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The high charges of HEMS in the USA

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The high charges of HEMS in the USA

Old 28th Nov 2018, 09:40
  #21 (permalink)  
 
Join Date: Jul 2002
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Originally Posted by BluSdUp View Post
Hi
Here in Norway MEDEVAC is free , hospital free, doctor free( after annual max 300euro)
All education from 6 years to Professor is FREE!
How you say?
We do not piss away the money to the greedy capitalists!

Oh and PS:
Our personal tax are the lowest in Europe.
You all have a healthy day now.
Regards
Cpt B
It always helps to have a tiny population (5m) and huge oil reserves. Not many other countries are so fortunate.
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Old 28th Nov 2018, 10:08
  #22 (permalink)  
 
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Originally Posted by BluSdUp View Post
Hi
Here in Norway MEDEVAC is free , hospital free, doctor free( after annual max 300euro)
All education from 6 years to Professor is FREE!
How you say?
We do not piss away the money to the greedy capitalists!

Oh and PS:
Our personal tax are the lowest in Europe.
You all have a healthy day now.
Regards
Cpt B
Except your cost of living is monstrous, property is eye watering, don't think about buying a car, you can't order a drink that is more than a double and you'd need to sell a kidney to pay for it. Love the place and the people but it is one of the most expensive places you could ever hope to visit.
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Old 28th Nov 2018, 12:18
  #23 (permalink)  
 
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The US proves every day, that a free market in health care produces the most expensive health system in the world with a declining live expectancy. That is not a success story.
I suppose you not read much of what has been said about our Healthcare system here at Rotorheads or elsewhere.

Our system is not "free" due to the States and Federal Government self imposed involvement on the system.

If the government got completely out of it.....then perhaps we would have that "free market" you assume exists.

One example....ACA known as Obama Care....imposed requirements for every Insurance Policy using a "one size fits all" concept as Government so often tries to use.

I am a single, un-married, childless Man yet any healthcare insurance policy I buy (each Policy has set coverages) will cover Maternity costs.

Last time I checked....it is biologically impossible for me to bear offspring.....so why am I required to have that coverage AND PAY for it?

For years Cafeteria style shopping of Health Insurance coverages has been sought by genuine reformers.....and it never happens because the States and the Federal Government refuse to allow it.

Odd thing...I do that for my Home Insurance, Auto Insurance, Boat Insurance, and personal liability Insurance....so why not health insurance?

Answer.....the States and the Federal Government don't get involved in structuring those kinds of insurance policies....the market does.

I live very near saltwater....and recently had some in my ground level rooms due to a Hurricane....my Boat Insurance has paid my Claim for damages, the Wind/Hail Insurance has assessed the damage and made a determination of loss (less than my Deductible), and the Flood Insurance (a Federal Program) has yet to make a decision.....see the trend?

The less involved the Government is in "Insurance" the better.....and the more "free" the market is.

"Free" to the government is defined as "Income Redistribution" where politicians take from some and give to others without any recourse by those whose pockets get picked.
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Old 28th Nov 2018, 13:13
  #24 (permalink)  
 
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This discussion is really about two separate issues; first government intervention in healthcare and second how healthcare is funded. The US has more political interference than other countries. Working in the US I am often prevented for providing certain care even if the patient is paying cash due to local, state and federal restrictions unheard of elsewhere. At the same time I dispair of incompetent political oversight in Europe as well, but regulation rarely imposes itself between my patient and myself.

Funding is a separate but related topic. The cheapest way to fund health is via national taxation eg income tax, followed by specific national levies followed by insurance policies simply due to the administative costs.

The US has additional issues not least those related to the drug manufacturers but the ACA has undoubtedly reduced healthcare standards. No system is perfect, and most countries are facing increasing costs in relation to GDP. However the US spends over twice what the rest of the developed world spends, the rate of increase is greater, and it is the only developed country where so many of the population are uncovered. Yes you can walk into an ER but you will only get treatment for specific entities. Children still die from asthma in Florida due to not being able to buy inhalers. The US has one of the lowest proportion of HIV sufferers on retrovirals as the cost has been placed on Medicare which is now the financial responsibility of the states. Sadly I see no hope of impending improvement to either HEMS or healthcare in general as the political system is broken. All I would ask is that those Americans who scorn 'socialist medicine' whatever that is reflect when they next pay their property taxes to fund education or argue against privatisation of ATC.
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Old 28th Nov 2018, 14:30
  #25 (permalink)  
 
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The notion that UK, AUS, NZ and elsewhere are 'socialist' in not allowing an open market competition in EMS is short sighted. With the exception of Queensland, all EMS helicopters in AUS and NZ are run by independent commercial entities (either not-for-profits or for-profit operators such as Babcock, CHC or Japan post). The government simply uses it's purchasing power to tender for the services across the region in an open market to ensure the best deal, and enforce minimum standards.

NZ did this very well recently in enforcing IFR capable, twin engine aircraft to replace the existing singles operating EMS. This benefits operators in providing long term, well funded stable contacts, patients in high-level consistent services and us pilots in providing job stability and safe, capable aircraft.

I would argue this is the evolution of the free market economy. The government does it jobs but legislating the standard and then uses its purchasing power to get a good deal for all citizens. Same as the government getting a contract for dump (rubbish) trucks vs everyone getting their own garbologist to collect their trash (rubbish).
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Old 28th Nov 2018, 14:37
  #26 (permalink)  
 
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Originally Posted by SASless View Post
The idea that people without Health Insurance cannot get health care in the USA is a myth.

One of the problems is the un-insured or those who do not qualify for government funded healthcare too often show up at Emergency Rooms/Trauma Centers to obtain what at best would be Urgent Care treatment or Primary Care Treatment.....and of course are unable/unwilling to pay for that treatment which cannot be denied by the facility.

The provider may limit their provision of care to that which is necessary to stabilize the patient then transfer the patient to another facility.

Those with Insurance, the Tax Payer, and those who self fund their healthcare do in fact wind up paying for the indigent who cannot afford or do not otherwise have healthcare insurance or coverage under a government funded source.
SAS
Even with universal healthcare in Alberta we still have people showing up at Emergency with a bad cold and asking for treatment even though Primary Care centers are free. In the US the Urgent Care and Primary Care centers are For Profit operations that can and I believe do refuse to provide service if you can't pay for it. Feel free to correct me if I'm wrong on my assumption.

Roybert
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Old 28th Nov 2018, 15:10
  #27 (permalink)  
 
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Emergency/Trauma Centers are required to provide necessary care to stabilize the patient and cannot refuse care.

Thus....the uninsured shows up with the sniffles and ties up the Emergency Room, and utilizes expensive care, and walks out without paying.

Urgentcare and Primary Care facilities are not required to provide services.

I have Medicare (being an old fart) and have purchased Medicare Supplemental Insurance....I can go to any Urgent Care or Primary Care facility and my care is cost free beyond my Insurance Premiums for both Medicare and the Supplemental Insurance.

I also qualify for Medical and Dental care from the Veterans Administration (VA).....if I don't mind all sorts of bureaucratical bullshit and slothfulness.

To add insult to injury....the VA will pass along their costs to your Insurance Provider for services rendered.

Single Payer Healthcare is not a good thing.....as a Canadian you should fully understand that.

For instance.......

https://www.medpagetoday.com/cardiol...syndrome/18279
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Old 28th Nov 2018, 15:33
  #28 (permalink)  
 
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SASless if you read the article you will see a patient is going to the US because his tiny tiny province doesnt have the expertise. This has nothing to do with systems or money. In the UK we do the complex surgery for Malta - a full member of the EU and a prosperous country that is just too small to provide for an operation that might be needed once a year. Even New Zealand exports its citizens for less common treatments not justifiably covered in a population of 4.5m. Doing these operations locally would be dangerous as the doctors would not have the experience - bit like only flying a couple of hours a year. That was the basis we expanded EMS in the US into interhospital transfers for trauma

You are fortunate to have several layers of insurance. Many of your fellow citizens cant afford any insurance and then have to pay a federal tax penalty of $400!!! ERs and primary care centres do not provide proper care for chronic illness (asthma, diabetes, hypertension) which needs ongoing supervision not occasional emergency salvage.

I am not a US citizen so you are welcome to tell me to stop poking my nose in BUT so many Americans have been fed rubbish about 'socialist medicine' and even death committees that there is no real debate as to how to provide universal healthcare which many would argue should be as much a right as universal education or universal freedoms enshrined in your constitution.
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Old 28th Nov 2018, 16:29
  #29 (permalink)  
 
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Krautland.
Wooppy Doo , who are You!

So you have lived and worked both side of the pond.Wow!
Well Kraut, so have I , in Canada , another well functioning socialist state.
And as Sweden and Denmark goes they have the same exact system as us.
As for the oil, they both had a shot at it: The Danish in the 60s when the offshore borders was drawn( Danish negotiator got drunk on Norwegian Aquavit!)
And the Sweeds in the 80s when we offered the Volvo/Oil deal!
We are hardworking and honest and would have been more or less at the same spot without the oil, but you wouldnt know anything about that Kraut.
We decided never to suffer like we did from 1940 to 1945 and our system for everything works better then anything in the US.or EU for that matter.
It is that simple!

I have lived and commuted into six different EU countries since 1985 while maintaining HQ in Norway.
Norway works, some lands , not so much.
Enjoy Your money were ever You are.
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Old 28th Nov 2018, 17:16
  #30 (permalink)  
 
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Radgirl,

Many of your fellow citizens cant afford any insurance and then have to pay a federal tax penalty of $400!!!
Not quite right.....only if you refuse to buy Insurance do you pay a Tax.

The ACA/Obamacare model requires enlarging the pool of insureds and by the Supreme Court Decision penned by the Chief Justice.....the Penalty magically became a Tax.

The Internal Revenue Service (The Tax Man for the Federal Government) collects those Penalties in the form of a Tax Levy.

Thus we have a situation where the Government is requiring you to buy a product it has devised and if you do not.....you are rendered a financial penalty.

The problem is the young and healthy generally need at most....a Catastrophic Event kind of medical insurance and not the ACA style policies.



Yes...far too many folks cannot afford to buy health insurance due to the structuring of the rates and deductibles and the rate increases each year under Obamacare (ACA).

The other problem is how many States are losing Providers due to the ACA's problems and thus access is becoming problematic for those who do have Insurance access.

Last edited by SASless; 29th Nov 2018 at 12:00.
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Old 29th Nov 2018, 08:14
  #31 (permalink)  
 
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Originally Posted by SASless View Post
Single Payer Healthcare is not a good thing.....as a Canadian you should fully understand that.
A quintessentially American response, .... but utter nonsense. 🙄
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Old 29th Nov 2018, 11:55
  #32 (permalink)  
 
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Care to explain why you thhk that?

Just calling a post nonsense does not advance the discussion at all.

Tell why the Canadian system works well and should be copied by us down south of you.

We hear about "Death Panels" (which is a hyped name for the method that determines what services are provided due to age and physical condition of the patient) that decide if a Patient can have a Medical Procedure.

We see that as being "rationed" healthcare where cost to the system trumps patient needs when the decision is made.

The UK particularly is accused of that.....and I have heard there are long waiting times for some care in Canada.

Are we being mislead about that?
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Old 29th Nov 2018, 13:35
  #33 (permalink)  
 
Join Date: Jul 2004
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Dear SASless
May I remind you, that the term "death panels" are a invention of your own Sarah Palin, talking about a very important bill in your own country? May I also remind you, that in a famous congressional hearing before the time of Obamacare, US health insurance companies admitted, that they denied life saving treatments to patients due to the cost and as a results these patients died?
The term death panels is a) a horrible choice of words and b) misleading. Under the Canadian system, when the patient can not take a decision, somebody else has to step in. Normally some other family member. If this person does not agree with the doctors, especially, if the doctors want to continue treatment and the next of kin thinks, that palliative care is the way to go, some sort of commission will look at the case and decide, what is best for the patient. This is actually a quite common procedure in many countries, where the will of the patients is decisive for the choice of treatment. Unfortunately your own politicians and press have perverted the discussion to a point, where it is impossible to have an adult and informed discussion about what to do with very ill patients, who can not express their will or even if they can.
Their is no such thing as rationed healthcare either. But anybody with common sense can understand, that the capacity of a health system must not provide every treatment at a moments notice. Sometimes one has to wait a few weeks for treatment. That is for several reasons. Everybody who has ever been in a waiting room of hospital with a common cold knows, that cases are treated due to severity. You came in by helicopter unconscious loosing blood, you are treated immediately, you jogged in with a hurting finger, you grab a coffee and wait. Same goes for more complex treatments.
Many countries have health care systems like Canada. Most of them work pretty well. The whole of Europe does a pretty good job at it (but we are also extremely good at complaining), not perfect, but we do not let people die, due to cost. We have the principle, that a society has to protect the weakest.
Before you come up with isolated cases I will repeat: It does work pretty well, but it isn't perfect. There is lots of room for improvement, but I think everybody around here will agree, that we prefer our system with universal healthcare for everybody at a reasonable price to society, to your system, which is twice as expensive to the society, compared to the second expensive country, but "lets the free market play" and yours does not even provide better care. Live expectancy in the US is way, way lower than in Canada or any European country. Even some second world countries have a higher ones.
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Old 29th Nov 2018, 13:38
  #34 (permalink)  
 
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I am keen to keep to facts, and agree SASless that one line rubbishers are unhelpful

Death panels were invented by US aspiring politicians during elections. There have never been any in the UK, nor to the best of my knowledge anywhere else.

In the UK certain procedures are not covered because they are considered cosmetic. Examples include breast augmentation. Even these are permitted and paid for if there is a specific reason, be it cancer or mental health issues. This is no different to US insurance policies, which do not cover certain procedures. Only Oregon as far as I know, has a method to allow the public to include new procedures. The UK public are unhappy about suggestions that some operations should be curtailed but this is because research has demonstrated they have no benefit or actually do harm.

New drugs may be refused NHS (state health) approval if the improvement in quality of life cannot be demonstrated to be more than so many years. I and other doctors do not fully approve BUT we can still use these drugs outside the state system. By comparison the US FDA continually refuse or delay equipment and drug approvals granted in the rest of the first world. I undertake several procedures on US citizens in the UK because the procedures are banned in the US even if they pay.

So overall I suspect there is no difference save that every UK citizen has access to all care....And in the main the same applies in other countries

Waiting times are an issue and you can certainly get faster care in the US, although it is difficult to accurately measure the downside of waiting save for those who have pain. What must be remembered is that rapid care in the US is not due to how it is paid for but supply and demand. US hospitals run at much lower bed occupancy levels - there are more medical facilities per head of population and this is another reason why costs are far higher.

My ideal would be the best of US medical research and university based medicine funded by taxation and universally available.
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Old 29th Nov 2018, 14:03
  #35 (permalink)  
 
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You will note that I am not a fan of the US Health Care system....primarily because of the problems caused by government policies....and therefor plain old politics.

I lost my Mom not so long ago at Age 97 and spent six years taking care of her....and know very well how our system deals with such situations.

She had government Medicare Insurance and a privately funded Medicare Supplemental Insurance Policy that picked up the costs not paid by Medicare.

She spent that last bit of her life in a Nursing Home and had one major surgical. procedure in that time.

While in the Nursing Home and receiving palliative care...we paid lots of money for that.

Her Surgical Procedure and after care that lasted almost three Months cost us nothing due to the Insurance coverages she had.

Big Pharma has far too much power over the Politicians.

The Profit Center concepts used by the Medical Industry is part of the problem.

Our Drug costs are atrocious....as compared to any other Nation.

We have problems....lots of problems....and they are not going to get any better until the Politicians set aside their bitter differences and start doing the people's business.

Sadly....we see them split philosophically today to such a degree that compromise just doesn't happen.

In a free market economy....competition drives prices, competition in quality of service, competition in timeliness of services, competition in costs of services.....but with the government involvement (both State and Federal), we have a very dysfunctional system.

I am in the midst of a struggle with the Veterans Administration (VA) over a second Hip Replacement Procedure.

The first one was done in a non-VA facility (a teaching hospital) but paid for by the VA.

Unfortunately....the other Hip has decided to wear out....and I have been dealing with the bureaucracy since August and am no closer to getting the authorization for the second procedure.

Yesterday....when I informed the Patient Advocate I had contacted one of my US Senator's Office for assistance in unraveling the mess.....I was assured I would have my approval within 24 hours.

Due to the problems with my Single Payer VA provider....I have gone to a non-government provider and have had three Primary Care visits and two Consults with an Orthopedic Surgeon and could have the Surgical Procedure down with a two week notice.

My Medicare and Supplemental. Policy paid all the costs for those visits.

See the difference in timeliness and why most Americans have a dislike for government run anything?

We look to the Postal Service and State DMV Offices for examples why government should not have anything to do with our health care....other than to prevent monopolies, and see to Licensing perhaps.

All one has to do is see the mess we have now and allowing the government to get further involved very much is not the thing that should happen.
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Old 29th Nov 2018, 14:21
  #36 (permalink)  
 
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Originally Posted by SASless View Post
Emergency/Trauma Centers are required to provide necessary care to stabilize the patient and cannot refuse care.

Thus....the uninsured shows up with the sniffles and ties up the Emergency Room, and utilizes expensive care, and walks out without paying.

Urgentcare and Primary Care facilities are not required to provide services.

I have Medicare (being an old fart) and have purchased Medicare Supplemental Insurance....I can go to any Urgent Care or Primary Care facility and my care is cost free beyond my Insurance Premiums for both Medicare and the Supplemental Insurance.

I also qualify for Medical and Dental care from the Veterans Administration (VA).....if I don't mind all sorts of bureaucratical bullshit and slothfulness.

To add insult to injury....the VA will pass along their costs to your Insurance Provider for services rendered.

Single Payer Healthcare is not a good thing.....as a Canadian you should fully understand that.

For instance.......

https://www.medpagetoday.com/cardiol...syndrome/18279
SAS

Never claimed that the Canadian System was better or worst than the US system. Our system is sometimes just a flawed as any other system worldwide. Waited 10 years to have my knees replaced due to damage and arthritis. First Doctor I saw was a _____ (you fill in the blank) wouldn't do anything because of my weight. Finally got them replaced two years ago because the Doctor had some compassion and it's been life changing but it also cost me 10 years of my life.
Bottom line is Health Care is an Essential service that All people deserve regardless of there position is life It's not a For Profit business

My two cents worth or half a cent in the USA

Roybert
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Old 29th Nov 2018, 14:31
  #37 (permalink)  
 
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Roy,

Could you have done like I did....seek some alternate source of care within your system....change of Doctor perhaps and then have a favorable outcome or were you stymied by the decision of that one Doctor (or a review board that made the actual decision based upon the Physican's Notes)?


Canadian EMS has some problems as well.

Let's look back at the Ornge EMS Operation and the turmoil that has taken place there over the past few years to include fatal accidents and wrongful spending and other accusations.

Do a search using the word "Ornge" here at PPRuNe and you will come up with numerous Threads seen here at Rotorheads in the past.

Blue times at ORNGE
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Old 29th Nov 2018, 14:38
  #38 (permalink)  
 
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Originally Posted by SASless View Post
Roy,

Could you have done like I did....seek some alternate source of care within your system....change of Doctor perhaps and then have a favorable outcome or were you stymied by the decision of that one Doctor (or a review board that made the actual decision based upon the Physican's Notes)?


Canadian EMS has some problems as well.

Let's look back at the Ornge EMS Operation and the turmoil that has taken place there over the past few years to include fatal accidents and wrongful spending and other accusations.
SAS

In Alberta, hip and knee replacements are funnelled thru one facility to try and keep the costs down. Took me five years to have them assign me a new surgeon. I looked at having the surgery done in the US but at the cost I was quoted and the length of time they wanted me to be there was just unrealistic give that I am still working. Actually thinking about getting on a bird next week and go with one of the company crews instead of sitting at a desk scheduling things.

And like I said never claimed the Canadian system was perfect
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Old 29th Nov 2018, 15:54
  #39 (permalink)  
 
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In a free market economy....competition drives prices, competition in quality of service, competition in timeliness of services, competition in costs of services
it drives those things but usually downwards as we see in the aviation world - a race to the bottom.
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Old 29th Nov 2018, 17:06
  #40 (permalink)  
 
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Looks like some might be trying to reduce costs
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