Posted by alexandra_k on January 4, 2015, at 15:00:39
In reply to Re: psychiatry is an ougrowth of society » alexandra_k, posted by baseball55 on January 2, 2015, at 20:38:57
The thing that surprised me the most about my visit to the US was... Just how similar to home my psychiatric care was...
While health insurance was a condition of entry on my visa (for Emergency / the cost of shipping me back home mostly) they said that they considered me a resident of the state since I was currently residing in it (not on a holiday). So I got... Psychotherapy (to talk to) a student doc and the state paid for that. Just like home ahahaha.
The main difference seems to be that we have GP's (that we pay co-payment for) and that they gatekeep access to specialists. (And increasingly, nurses gatekeep access to GPs - mental health nurses gatekeep emergency access to psychiatry). So... We need GP to refer us for specialist services. If you don't have health insurance you have to take what you are given but the service is free. Health insurance can help with your GP co-payment and give you (limited) options on specialists including which one you go to and whether you get treatment in private hospitals. But services are very limited there so usually you basically just in effect get yourself bumped up the public hospital waiting lists because your specialist probably works there some of the time anyway).
One thing that surprises me... Is the diversity of services within a country. I know that people move to the US state that I was in precisely because of access to education / health care. That things seem very different for people in different states. I think the teaching hospital thing makes a big difference (health care becomes much more accessible because students have to practice and they are just learning so not charging so very much of a fee). Then being a graduate student... I would expect that I would have got the better-end of free healthcare on offer there because the doctors would have more readily identified with me rather than many of the other cases walking through the door...
:(
In NZ we have different 'District Health Boards' that seem to result in there being significant differences in the care received in different parts of the country...
I've only more recently learned that my experience of healthcare is fairly different from most people living in NZ. The region I grew up... Has the distinction of having the largest hospital in Australasia with the largest service coverage area... Most other places have lots of smaller hospitals... Most of the smaller hospitals / clinics don't have student docs. This one had... 2 general community psychiatric wards (around 24 people per ward) 1 higher care ward... 1 seclusion cell ward... a couple lower care / more transitional to community / longer term wards... a forensic ward or two... Was a bit of an outcry when they shut down the haunted institution out in the country and brought the psychiatric units (including forensic) into the hospital in the city... But there it is. So very much easier to discharge people by simply booting them out the door... to transition people by extending their day-leave... or night leave since we don't have enough beds...
Anyway... Big hospitals. That's what I think / that's what I'm used to. But apparently this isn't 'normal' for most people in the country around here... So...
Seems that we do some cross-country comparison. Mostly... As a bit of a platform to teach us why we have gone the way we have. I've looked at the readings a bit and... Well... It is a first year paper (rather than being a graduate level paper) and it is supposed to be a load-lightener for the pre-med's... The moral of the course seems to be something-something about trade-offs. These much abused notions of 'accessibility' and so on... Second semester we do a course on equity of healthcare... Have to write about an inequality but not allowed to be SES. AW. has to be to do with age or gender. Yawn. maybe i'll write about the abuses of trans-gender individuals in the name of 'healthcare'... Or about infant circumscision and the gender hypocracies there are around that... THink the state pays for boys and prosecutes for girls ahaha.
Specialist care is free. That's a big deal. If you get hit by a bus you will wake-up pre-theatre, post-theatre and your operations will get done. And you won't rack up any kind of surgical / hospital bill at all.
But then... I guess... I suppose... What really happens... Is that the triaging / managing / prioritising / deciding goes on behind the scenes. With respect to what they do do / what they don't do etc. They saved my foot... Some other doc may well have decided not to... I don't know... I think mostly he was trying to teach his students a thing or two since when they did their ward rounds some gasped in horror and one actually proclaimed 'it's f*ck*d!'
And 'non-urgent' things like hip replacements... Waiting lists are long. In large part because they only want to be doing one of them and the expected life expectancy of a hip replacement is xxx years so they want to wait until you are of the age such that you won't be requiring another one. Ugh, ugh, UGH.
poster:alexandra_k
thread:1074584
URL: http://www.dr-bob.org/babble/social/20141123/msgs/1074796.html