Saturday, December 5, 2009

"My experiences with socialized medicine" by Judy Gerjuoy

A guest post:

"My experiences with socialized medicine"

by Judy Gerjuoy

I am a natural born American. Until I met the man I subsequently married, I never would have dreamed of not spending the rest of my life in the USA. I love the USA, my family and my friends, and never considered leaving. Then, I met my husband who was born and raised in Finland, spent his life there, and never had any real thoughts of leaving. So, ten years ago I moved to Helsinki, Finland to take up residence with my Finnish husband. I had no real experience with life in Finland, outside my visits to see my husband, or in fact of life outside of the USA, and one of my concerns was how I would deal with the Finnish medical system, which was different from anything I knew.

I had grown up under the American system of health care. I had received medical insurance through my job, and had noticed over the last ten years, how health insurance cost my office more and more and gave us less and less. Because of the costs, my work had to switch from health insurance that allowed us to see any doctor we wanted to, to a PPC program that vastly restricted who we could go to. Our co-payments for office visits and prescriptions went up almost every year, etc.

One of the first things I found out when I got to Finland was that under their medical system there was no such thing as a pre-existing condition. No matter what medical problems I had, the Finnish medical system would take care of them. Since I was moving to Finland with some medical issues, that was a real relief to me.

In Finland all citizens, and permanent residents (which is what I am) are covered by the government health plan. Some people also have private insurance through their job, but the vast majority only have and use the government system.

The first 6 years I lived in Finland the medical system didn't impact me in any meaningful way, although I was impressed to find out that mammograms were considered a routine medical test, and every woman once they reached a certain age (depending on location) was automatically scheduled for one.

Then, June 2006 I became seriously ill and had to go into the hospital, and was left with a long-lasting physical problem – I have been assured by American doctors that the same thing would have happened if I had gotten sick in the USA. I quickly learned more than I ever thought I would about how the Finnish system works.

Before I go into that, here is some background information. The fees I mention are what people pay for medical care, assuming they can afford to pay. Medical care is considered a right, not a privilege, so if people cannot afford to pay, it is free. So, all fees I mention are the most someone will pay out of pocket.

Prescriptions: When you get a prescription filled you pay roughly half the cost of the medicine, the government pays the other half. However, once you have spent roughly 620 euros on prescriptions in a single calendar year, your out of pocket costs go to 1.50 euros per prescription each time you fill your prescription. This is for most prescriptions However, for some diseases the most common healing/maintenance drugs are free (100% paid by the government) or mostly free (72% paid by the government). Examples of these include: diabetes, various cancers, epilepsy, etc. As in the USA, new and experimental medicines may not be covered,though they are reviewed on a regular basis and their status can and does change.

Doctor visits and hospital stays: Doctors visits are 22 euros a visit if you see the doctor. If you are getting routine treatment that a nurse does, such as allergy shots, wound cleaning (which I receive weekly), or something like that, if you go to the health center it is free. Also, if your combined doctor and/or hospital expenses go over roughly 500 euros in a calendar year, your doctor's visits are free and the hospital stay goes down from 26 euros a day to 22 euros a day for the rest of the calendar year.

Medical tests: Medical tests are free provided they are requested by a doctor. I have had assorted blood work, cat scans, x-rays, EKG's and other tests I can't remember off the top of my head, and my husband has had hearing tests and allergy tests, and we have paid nothing for any of these tests.

I was in the hospital for 12 days and the bill for the entire time - doctors, nurses, tests, the stay itself, etc. came to 312 euros. And, since it is covered by the government, it took no time at all to check in or out – I gave them my Finnish social security number and that was it. About a month later I got my bill,and when I called to see if I could arrange to pay it over 3 months (more to see if I could, than really needing to), it was arranged quickly and easily.

Once I got home, I still needed treatment. For over 2 months special visiting nurses came to my house at least once a day to take care of me. They provided all medical supplies except for some of my prescription drugs. They provided the special bandages I needed and the over the counter aids. The cost for a visit (including the supplies) was seven euros – and if the nurses have to come more than once during the same day, it is capped at 10 euros a day. I received this treatment everyday, including weekends and holidays. The cost never went over the 10 euro cap, no matter what the day or what time they came, including the time they had to come at 2AM.

After the two month period I was transferred over to the visiting nurses from my health center, which was more expensive, 22 euros for a home visit, but still very reasonable. I normally only needed them two times a week, but they were available if I needed them every day of the week, and holidays. Again, the cost did not change, no matter what day they came.

I need special bandages, some of which are very expensive. Every type my health center keeps in stock after I was ill for three months they gave me, for free, along with gauze pads to clean my wounds, gauze to hold the bandages in place, special tape to tape everything onto my legs, pads for my bed so when my legs leak fluid I don't make a mess, etc. All of this is given to me at no charge. I also need another kind of special bandage, which is a hydrofibre dressing which is not stocked by my health center. I have to pay for it myself, but the Finnish government gives me an allowance each month to help pay for it – and that covers about 75% of their cost. I am one of many people who receive assorted medical allowances to help pay for their medical problems. One of my friends has a daughter who is a celiac – she cannot digest gluten. Her daughter receives a grant each month to help pay for her more expensive special gluten-free foods.

My health center has also loaned or, in some places, has given me, medical equipment, at no cost to us. They gave me a special mattress for my bed which helps reduce the possibility of bed sores. They have lent me a cane to aid in my walking. When I needed it, they lent me a wheelchair and a stool for the shower (when I couldn't stand up long enough to get really clean). I needed some help going up or down one step into my bathroom and into my living room – they gave us metal grab handles that go in the doorway so I have something to hang on to, although we did have to install them ourselves. We are now in the middle of filling out paperwork which, if approved, they will even do some minor remodeling of our house to make it more handicapped accessible. If we are approved for the remodeling it will be done for us, at no cost to us for labor or supplies.

I am also covered under the Finnish dental system, where the government pays roughly 50% of my customary and reasonable dental bills – cleanings, fillings, root canals, etc. I had to have emergency dental work where one of my teeth more or less fell apart. I went to a private dentist instead of going to the public one, mostly because I did not think of calling the public one, and the private dentist was able to save the tooth with a giant filling and some other work. The work was quick and virtually painless and my out of pocket cost, which was a lot higher than it would have been if I had gone to the public dentist, was just under 80 euros!

We do not qualify for this, since my husband is in fine physical shape, but if I lived alone, or we both had medical issues, it is possible, through the health system, to get someone to come to our home on a regular basis to clean it. We would not pay for this help, the government system would.

If this was the USA we would probably be bankrupt by now, even with very good health insurance. Even the best health insurance would not pay for my special bandages since they are not prescription, and those alone, when you add up the cost of the ones I pay for and the free ones, are over 600 euros a month.

For the record, my 78 year old father-in-law, has had no problems getting medical help under the Finnish system. He has had cataract operations, was hospitalized after he had a stroke, and other assorted medical problems. The government system treats him the same as anyone else, despite his age. There are no “death panels” or people being denied treatment of any sort because of their age or state of health.

Now, as with all systems there are some drawbacks. The main one here is that we do pay more in taxes than you do in the USA. And, that is a drawback – none of us like paying taxes, and everybody, no matter their tax bracket, feels that they pay too much. However, I figure I can only wear one dress at a time, I can only drive one car at a time. There is a lot of peace of mind in knowing that we don't have to worry about health insurance or medical costs.

There are many social benefits in Finland that I will never take advantage of, such as free college education (college is competitive to get into, but if you get into it, tuition is free, housing and food is subsidized and students can get a student allowance for up to 55 months – most Finnish college students graduate with a masters because of the subsidized education). My higher taxes go to pay for this and other social benefits, but it also helps ensure that life here has a lot less crime of all sorts,lower infant mortality, less everyday violence, etc. Even though I have never paid any Finnish income taxes (though, of course, my husband has), when I got sick it turned out I was eligible first for a year of sick leave money, and then two years of unemployment money. Because I had not paid into the system I only receive the minimum, but that is still slightly more than 400 euros a month, and that makes a real difference to our budget.

Do I think the Finnish system is perfect – of course not. Every system could be improved. But, having been sick, and even hospitalized several times in the USA, I can state that if I had to be sick, not that I want to be, I would much rather be sick here, under socialized medicine, than back in the USA, even with the best medical insurance.

© 2009 Judy Gerjuoy