I’m traveling again today, but thanks to the musings of my type 1 friend across the pond, there’s something popping up here on SUM today.  Actually, I love this guest post, because Tom Hrebren gives a Brit’s-eye-view of the American health care system, and it surprised me a little bit.  And he opens with a little William Blake … 

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Tom of Brighton.  Not Maine.

These feet (ulcer free) walk upon England’s mountains green. Albeit in not so ancient times but the present times and unlike those mentioned in that hymn which is an anthem to public schoolboys such as I; they still carry me from A to B unlike the feet of Mr William Blake who now spins in his grave thanks to me hijacking his hymn.

Kerri has graciously invited me to do a little waffling here thanks to a few choice comments of mine on a link she posted on Facebook in relation to her post “Need vs. Want”. She doesn’t know what she’s let herself in for. (Cue evil laughter.)

I’m here to give an Englishman’s, therefore an NHS patient’s, views on the care received by Americans. 

Where to begin? Well, I suppose that I had best start with the quality of care. Here in the UK, where you live very much influences the standard of care that you receive from the nearest hospital to you. it’s called “The Postcode Lottery.” I myself have been a victim of it. My paediatric care was shocking. However, I am still under the same adult team at the same hospital yet my care is now fantastic. There are five DSNs (diabetes specialist nurse) for all the adult patients and two consultants. The two consultants have both cared for me and have been wonderful. The nurses are damn good, too. Compare this to the paediatric service: At the moment there is one dire consultant under whose care I was once under. There is one paediatric DSN who has to split her time between that hospital and its sister hospital. She is also abominable. 

In America, where you live seems to have little or no bearing upon the standard of care you receive as you can pretty much pick and choose who you see. If you want to do that in the UK, you have to get a referral to the team which you want to see. This is now much easier under Patient Choice than it used to be. Many parents of kids with diabetes that I know are referred (not without struggle) to Professor Hindmarsh and his team at University College Hospital, London, or other centres of excellence such as Leeds. This is because the care in their local area is dire and totally unsatisfactory. 

Technology is my next one. Many more type 1s in America are insulin pumpers than there are in the UK. This is because it seems to much easier in America for a consultant to get the insurance companies to hand over the cash for pumps and CGMs. Here in the UK it is vastly different. Pumpers such as I are fewer in number. Many have to fight tooth, claw, and nail to get them. This is for many reasons; number one amongst those is the interpretation of the NICE (National Institute of Clinical Excellence) guidelines on insulin pumping. In essence, if a consultant states that you are suitable for a pump and would benefit from it then by law the PCT (Primary Care Trust, an organisational unit of the NHS, soon to be abolished) has to pay for one. It’s all nice in theory, however in reality it is much harder as PCTs have been known to put pressure on consultants as they don’t like paying for them due to the costs of the initial outlay and maintenance of a pump. That’s the second reason. Thirdly, consultants can be positively anti-pump and their interpretations of the NICE guidelines can be horrible. 

Money, something that everyone understands easily. As an NHS patient I pay nothing towards my care directly. It is all paid for in my taxes. Americans are obliged to pay for private health insurance. Here some people choose to go private as they can afford to do so. Americans are obliged to. Sometimes the accountants seem to know what’s best for you, at least it feels like that. My major bone of contention is test strips for my BG meter. I get three hundred per prescription. This was upped last year from two hundred and fifty. When I suggested that to my GP (general pillock, whoops, practitioner I mean) she mentioned money and it being very expensive. Almost as if I was asking her to pay for my treatment herself. She gave in at the end. Had she put up more of a fight I would have asked for her to compare the cost of having me blue lighted to A&E by ambulance owing to DKA or an unnoticed hypo because I had run out of strips and the admission A&E, possibly HDU and ward after A&E. That usually gets the buggers. However, I will happily admit that the care I receive at the moment is the best that I have ever had. 

That said, ultimately you get what you pay for. If an American can’t afford a good insurance deal then they ultimately get substandard care which never fails to shock each time I hear a horror story about health care in America. What is nice to know is if I ever need to roll into A&E I will never be asked to provide my insurance documents. I have been told hair raising stories by former colleagues who have holidayed in America and been forced to fall onto the hospitals there.

How am I to end this before I drop into the “I’m going to rant all night” mode? It’s a sad note for me to end on but from what I understand and what I have learned of American health care over the years it is more of a profit generating industry. It seems to revolve more around the money than the patient than the NHS does. I fully understand that the NHS has its own financial issues, however, they are in different areas and sometimes less prominent. I’m glad that I pay for my health care through my taxes as then the government is the only person shafting me. To my mind the government is more accountable than a health insurance company and less likely to try rob you blind. I would hate to have to fight against a commercial giant. I just have to fight against a government, the playing field is more level and I find that I can use more back doors than I suppose I would if I were tussling with a private company. It’s pitiable, at least in my eyes, that something which is so vital to every person on the planet seems to be so greatly orientated by money. 

I’ve not covered everything as if I had, you’d be here well into the next century. Please don’t get me starting on overhauling the NHS as I have been known to go a bit mad at times …  

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Tom offered up his own bio, which I loved, and didn’t want to change a word of it because something about “I start scaring people in September” sounds awesome.  Note:  He doesn’t link to a blog, his Twitter account, or anything else social-media-y.  He’s a true trailblazer.  🙂 

Tom’s Bio:  What is there to say? My name’s Tom. I was diagnosed in August of 1996 (records have it as the tenth of that month). I’ve been pumping a year. Currently living in Brighton but soon to move to Oxford to become a student nurse, I start scaring people in September. I haven’t quite got a favourite tea, more a favourite beverage quite local to me – Harvey’s Sussex Bitter but I take my tea white with four sugars (twenty grams of carbohydrate). I apologise for the photo. It’s from my leaver’s ball at college and set the standard of photos of me for the next two years. I’m drunk. 

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