wish people would understand that the NHS is far from perfect.

I think you were lucky because it’s not at all unusual to wait many hours in A&E in the UK. Perhaps your child’s eye injury was assessed as critical, and you jumped the queue. However, from my experience, enjoying excellent and entirely free treatment is entirely normal at NHS hospitals.

FWIW, London actually has several minor injury clinics, including one at Guy’s Hospital, just a short taxi ride from Parliament Square. These clinics resemble A&E depts but tend to have much smaller waiting times (an hour in and out is not unusual) because they don’t deal with major traumas.

The UK NHS is a far better,more equitable and indeed cost efficient way of delivering Healthcare to it’s citizens.c

How nice to see a positive write up of the NHS. Having worked for it for 25y I have to admit it has its failings, usually related to chronic (i.e. long term for the non-medical) care. We do have waiting lists for routine operations which has been used by the anti-Obama-care endlessly and in an inappropriate way. However, acute (i.e. of rapid onset and rapid need) care we do pretty well. Thank you.

As one of the UK’s rural family doctors who has recently been squeezed out of the system by the big boys (NHS corporate trusts and corporate pharmacy) I worry that this is simply promoting the perception of the NHS it’s bosses and health ministers wish for us Brits to believe in.

Come on! This was a simple corneal abrasion/foreign body requiring little more that a drop of local anaesthetic, (with, perhaps fluoroscein stain to exclude an alternative cause) judicious use of a cotton bud with an otoscope acting as an illuminated magnifying glass to aid in detecting and removing that piece of grit – failing which a full examination of the eye with a cobalt sllit lamp ophthalmoscope and/ or referral to the eye clinic located 50 miles away in the centre of town might be appropriate.

This is TRIAGE

Not quite as simple as a splinter of wood in the skin but it was hardly a life-threatening or sight threatening emergency.

There is no such thing as a free lunch and someone must pay. In this case it is the Clinical Commissioning Group who, one way or another, will pay for this case of over-investigation all at specialist rates and yet another example of the increasing trend for the British taxpayer to pay specialist fees at a centralised institution for something that could so easily have been done locally, rapidly, safely and cheaply in good old fashioned British General Practice.

Oh I forgot, we have not had a GP service in the UK for about 10 years.

At least the American system is openly capitalist and is not bankrupt in trying to provide all things to all men.

It cannot and it will not last!

We (two American ex-pats living in Germany) were spending a few days with friends in London when our daughter took a spill down their half-flight of concrete stairs. She didn’t pass out, didn’t vomit, didn’t show any classic signs of anything serious, but the bump that swelled up on her head was huge and ugly so we followed the flow-chart on the NHS site and ended up with “you’d better call the emergency number”. About 15 min. later an ambulance showed up, examined her, took us off to the hospital (all the while carefully — but clearly seeking to rule out child abuse/neglect — questioning us as to why we had a half-flight of concrete stairs, a toddler, and no baby gate: We explained we were visiting). By then it was clear we weren’t urgent — the lump was still there but she was running around happily. We waited maybe half an hour before being seen, and when we were seen the dr. ended up calling for a second opinion, since the goose-egg was right at the 5cm cut-off point above which they mandate a head scan. However, it was just small enough, she was showing and had shown no signs of internal trauma, and our flight back to Germany was that evening, so they sent us on our merry way.

We were never asked for our address, so even if they wanted to send us a bill, they wouldn’t be able to.

Hi, I’m Brazilian and lived in London for 2 years. You won’t get a bill from NHS. The whole British heatlh care is based in free care for everyone. Brazil has the same system. However, in England it works because the government money for it actually gets to where it’s suposed to, whereas in Brazil the government steals for themselves (corruption).

I am Canadian, but I had the same experience when my daughter was stung by a hornet on a beach in Wales. She quickly developed a reaction to the sting (for the first time ever). We rushed her to the local “cottage” hospital where she was treated. I offered my out of country medical insurance information, but was politely told it wasn’t necessary. We have never received a bill for the treatment. I always purchase out of country medical insurance, just in case…. And most certainly NEVER cross the border into the US without it.

According to the NHS website, there is NO charge for walk-in A&E (ER) treatment, as long as you are not admitted for a stay in the hospital.

http://www.nhs.uk/NHSEngland/AboutNHSservices/uk-visitors/Pages/accessing-nhs-services.aspx

I’m off to the USA in December this year an having read all the comments, I’ll be double-checking my insurance details and taking all the necessary paperwork with me – just in case.

I have used A&E a few times over the last few years and I work in the NHS. When people go to A&E appropriately they will get great services eg cuts, abbrations, broken bones etc and I have rarely waited more than 30min before receiving treatment and frequently much less time than that. Its when people turn up with gallstone pain or nonspecific long term problems and think they will get a diagnosis that’s where the dissatisfaction starts. I spend hours of my week explaining to patients how to pick the right services to get a satisfactory service (they are in pain so it won’t be fun) to treat their problem. I think there needs to be quite a bit of education on the appropriateness of where/how to find treatment (often the GP or out of hours GP service is better for their conditon) and that I find is the bit that goes wrong. Our GP service has always been private (yes I know you probably didn’t expect that!) And its this provision that can be poor. They doctors have always been paid on a per item basis so there is little incentive on prevention not cure. GP’s the claim back from the CCG (used to be PCT) the money for your treatment. Some GP practices can be brilliant (like mine) and really engage with their patients and offer excellent care but others just seem to feel entitled to receive NHS payment and provide poor service.

Anyway, I’m glad your son had prompt and excellent treatment. Nothing ruins a holiday like unexpected injury (and, of course in america, a huge medical bill).

The tariff that NHS Hospitals can claim for an A&E attendance is not classified but is buried deeply in the Department of Health website. I also don’t know what the charges for overseas visitors are, but they are probably the same as the internal NHS Tariff, the tariff is designed to encourage quick, effective treatment, whilst discouraging the use of unnecessary diagnostic processes. i.e. you don’t do a CT for an eye injury. For the kind of visit described the Hospital trust would get considerably less than £200. Probably about £130.

As a UK resident (although originally from NZ) I have very mixed feelings about the NHS. My family has had occasion to use A&E three times in the past 10 years, twice for an asthma attack and once for post-operative haemorrhaging. The emergency care was superb in all three cases.

However day-to-day care is very poor. Over stretched GPs haven’t the time to see you properly and don’t really know you. Coming from NZ this shocked me. We pay to see the GP in NZ and this seems to ensure much better continuity of care and a far more personal approach. My maternity experience at the Radcliffe in Oxford 12 years ago still gives me the horrors – it was quite one of the worst experiences of my life (not, fortunately the emergency c-section, but the extremely poor aftercare and the filth on the maternity wards, which was like some third world country). In years following the birth of my child I have had two last- minute cancellations for operations, causing major disruption, and a failure to diagnose post-natal depression.

When the NHS works well, as it does with emergencies, it is a wonderful institution staffed by incredible people undertaking really challenging work. Sadly, more people experience the frustration and indignity of a day-to-day service that is stretched to its extreme and cannot function to fully support patients in the way that they need.

You won’t receive a bill. We don’t even have a system to bill you which is part of why our system is more cost effective- there’s no medical billing admin cost. If you feel you would like to pay feel free to donate to one of the organisations trying to save our NHS from current government’s attempt to privatise it, or to a US organisation trying to provide medical help to the poor, or directly to me who discovered the night before my emergency surgery that my travel insurance had quietly expired. I hope to never deal with medical bills again which is one reason I doubt I will ever live in my American motherland and will fight loudly for the NHS. X

Many thanks for your column in The Independent today.

I am glad your experience of the NHS was so positive. I work for the NHS in a different part of the country. I am glad you were not forced to part with money in order to get treatment, but you should at some point receive a bill. Clearly you were not planning to be there, however many many do. The UK has a high number of health tourists, people who visit to take advantage of our healthcare provisions. In part it is the inability to recover this money – patients do not always give correct details or respond to payment requests once home – that puts the NHS in such a precarious position moving forward. I can not always get the treatment I require from my area, despite my GP stating it would be best practice. I have also correctly diagnosed myself after 13 years of looking for answers (recently confirmed by the NHS). Through my taxes I pay for my healthcare through the NHS and feel everyone should contribute through proving they pay tax or by payment before they go home. If everyone tried to pay and was enabled to pay at the point of contact the overall experience would have been even better with top rate equipment etc.

Dr Gunter, you will not be charged for your sons care, because under the NHS charter, everybody is entitled to free EMERGENCY care, if accessed through “Accident and Emergency” (ER) or Walk in Clinics. No matter what your nationality, if you’re in need of care (ie gun Shot wound, appendicitis we won’t wait until you’ve made a phone call while you’re in a coma, or make your ambulance go another 20 miles to a charity hospital so that you can die on the way to there! We treat and care about people, not about your wallet! I have worked in the NHS for nearly 30 years, it’s brilliant. Welcome to the UK, I hope your vacation gets better, and take comfort that if NEEDED you will be taken care of!

I love our NHS, glad your boy got the care he needed. All I can say is I’m glad that I pay for the NHS and our welfare state. It’s far from perfect but brings a peace of mind knowing that my mother is well taken care and should my daughter need health care it’s there from her. The welfare state is flawed but precious and needs protection, thank you for praising it.

Hi
I was visiting the UK Wales to be specific last summer, when my appendix decided to give in the day before my trip home. So off to A&E we went, where I was seen promptly and subsequently admitted for emergency surgery. This was at the royal Gwent hospital, where I received excellent care, there was some waiting involved but that is too be expected. Long story short I have nothing but good things to say about the care I received. Now once I was admitted, the service was no longer free so I did receive a Bill in the mail however it was for around 2500$, this included the surgeon, the surgery, an overnight stay as well as the drugs for pain etc. This would run into the tens of thousands here I believe. So I’m misty certainly not complaining.
The nhs may not be perfect but it’s a damn sight better than going broke trying to pay your medical expenses.

Thank you Dr Gunter for your comments. I have worked in the NHS for 30 odd years and feel very proud to have done so! I feel that it is an institution to be proud of despite all its problems and i am glad you found it so too. I wish more people would sing its praises.
A lot of people would not get the appropriate treatment if they had to pay for it or access it thro’ insurance so lets have more votes for the NHS free at the point of access!

Thank you for making such a positive post. I have recently moved from the UK to the US and am saddened by the overwhelming negative attitude to the NHS over here, mainly from middle class people who can afford health insurance. My heart goes out to those who can’t. When in the UK I was a podiatrist in the NHS and was proud of the service we provided and the commitment of all of my staff, from the receptionists who did their best to fit everyone in when they needed to be seen to my foot care assistants who worked with us and my fellow Podiatrists.
In addition I have been in and out of hospital since I was 6 weeks old with long term illnesses that made me nervous about coming to the US. My godmother offered to pay for me to go privately on many occasions but I could not have had better care than I had from the NHS, from my GP, in the ER, on admission or in theatre. It was that care and dedication that steered me to my future career.
I have only been in the US a few months, the care I have received has been excellent but I don’t enjoy receiving the bill!

I moved to England three years ago to come to university. During the 2nd week I got hit by a car. (They drive on the wrong side of the road). I woke up in the hospital 4 hours later, they had already given me a head scan to check for any serious damage (there was none) and then they stitched up my ear, gave me a meal and offered me the bed for the night. I refused to stay in the hospital overnight so they gave me a phone to call someone to pick me up. Everyone i met was incredibly nice and caring. I have not one bad word to say about the hospital. Would have been a great experience if it had not started with being hit by a car.

Neoliberal propaganda is what frightens them. It also fightens me! But l love the NHS, it bought me into the world, through a complicated birth, when it was only five years old itself, but l fear l might out live it. lf l do, l guess it will only be for as long as l remain healthy.

I’m an America who lived in London and I have only good things to say about NHS. It’s not just the UK, though. Oddly enough, I had the same experience of a bit of dirt blowing into my eye in Rome. I went down to the local eye hospital, conveniently located down the block, waiting a few moments, was moved towards the front of the line because I was slightly uncomfortable, received great care and there was no bill. We need this so desperately in the US! I have been singing the praises of “socialized medicine” ever since. Last February I had the flu with a high fever so I went to an urgent care center in my neighborhood, was seen by the doctor for about 10 minutes, was told I had a fever (you don’t say!) and was given some Tylenol and went home. I waited about an hour and a half to be seen while in a lot of discomfort and trying to corral my toddler. The bill was $1400! And that was THROUGH insurance (!) because I have an outrageous deductible. I asked what the cost would be out-of-pocket and it was $450. This is also outrageous and that $450 doesn’t even count towards my annual deductible. I feel forced to forgo health care because I’m worried about the bill. Meanwhile, my family pays close to $400 per month in health insurance premiums. This is shameful.

My father had a mild heart attack in the US. He had a full body CT scan which uncovered a much more serious kidney issue that saved his life. The NHS wouldn’t have carried out the scan. The bill , including helicopter transfers etc was £50k which was eventually covered by his travel insurance after months of correspondence. Initially, there were never any questions asked about how he would pay but he was asked for his credit card on discharge . He now has one kidney and his life so we are all very thankful for the care he received in the States and we wonder if he would still be alive today had he had the heart attack at home ! So there’s good and bad in both systems!!

I hear that emergency treatment is excellent on the NHS, and despite having lived in the UK for the past 20 years, I’m lucky that I’ve never had to experience it. I’ve experienced maternity care. Apart from the initial booking and the 12 week scan getting delayed so much that it was too late for it due to a bureaucratic mistake (that the GP wasn’t “allowed” to put right), everything was great.
HOWEVER, when I started getting worried about my 18 month old toddler’s health and visited my GP, he suggested I should see a pediatrician as he didn’t know the answer to my concerns. He said he’d schedule an appointment. A month later, I got a letter from the NHS to let me know that they’ve scheduled an appointment for 2 months later. 3 months to see a pediatrician??? I don’t think there’s another country in the world, where one has to wait 3 months to see a pediatrician. Very disappointing.
We’re a healthy family and hardly ever use NHS resources, and the one time that we need to see someone, we have to wait 3 months. I wonder how long I will have to wait if she needs any treatment following her appointment. Shall wait and see.
My overall opinion is that the NHS doesn’t work, and we desperately need some drastic changes to the system.

I was interested to learn recently that the cost to taxpayers for the American healthcare system is actually HIGHER than in comparable tax-funded systems.

Glad your little boy is ok 🙂 this was an unplanned incident its not like you came over specifically to get treatment on the nhs. My sister in law was in vegas and caught her leg on a fence or wall or something. She got taken to the ER and they had to put her out to stitch the wound as it was really deep. She just got a bill for £ 17000!! Now theres a huge problem with her insurance paying it because the hospital were supposed to get her to check with them that they would pay up first. Booooo to the USA!

Hi. Great to hear that you were impressed and I (a British/Canadian used to healthcare) want to share a story of the USA with you.

Went to LA (Culver City) to visit a friend and arrived with a cough which slowly got worse. Eventually I knew i needed to see a doctor and as I had health insurance and a clean credit card made my way to the hospital fearing the worse.

I entered the ER and asked to see a doctor saying I was from the UK and had insurance. They took my details and within about 15 minutes was brought in to a room with beds to wait for a doctor. When she arrived she did the usual checks and then listened to my breathing. Diagnosed it was bronchitis and prescribed a dose of antibiotics. The hospital provided me with a very detailed printout of my condition and instructions.

Then they discharged me. I went to give them my details which they took written on a piece of paper and that was it. Never heard anything after that.

I have been told that hospitals can provide ‘free’ care in the US but it is up to them on how it is done.

Our NHS is amazing. I am sorry you had to use it but glad you got to see it at its best. Sadly our current government are eroding it but I have never understood why every civilised country doesn’t have something similar. It appals me that people in a civilised modern country have to bugger themselves to get medical care.

So pleased you had a positive experience in our “free at the point of care” NHS. I am Staff Nurse on a surgical ward in the NHS and couldn’t be more proud of the service we give to everyone, regardless of your sociological status. I cannot imagine suffering the pain of Cholecystitis or Appendicitis, or not getting my bowel symptoms investigated for fear of whether I could afford to pay or not. Our system has flaws, like any other, and sometimes mistakes are made, like any other company, but when you consider the millions of people every year who are treated, the percentage of errors is small. If you have to wait a long time in the A&E it is more than likely because the staff are busy saving someone’s life, or because of the sheer volume of “customers”. We should be proud of our system and ensure that we don’t lose it.

Our 2 children are only here because of the NHS. One was born at 32 weeks and spent 3 weeks in SCBU. The second was born at 27 weeks and spent 10 weeks in SCBU. The care whilst they were in SCBU was amazing and the follow up for the next year was also faultless. Had we had to pay for all this, our second daughter certainly wouldn’t be alive today.

I’ve often wondered as to why America, and certainly Republicans are so against a national healthcare system, and the only logical explanation I can come up with is this –

The Republicans (arguably) are a corporation-controlled party. Their interests of decentralized government, minimal taxation and minimal regulation are borne out from the lobbyists (for corporations) whose primary interests are profits. A nationalized health system, in as much the government guarantees health insurance for all of its populace as standard, is an affront to profit making. By ensuring corporations control the health insurance it keeps their employees in a state of fear. They’re afraid to leave or rather lose their job in case they or their family get sick whilst unemployed and they have a massive medical bill waiting for them at the end of it. This fear ensures that employees take the fewest holidays – Americans get on average 14 days off a year (compared to the British 28) but only take about 10 of them (compared to the British 28). It ensures they work longer hours – it’s becoming standard across America in most industries to work upwards of 12-hour days (compared to the Western European standard of 36 hours a week). Why? Because as long as the corporations have carte blanche to fire employees who aren’t pulling their weight and control over their access to affordable medical care, the employee will accept whatever demand is made of them. It ensures maximum profits for minimum costs.

This is the only explanation I can find as to why a first world country will protect it’s populace with a military, a police force and fire department but won’t protect it’s state of health. It’s entirely about money.

Dr Gunter, thankyou so much for your article. It was so encouraging to read. The NHS has literally saved my family’s lives more times than i can now count. A few years ago my dad underwent a routine scan to identify a slipped disc in his back. They found one kidney full of cancer. Only TWO DAYS later, he was in surgery and it was removed. Fast forward 8 years and my dad’s cancer came back, as it sometimes sadly does. He has been in intensive care 3 times, for weeks at a time sometimes, receiving round the clock one-on-one treatment as they battled to save his life. My brother and sister in law visited from the states. She just couldn’t believe that he was receiving all of this – for FREE. In the States, we would have had to have made some awful decisions and likely turned off his machines a long time ago as it would have cost more than our house. Over the course of his treatment there were times when things messed up. Sometimes there were long and frustrating waits. But when he finally did die, in an NHS hospital bed, he was treated with the utmost care and dignity right up until the end.

Both he and I have paid taxes all of our lives, and so contributed his fair share to the NHS. But his entire life’s earnings were probably not enough to cover the cost of the intensive treatment that he actually received in the end. There are some winners and some losers when we all contribute to a big pot in terms of what we receive from it. If I never have to use the NHS myself again I will count myself blessed indeed (which of course will never happen!), and will remain delighted that I can contribute to something that means others will ALWAYS receive the care that they deserve – because their value is not in how much money they earn and what they can afford, but because they are intrinsically valuable as a person.

Thanks God it didn’t happen in Ireland… but this is other story.

I am so pleased that you found our NHS so efficient.

My husband and I were on holiday in the USA when he was taken ill. Our trip to A & E was quite a shock, in the fact that a credit card was asked for first before he received treatment. The bill was for $900 dollars, of which he had 3 bags of saline which were charged at $150 a time.

I have also lived in Nigeria, where cash is needed to be handed over before they will touch you.

I just thank god that I live in the UK where we have such an amazing NHS.

I have nothing but praise for the NHS in S Bucks. I can see a GP without delay and have never had issues waiting for surgery (& have had numerous repeat surgery for a recurrent problem which may not have been funded by private insurance). Am currently awaiting knee surgery which will be funded by NHS at the local private hospital on a date agreed mutually with the consultant. Prior to this I gave had great support from the NHS physios. I had superb ante natal care with a very complicated twin pregnancy. There’s no way we could afford the premiums being mentioned by US residents. Where the NHS works, it works brilliantly and I for one am immensely grateful.

One or two observations.
We do pay for the NHS through income tax and national insurance, if we are earning. If you don’t earn you don’t pay.
I and several of my friends are still walking the Earth and not bankrupt owing to the NHS.

I think the NHS is one of the best things out country has ever done. The beauty is that you are assessed based on your condition not how able you are to pay. This annoys some wealthier members of society who are spoilt with service in other areas of their life and also businesses who could make a lot of money if our health system was privatised. From the outside it would appear that the fear in the US is stoked by the two groups above – who are well served by the current health system and see no reason for change

What a great story! As an American who has lived in the UK for the past 35 years, I have watched the American healthcare debates in recent years with horror. The NHS is brilliant! I am alive today only because of the swift, fantastic and top-quality care I have had, after contracting a severe and rare bacterial infection last year. And all of my treatment was free. It doesn’t take a lot out of my salary in taxes, and I would happily pay higher taxes to keep the NHS. Indeed, most European counties have excellent healthcare systems. It is so sad that the US doesn’t. Thank you for spreading the word!

As a UK resident I have used the NHS numerous times, from A&E for injuries (mostly of my own doing through sports) through to surgery for reflux disease. I think during 40 years I have had 2 bad experiences, one with a grumpy GP when I was a teenager and one with a grumpy nurse as an adult. The reason those 2 stand out is because they were so different to all of my other experiences, I can still recall the nurse leading me in for a general anaesthetic making me giggle all of the way to OR, almost every contact with NHS staff has been excellent.

We are proud of the NHS in the UK, we are proud because it is good, bloody good. We pay for it through our taxes and yes, that goes toward paying for treatment for people who never pay a penny, often because they don’t have any money, we are proud of that too. The care I have had during my life has been superb and a number of friends and family have gone through the system and been treated with dignity and care by the professionals involved, some of them wouldn’t be here today without the NHS.

There are some issues, Britain is a small Island with a lot of people on it so some hospitals struggle with resources and management, some drugs can’t be accessed, some procedures aren’t available, but we still have the option of insurance or we can still pay privately for those if we wish to bypass waiting lists.

Who would have thought we have more freedom and choice than the land of the free?

I have had a similar case in the US.

About 5 years ago, my son got something in his eye while riding home on the bus from school. I tried to flush the speck out at home but was not successful. I waited until 3:30 pm to get his sister from her school, then drove to Urgent Care. We were seen in less than half an hour. They found the speck in his eye, but were reluctant to remove it because he was anxious and very squirmy, so they referred us to a pediatric ophthalmologist. (If he had been calmer they would have been willing to try.) They gave us a list of nearby doctors (at 4:35 pm), so I started calling from the parking lot and found one that was willing to stay open. I drove him over and he was seen immediately by the waiting staff. The pediatric ophthalmologist was very reassuring and gently talked my son through the procedure. He removed a tiny, metal spot from my son’s cornea. He said that if we’d waited a day to get it removed, it could have rusted and created a ring of rust on the cornea that would need to be scrubbed out. Ick! The visit was pretty quick, though, and we were out of there shortly after 5 pm.

We ended up paying two co-pays, one at Urgent Care and one at the Ophthalmologist’s office. I can’t remember if we had $10 or $15 co-pays at the time. We also paid $5 for generic prescriptions (eyedrops). Our statements from our insurance company said that they had paid between $100-$200 to both the Urgent Care clinic and Ophthalmologist. I don’t think I still have those statements around. I remember thinking that those were both quite reasonable costs, give the services provided. We were lucky that it was during business hours because I would think that ER would have billed a lot more for the same services. We are also lucky to have pretty good insurance coverage through my husband’s employer.

So I’m pretty sure that between our co-pays and what insurance paid, it was under $400. If my son had been less squirrelly, then it would have been half that because we would only have been seen at the Urgent Care.

Great story. Glad your son was well looked after by our NHS A&E.

I’ve had the pleasure of partaking in some clinical electives in the States when I was in Medical school. My university also had alot of American students, and this was around the time when Obama was trying to pass his signiture health care act.

I remember the first time I went to doctors out-patient clinic, I couldn’t believe that the first thing the receptionist asked for was proof of payment (insurance card). I really wanted to ask the doctors I rotated with about this, but decided I didn’t want to upset anyone. I remember thinking that even though all patients in America know they have to pay, I have yet to see a hospital or doctors clinic that has a price list of some sort. You may find it funny, but I’m actually shocked to why they don’t have such a thing.

Anyways, the main point I wanted to make was as follows. I had a really good chance to observe the debates about Obama care and gain perspective from US natives and US TV. I’ve also lived in the UK all my life and so I have had first hand experience of the NHS system. The thing I’ve noticed is that in both countries, politicians use their health care and any talks about changing /upgrading /updating the system for there own political gains. Neither countries politicians are brave enough to seriously stand up and seek change, because they know there’s an “army” of politicians that know how to scare the general public to the point where that individuals career comes to a stand still. We hear “horror stories” about the US system here in our news all the time, and I’ve heard almost the exact opposite about the UK system from US news companies.

Neither country has the perfect system. The UK is the “flag ship” social health care system of the world, a system which every other nations social health care is compared to. The US has the “flag ship” private health care system, to which other private health care systems are judged upon.

With our rapidly growing aging population and obesity crises, great changes need to be put in place with both our nations health care systems. Obama care, in my opinion didn’t go far enough. The NHS, in my opinion needs substantial investment and needs to create an environment where medical professionals can develop entrepreneurialism at the local level, to help care for the needs of the local population.

Basically, we need to learn from each other, and have the opportunity to introduce change for the better. In my opinion, a close to perfect (I use the term perfect in a very very loose manner) health care system is somewhere in the middle of both of ours (US and UK).

If only policy makers spent more time engaging and educating the electorate, instead of fueling fear.

Last point to add. As a recent medical graduate, one important lesson I’ve learnt is that every patient presents differently, every treatment plan must be patient focused, and there’s ALWAYS advances in medicine that bring about new treatments. So medicine is dynamic and always changing. One would think this is what national medical health care systems should also do, too bad it doesn’t really y happen.

I am a brit, recently moved to the US. Let me tell you, the process of getting health insurance is both confusing and long winded. Not to mention expensive. Still, I had to do it so I endured the paperwork and confusion. Now I have insurance, which I pay a pretty penny for each month, and I have to see a doctor for a physical. Again more confusion trying to find a local GP in my network and close to my home/work (I’d prefer not to travel too far since I can’t get my driving license without the previously mentioned physical…). After contacting several doctors the best option I found is a 20min drive out of my way, in another state, and there is a 2 week wait. I’m not so sure this system is better than the NHS in any way at all.

What Americans fear about the NHS is that it’s not a highly profitable organisation. Medicine in the states is entirely an economic affair. You’re prescribed drugs more frequently because you’re seen as a paying customer. If you can’t afford treatment -you die. There is no logic in this to us. Someone’s ability to live shouldn’t depend on their salary

Thank you for your blog post, Dr Gunter. I’m glad we (speaking propriatorily as an NHS doctor) gave you and your son good care.

‘It makes you wonder exactly what frightens Americans about the NHS?’
Two words: Fox News

You may well know that the Washington DC based Commonwealth Fund recently found the NHS to be the world’s best healthcare system, whilst sadly being critical of the US system, ranking it bottom of the 11 countries assessed.
http://www.theguardian.com/society/2014/jun/17/nhs-health
This is of course a reflection on the system rather than the doctors, who are amongst some of the best in the world.

Same sort of results here. I am a US citizen, and lived in Sydney, Australia, for 5 years. The systems aren’t identical, but my Australian medical insurance (for me and my wife) was under AU$300 per month for premium coverage. We never had any serious problems, but my wife had a number of tests and procedures for various issues; the actual charges for any procedure were always under $100, even when general anesthesia was used. In addition, you were always given a copy of your test results and the doctor took the time to explain them.

My US insurance, the least expensive, high-deductible, plan runs over US$900 a month, and has increased over 10% for each of the last five years. That fact alone was almost enough for us to want to emigrate – the only reason we didn’t was that the US is our home.

Hi,I work within the NHS ,in many departments including A&E,and as far as I am aware,emergency treatment in the first instance is free to all.It would only be billed if your son had needed and inpatient stay.I for one am very glad your experience of our wonderful instition was a good one,I too have had to visit the A&E department of St Thomas,not for mysef but for a grown up child ,they were very thourough,although not so quick due to the fact my daughter had been involded in anRTC

Glad your boy is ok and you had a great experience in an NHS hospital.

No bill will be sent as the care was for urgent/critical care to save life or limb. If you rocked up for an elective treatment, that’s a different story and there’s an overseas tariff for that.

I got sick in the US once. It cost me $200 dollars for a five minute consultation and two prescriptions. The next month, an American friend got off a plane here and came down with malaria. Five days intensive care, no charge. He kept deliriously offering them his ID, they weren’t interested. His boss emailed me in a panic worried that I’d had to remortgage my house to ensure he got treated. That’s an anecdote, not evidence; but the evidence backs it up. the NHS is one the best and most efficient systems in the world. Far better than the US. The Tory govt and the Murdoch press (same thing) are busy slagging it off so that they can sell it off to their rich mates and make packet. Private heatlh care companies are among the largest funders of the Tory party. Wonder why.

Hi, it’s fascinating reading about your experience. Although I don’t still hold record of the bill, but my sister had a similar emergency hiccup in her trip to Orlando US, with a different – very different, experience at the US ER.
My sister visited me in New York where I was doing my masters. She went with her friends to Orlando. They called me one day in the evening telling me she’s not feeling well and exhausted, dizzy, felt nausea, and headache. I suspected a flu or sun stroke.. Told her to take some aspirin.. But she and her friends insisted to go to a hospital. I had lived in the US for a year and knew what she will be facing.. Hours and hours of wait.. And a big fat check. Exactly.
They made her wait for over 5 hours until she was checked and diagnosed with dehydration! They hydrated her at the ER and voila she got slowly better and better. Given she was not a US resident nor was insured.. She paid around $900+ in CASH! And had to cut her Orlando trip short! Sigh!

I have just beaten breast cancer. I had 6 sessions of chemo, more medications than I care to count, a PICC line inserted and line care weekly, a total of 9 MRI scans, 3 CT scans a bone scan, two trips to A&E, two admissions for dehydration, a mastectomy with overnight stay, 5 follow up appointments. All on the NHS. My treatment was not only superb but successful too. I was told that if I went private the cost of beating cancer would have gone above £30,000. I never paid a penny. No one can really fault the NHS. To the original post, you will not be billed, it’s just not what we do. I’m just glad you’re telling the world how amazing it is

It saddens me that the only comments so far are fairly negative. We have the best health system in the world. The only thing that threatens it is privatisation.

We love the NHS. My family and I have received so much brilliant care for a range of complicated conditions. I dread to think how much it would have cost us if we lived in the US. We’ll always be grateful.

I never understand the fear of national health schemes that since US residents suffer. The NHS is fantastic – not perfect, but as you’ve pointed out, nor is private care.
Some people complain that they have to pay tax and “don’t use the NHS that much”. I haven’t used it an awful lot myself. But I will be forever grateful for the treatment my mother received when she developed pneumonia. She was admitted, diagnosed and treatment was started so quickly – it’s no understatement to say the efficiency of the NHS saved her life. For that reason I am more than happy to pay taxes for the privilege of having my mother still around.

We had a very different experience in the US.

My son also had severe eye irritation, and my first response was to turn the sink faucet upside down (on a hose) to let him fully irrigate his eye to wash out whatever was the offending particle.

It was a Saturday, and my first attempt at getting him help was to call the ophthalmology practice we had used for years. They returned my call about an hour after I first spoke with the answering service. The ophthalmologist was not near the clinic at the time, and made it clear that it would be a considerable wait and recommended we go to an urgent care clinic.

I next called the local urgent care clinic, reporting the issue and inquiring about their hours. I took my son into the clinic, where we registered, and waited, and waited (about 1 1/2 hours) … before a nurse came out to the waiting room to inform us that the urgent care clinic would not see a patient with an eye problem.

Off to ER – we waited over 4 1/2 hours with no feedback.

Finally, I called my wife, a veterinarian (she’d been working all day – now at the end of her shift). I took my son to her at the vet clinic…slit lamp inspection, scratched cornea, Rx for “my dog” … problem finally solved.

It took a veterinarian (after 8 hours of waiting for a human doc) to solve the problem.

Many years ago I was a radiographer at St. Thomas’ Hospital. I’m glad to hear that it’s still as good as it was back when I worked the emergency room.

And I’m delighted that Victor’s OK!

However – the coalition government has passed new health care regulations which have already seriously altered the basic principles of our NHS. e.g. “Areas which are no longer required by law to be free of charge are: maternity and children’s services, illness prevention, ambulance services, mental health services, dental and sexual health services. Local authorities must decide whether they can afford to provide these services.

CCG’s can now decide which services are free and which must be paid for and no privatised service delivers more than the NHS for less without also excluding the poor and sick.” ref. 999CallForTheNHS . They have organised the People’s March for the NHS leaving Jarrow on 16thAugust and arriving in London 6th September. Support them if you care to keep our free at the point of need National Health Service.

as an NHS practitioner i can tell you that this is an amazing institution and it does not surprise me to hear your story that when you needed us we were there, and not driven by money. this is how a humane society SHOULD work – devoid of corporate greed and capitalism where the main structure is funded directly by everyone who is deemed able to afford it, at source.
however, the NHS is dying. it is dying due to the direct impact of greedy and corrupt politicians – none more so than this latest government we have …..another couple of years and we will be taking our last breaths in favour of the american model.
why are we failing and dying?……..reduced funding, budget restraints and dodgy contracts to outsourced companies we are forced to ‘work’ with on everything from CAT scanning to paperclips, closure of frontline teams who are only missed by other frontline practitioners and not the general public, higher caseloads too high to safely manage,a mass of unnecessary paperwork, audits and targets that prevent us doing what we came to do – help people!
another couple of years and you will hear on the news our politicians tell you : the NHS is no longer fit for purpose and needs to be contracted out”….and it will be because we have been murdered by slow poison which we are forced to drink everyday.
im glad though, you saw us whilst we were great.

NHS: RIP xx

I am curious that Americans think the NHS has “death panels” to consider who gets treatment or who dies. I imagine the concept of a social welfare service is that one gets treatment regardless of its affordability. On the other hand, if an American cannot afford treatment, isn’t he turned away? Or will the hospital provide treatment gratis? Isn’t being turned away because of, say, a lack of insurance in itself conceptually similar to a death panel?

Just for clarification. You will never receive a bill. ALL emergency care is free on the nhs regardless of nationality

you won’t get a bill. It’s amazing. Any child in the UK is covered 100%, no questions asked. It’s astounding. I’m an American living in the UK and I still cannot get over this. I always have awkward moments in the pharmacy getting prescriptions with my daughter where I stand there awkwardly, expecting them to give me a total to pay.

So pleased you were happy with the care you received. We get so used to having the NHS run down it’s refreshing to hear.
I too was surprised the A&E registrar asked ophthalmology to see you. I suspect this was less to do with prematurity and ROP and more to do with you being a dr. More specifically an american dr. The stereotype of the awkward american patient (in no way am I suggesting anything about you) demanding specialists and threatening to sue everybody in sight is sadly widespread, a lot of the time very unfairly. So widespread is it that my med school finals OSCE exam featured an american threatening to sue if he didn’t get an MRI for something a CT was more appropriate for.
Sorry for the stereotype and thankyou for your kind thoughts on the NHS.

What frightens Americans about the NHS? Good question.

It could be that the US political lexicon is so tainted by hatred of anything remotely “socialist/collective” that it cannot and will not accept evidence, anecdotal or otherwise, to the contrary.

It might be that Congress is bought and paid for by lobbyists and the Insurance companies who run the rule over healthcare in the US have the deepest pockets.

Or it could be that the USA believes itself when it tells everyone that the USA is the best country in the world so therefore it must follow that everything that exists in the USA is also the best in the world.

Obamacare is a far from perfect system and certainly won’t match up to the NHS but within the limitations of the political landscape of the USA it was probably the best you could hope for. But don’t be too hard on yourself or your country. Here in the UK it took WW2 (where British civilians were in the firing line and the nation became a far more collective institution than in the USA because of this) to establish the political will to create the NHS.

Sadly the current political landscape in the UK (on the right certainly) is aimed at the NHS’ demise. So take your experience of socialised medicine with you and remember that it can and does work. For it might not be around much longer. In over a decade working in A&E (ER) I’ve treated a number of US citizens, only one of whom was a health tourist. In all but that one case (he phoned the Ambulance from the airport for a longstanding complaint that required an operation he couldn’t afford in the US) the US citizen was surprised by the friendly efficiency of the NHS and stunned that no one would take their money.

It might be this lack of a profit motive that most disturbs the US establishment. Vivre la NHS, long live healthcare for the patient, not the profit.

As someone who has had hiv/aids for 30 years and been unable to work through much of that time, I can unequivocally say (from direct advocacy experience in the US) that if I lived in the USA or, living as I do in Britain, were it not for the NHS I would be dead.

Great story (apart from the dirt in the eye bit!). I live in the UK and have had two live donor kidney transplants on the NHS. The 2nd from my American cousin, whose travel expenses and loss of earnings were reimbursed by the NHS. I regard the service I’ve received from the NHS as being utterly superb. I can’t think of a better, more efficient way for it to be provided, than to be provided as required to anyone with the misfortune to need it. Why create layers of costly insurance & billing mechanisms for something that nobody is ever going to choose to have if they can avoid it? Sure there’s always room for improvement, especially in the more ‘difficult’ areas mentioned above, but if anyone here in the UK has a serious condition/injury that can be helped by medical intervention, the NHS usually does whatever’s needed. I’m a dual US-UK citizen, and earn a modest and unpredictable living as a freelance jazz musician. I know I could never afford to do that if I lived in the USA.

My husband fell ill working in Oman and as expats we had to use private hospital as the public health service is for nationals only except in emergency. Even though it was one of the better private hospitals we could tell right away the nursing staff were not expert and the ICU was a joke. This hospital misdiagnosed his condition and almost killied him. Only after a cardiac arrest at work could we finally get him to the public hospital. This was the equivalent of our better NHS hospitals, medical expertise of the highest order, no frills accomodation and very basic food, and very busy. After extensive, exhaustive tests they pretty quickly diagnosed the true problem.

We were entirely confident of their care, but more urgent surgeries would mean a delay for him so we elected to use our insurance to get a mitral valve repair and double bypass in Germany. The surgery worked well, but he failed to wean off ventilation which was serious.

Thankfully we managed to get him into The Royal Brompton in London which is expert at weaning patients off ventilation. As a UK citizen he would have been entitled to free care but BUPA insurance paid for it which pleased us as it would fund further free NHS care to others/save the taxpayer money (at no extra cost to us).

The Brompton is a superb hospital from the consultants, juniors, nurses, physios down to pastoral care for the relatives. All patients and families got exactly the same treatment no matter whether NHS locals or foreign private patients (who do pay here)

For any serious healthcare the only choice is a specialist NHS hospital whether as private patient or NHS. There are wonderful doctors in the private sector but the ones with the best reputations work and are trained by the NHS.
The fact the same highest standard of care is given to each and every patient makes me proud to be British and proud, and grateful of the NHS.

You won’t get a bill. I was a tourist visiting the UK and went to the local doctor (not even the ER) for antibiotics for a kidney infection. Free and free.

Now I live in the UK. I had sinus surgery, including a CT scan and an overnight in the hospital for free. In Northern Ireland our prescriptions are free. I get physio for a bad shoulder for, yep, free. I pay my National Insurance out of my paycheck, but it is a pittance compared to US health insurance.

OK, so the NHS has financial issues, and maybe ‘free’ isn’t the way to go for everything… but after living in the US with nothing but a small ER insurance policy, I love the NHS.

I used St Thomases about ten years ago for an urgent appendectomy. I was seen inside half an hour, had the op that very night and had my own room to recover in. There was no bill to pay. One of the very best hospitals in my opinion and the nurses there are fantastic.

Let’s not forget that Brits also have the option of purchasing supplementary private health insurance. Still, the point is that you won’t be turned away for not being able to pay your bill. You would be crippled by debt in the US for many of the same procedures. I much prefer the NHS universal payer system. It makes more sense to me. I’ve been in the US for 17 years and I still cringe when the health bills roll in 😦

You won’t get a bill. The NHS operates a free point of care for ALL policy. Had you received treatment beyond A&E, there would eventually be a bill in the post…if the overseas patients team got their act together.
Very pleased to read of your good experience with our overburdened, inefficient but somehow adequetely effective National Health Service.

Because you attended A&E you won’t be charged. Emergency care is free in the UK – you would only be charged if your son was hospitalised. Even then, this was a minor injury that took all of five minutes to resolve – it wouldn’t even be worth billing you for it.

See: http://www.nhs.uk/NHSEngland/AboutNHSservices/uk-visitors/Pages/accessing-nhs-services.aspx

I was travelling in Europe for the better portion of a month with my wife who is British. We ended the trip with a week long visit to see the sister-in-law in Birmingham. I seemingly caught something in my travels and fell ridiculously ill while there. After a few days of misery in bed, I noticed a sudden rash…it was concerning. The sister-in-law told me to call the NHS hotline and see about getting checked out. I resolved myself that they simply weren’t going to let me on the flight back home in this condition, so I prepared myself to pay whatever I needed to, and to whomever.

I called them. I told them that I’m a US citizen travelling abroad, and seem to have fallen quite ill. She had me describe my symptoms, assessed the situation, and ultimately said she was going to consult with another doctor and she’d call me back in about 10 minutes. Sure enough, 10 minutes later she called me back. She told me that she had already booked me an appointment at the local hospital, gave me directions to the place, the approximate location of the emergency room (because apparently it was around the back of the building), and it wasn’t going to cost me anything. I had her repeat that last one, and even ask if she was SURE that was correct. She assured me it was.

I followed her instructions, and when I arrived I was told I was expected. I waited the exact amount of time it took me to fill out all of my forms (which wasn’t long) before they took me back to see me. They assessed the situation, diagnosed me, and gave me my prescription to be picked up at a local pharmacy down the road.

Total time spent from NHS call to back at home with meds: 45 minutes.
Total amount spent on emergency room trip: $11.00 USD (for the meds, which was 7 pounds 50…roughly $11)

They were amazing, and it changed my entire perspective of socialized medicine.

All emergency care is free in the UK, no matter what you nationality. It’s only if you get admitted or need follow up out-patient care that you get charged. The NHS is wonderful, people forget that sometimes!!

“It makes you wonder exactly what frightens Americans about the NHS?”

Answer: ideology, propaganda and disinformation that goes back to Ronald Reagan and the AMA in the 1950s (as seen in Michael Moore’s Sicko). Tea Party types are so pig-headed that they’d rather be ripped off by private HMOs and insurance companies than admit that America has got it wrong for the past 80 years.

What are they frightened of… loosing profits.

I have a feeling that we have the US to thank for the emergent ‘litigation culture’ that has meant that our doctors and nurses (NHS) now spend a ridiculous amount of their time filling in forms and documenting everything rather than actually caring for their patients. Simple procedures like cannulation and toileting now require a form to be filled in stating explicitly that the ‘operator’ washed their hands and followed other policy stipulations. There is definitely a new fear factor amongst staff that they will be sued.

Other ‘initiatives’ such as the newly proposed naming and shaming of GP’s who have low cancer diagnosis rates further adds fuel to this fire and will soon remove any joy or desire to practice medicine, especially when young, intelligent people realise they can have higher job satisfaction and get payed plenty more in other areas of work.

I’m glad that your experience of the NHS here in the UK changed your perceptions. Yes, a lot of our hospitals may look a bit ‘drab’ because they often occupy buildings that were built early 1900, some are concrete monsters from the 1960s etc. Unfortunately a downside to the nhs is their sever lack of funding which often looks like some hospitals are a bit neglected however this does not mean care is compromised as you found 🙂 Some hospitals recently are being rebuilt to be more modern like and what we would define as more ‘American’. An example would be Southmead hospital in Bristol if you want to have a look. Originally consisted on lots of buildings on a big site that was hard to get around, now opening last year it is a brand new glass building with carefully laid out wards.

As for cost, that has been a contentious issue here in the UK about who should/shouldn’t have to pay for treatment. If you are from within the EU and have an insurance card it should be covered however outside of this there is normally a charge. There have been recent findings though of hospitals either not billing ot failing to chase up payments from visitors to the UK which is causing some arguments between government and the NHS about how best to get this money back. It does seem we are the only country in Europe with a very lax policy on health insurance for visitors.

As a citizen of the UK I am very grateful to have the NHS. I have spent a lot of my life in and out of hospital. I’ve had 5 surgeries so far and countless hospital visits. I know that long waits are expected, I just get on with it. I accept at the end of the day if you need help then you have to wait. There is nothing you can do. That said, when I have been unsatisfied with a hospital visit I have chosen to have a private consultation for a 2nd opinion. I would not be alive today if I had to live in an American style system because I really wouldn’t be able to afford the amount of hospital visits and surgeries I have.

Im glad that we have the choice here of both private and NHS. You don’t have to pick one or the other. I’m glad that your son is ok and you enjoyed your time.

I love the NHS. I am a generally healthy adult but when I needed to check out a heart irregularity it was done, blood tests taken, consultants check up, no charge. It does get abused by the drunks at A&E on a Saturday night, by the endless hypochondriacs, and by the private healthcare ramp. What we need is a serious debate on quality of life care in old age.

Thank you. I am one of the Consultant (Attending) team at St Thomas ED. This is a lovely story to hear and I’m glad things worked out so well for you. To answer a couple of the points raised by posters above:
– We never charge foreign visitors for their care in the ED. That is a matter of national policy.
– Visitors should be charged for admissions or follow up.
– NHS charges are vastly less than the US. St Thomas will be reimbursed about £100 ($150) for the care Victor received. When no one else takes a cut, it doesn’t cost very much to treat people.
I will pass on your story to the rest of the ED team!

As a doctor working in our NHS I can tell you that you won’t receive a bill. The NHS provides emergency medical care free of charge to all who walk through its doors, regardless of nationality. Had your son needed follow up or perhaps an elective procedure at a later date then perhaps your insurers would have been billed. You can rest assured that you son’s emergency treatment was ‘on us’, a present from a civilised healthcare system.

Just to further increase you sample size, and add my own little twist, this is essentially the *exactly* same experience my wife and I had with a national healthcare system in Tokyo a couple of years back.

My wife grew up in Tokyo (life-long American citizen…her parents were/are international school teachers) and we were there apartment-sitting for a friend of her parents. About two days before Christmas, my wife started complaining about a earache. Sure enough, come Christmas day she was in intense pain and running a slight fever. So, we decided we needed to get her treatment just to be on the safe side.

Since neither of us speak Japanese (my wife can navigate Tokyo just fine, but certainly not well enough to work with a doctor), we sought out English-language clinics in the area. Of course, all of the gaijin were home celebrating Christmas and all of the clinics were closed. So, after much laboring and fretting we decided that we’d just have to use the emergency room…Certainly an earache is not an emergency, but I’d rather take her in when we don’t need to than not and end up with a serious situation.

We hoof it down to the ER. We’re met by a large waiting room, panels with patient numbers and this long counter with various stations. It had a kind of sad 1970’s look to it, and I started to get this sinking feeling that this was going to be a complete disaster. We go up to the check-in counter, girl doesn’t speak English…but she promptly calls over a slightly older lady who speaks functional English and helps us navigate the check-in process, and sorta translates as we go (think that scene in Lost in Translation, where Bill Murray is doing the photo shoot…”You like Roger Moore?”). As we’re finishing up, she tells us that my wife is going to have to see an ENT specialist, and that because we’re not part of the NHS the bill will be *twice* what it usually is (in typical Japanese fashion, the lady was mortified to have to tell us this and apologized profusely). Being an American and having had to go to the ER without insurance, I immediately assumed this was going to cost us at least $3000. “But, we’re here and let’s just get through this and we’ll figure it out later.”

We wait and finally get called up to the specialist. He sees her, writes her a prescription and sends us back downstairs to fill it at the pharmacy (the left-most station at the long counter). We fill it and get the final bill (while we’re waiting to get called up to pay the translator lady finds us again just to check on us…gotta love the Japanese!)…it was a completely absurd $200 (visit, antibiotics and an anti inflamatory/sinus medication). All told, we were there 45 mins.

Allow me to repeat that. We went into the *emergency room,* *without insurance,” had to find a *translator,* saw a *specialist,* and picked up *two prescriptions* in *less than an hour* which cost us *$200* paying *twice* the normal rate. If this is what the damage to our health system would look like if we switched to a single-payer system, then I say smash the SOB…we are simply doing this wrong.

Ah — but NHS hospitals never have sparkling new buildings with fountains!

The thing is, it’s not just those quick, easy, emergency visits that go so well, and it’s not just because you were in central London that you had good service. I do not live in London so there is very little chance of MP’s ending up in my local hospital, and yet the service here is impeccable too.

I have had family members treated in NHS hospitals for pneumonia, cancer, heart problems, broken hips. I myself was in and out like it had a revolving door as an accident prone child with all sorts of broken bones. I have never had anything less than exceptional care. In addition, the out of hours GP provision is extraordinary – twice I have been very ill over the Christmas period when regular doctors are closed, and without them I would have ended up in much worse condition being treated next door in A&E.

Are there bad people, bad systems, bad hospitals? Yes. Like any business, industry or organisation. My grandfather was temporarily placed in a different hospital to our local one when he required treatment best provided by a certain hospital. The worst hospital I have ever seen, with frankly dangerous practices. Are they the very tiny minority? Yes, they really are.

I wouldn’t swap our NHS system for the world. It’s not perfect but it’s an amazing resource I am proud of, and relieved that I have access to such a great service when I need it.

I broke a little finger in a fall in Lochcarron Scotland – was seen by a local Dr referred to a hospital on the Isle of Sky x-rayed advised (see hand surgeon when I got back to South Africa – have arthritis complicating treatment) strapped and even had follow up visit to check progress, Cost Zero,

Americans should not be afraid of an NHS type system. I’m not saying it’s perfect (far from it) but I (being a UK resident all my life) have had plenty of experience with the NHS, the most important of which was when my younger brother fell out of a 3rd story window suffering a severe head injury, fracturing his spine in three places, puncturing his lung and also losing a small amount of brain tissue through his ear. The emergency room and in fact all the professionals that helped my brother over the next 10 months whilst he recovered (yes, he did in fact recover) in hospital were outstanding, I can confidently say that without those people and services my brother would not be alive today and I cannot think of a higher commendation of a health service to be honest. All without costing a penny. We have paid for extra rehabilitation services (such as speech and language therapy as his speech was very severely affected by the head injury) but these were additional rehab services we wanted to use to try and help speed up his recovery (he did receive speech and language therapy on the NHS as well but it was only once every couple of weeks and it was taking a long time for him to make progress). The essential services which saved his life were all 100% free and as you may have guessed by now, I am a very staunch supporter!
Surely it should not be that someone doesn’t receive the care they need because they cannot afford it, or finds themselves in massive debt through unavoidable medical bills (I absolutely shudder to think how much the three weeks my brother spent in intensive care alone must have cost!)
Anyway I just thought I’d share that personal experience as a UK resident as I think the NHS is one thing we have actually managed to get right and I would definitely recommend people living in the US or other places where there is no national health care system should really consider supporting the development of one – as someone earlier pointed out there is always the option of paying for private healthcare or aspects of private healthcare if that suits your personal preference and/or budget!!

as an english woman with four children i cannot tell you how fantastic our NHS is and find it unbelievable healthcare is not free in all countries never mind the US. As you may of already guessed have had my fair few visits to A&E over the years and have always felt we received the best possible care. It is a shame our media tend to focus on the negative instead of the wonderful work done by our hospitals, healthcare workers & GPS. As for lawsuits, there seems to be a trend of adverts urging people to make a claim for unsatisfactory treatment, whilst i agree health professionals should be held accountable can only hope that we dont turn into a nation that claims just on the off chance we may get some money,especially as the money would be put to far better use going back into the NHS

As another commenter said, your Emergency treatment is “free”. But, actually, for the duration of your stay, you are a taxpayer – most of what you pay includes Value Added Tax at 20%, plus duty on petrol, alcohol etc. So, you’re paying according to your ability & receving according to your need! I’m glad you had a positive experience. It’s not always quite like that eg Friday/ Saturday evenings.

I had my tonsils removed in the UK while I was a student over there. I didn’t pay a penny for anything – they even kept me overnight because they wanted to keep an eye on me post surgery. It was an amazing experience.

The wait was short for the NHS, but many hospitals do now fast track kids. The care was as I expect: thorough. I love the NHS, but our government wants it to be more like the US at a time when the US has finally woken up to the fact that this is more than a little disfunctional.