While in Brazil a person very close to me suffered a very destructive paranoid psychotic crisis. We've tried help from the public healthcare but their earliest waiting time was 1 month. I've slept for days at the door because she was convinced there were Russian cameras and radioactive emitters planted at our house and wanted to run away. That person stopped to eat and bath and wasn't thinking rationally. We couldn't wait a month.
It was the worst time of my life. I had to pay a private psychiatrist to treat her. A very good one - we plotted together a plan to partake on her fantasy and administer a risperidone injection which was super effective. She is fine now and visits said doctor once in a year only.
Sure you can go to a general clinic but the doctor will forward you to the proper specialist queue which might take months or even years.
In the Netherlands I once sought an eye treatment for my wife. The local hospital only had a waiting time of 2 months. So I called my insurance company who then found another clinic ~45 minutes away by public transport in some small village, which had a waiting time of 2 days. Everything (besides the bus ride) was still covered by the public insurance system.
From a country that had it, it usually means: ugly hospitals, sad faces, long queues for treatments (I mean wait time for "free" treatment can be well over a year).
There is no free lunch.
On the other hand, I usually can get my kid to doctor same day, while using private healthcare provider (paid by my employer) it is almost impossible, 2-3 days wait.
On yet another hand, to get registered to my local doctor I need to use phone and start calling when they open up (8am) - sometimes I can't get to registration. The private healthcare has a normal website where I can look up registrations - so it is less time consuming (and automateable to some degree).
Private hospitals are rare here, and most of real work is done by public ones. Because the hospitals don't have enough money, they e.g. don't provide separate meals for people that need them (e.g. you had a digestive tract operation), so it is up for the family.
Good thing recently is that if your kid needs to go to hospital, there might beds for parent to stay with the kid (I'm not sure if that is that common in all hospitals)
I think the right solution is the middle - private primary care and public chronic & advanced care. India does this but loses out on effectiveness because of capacity problems and simply the huge scale it needs to work at.
Primary care is provided by private doctors and hospitals, so it is almost like a business. Doctors offices have websites, and get reviews from general public. You choose where you go to. All health insurances cover almost all of them. The doctor's offices are "competing" to provide a good service - being clean, solving problems correctly, not charging too much etc.
The government spends what ever money it allocates for healthcare on Public hospitals that focus on expensive medical equipment(labs, diagnostic machines etc), and treating chronically ill patients.
In an ideal world, you go to private doctors to figure out what is wrong, and then use the public facility if you can wait, and get the surgery/medicine/treatment for free. Often times, the private doctor refers you to a public doctor with a specific note that says this person needs this particular surgery using this particular medical device.
However, this systems leaves a big hole in catering to the poor who cannot afford to go to a private doctor for primary care owing to costs. No system is perfect. I think this model has the most potential for better healthcare.
I think a good entry point for making public healthcare better would be making each doctor visit require a small amount of money.
E.g. $1 or $5. This way people that go to doctor just to have a talk (because they are bored - yes that happens in public healthcare, because it is free so people abuse it) would free up the queue for people that really need the visit.
AFAIR there was such proposition in France some time ago, I don't know how they solved that.
I live in east Europe in a country with public healthcare (our system even considered to be in bad state). However if I have to choose between spending the saving of my family and spending a week or a month in an ugly hospital, I choose the latter without thinking. The doctors doing the healing are the same, the quality is the same, only aesthetics differ.
There are problems with puclic healthcare that needs solving, but I would much rather focus on thoose problems than pumping insurace companies with money so private hospitals can charge 10x-100x the price of a treatmant (compared to Europe for example).
Coming from Canada, and having had multiple large surgeries and hospital visits over the years, I've had an entirely different experience. We have universal healthcare and some of the best hospitals in the world. As well, the NHS in the UK is consistently ranked among the best healthcare in the world. I have experienced just as long wait times at U.S. hospitals as I have at Canadian ones, but with honestly far worse service as it felt like the doctors were trying to get me out of their sight as fast as humanly possible.
In the UK there is a department called NICE which uses health economics to understand how to best utilize the funding for the national health service to best improve health outcomes (generally measured by increasing QALY or Quality-Adjusted Life Years, but there are multiple measures in reality). This means that if there is a £500k treatment that could save the lives of a 70 year old, but there is a £1m treatment that could save the life of a 20 year old, and there is only budget for one, it would go to the £1m treatment because it has the biggest impact on QALY.
So the treatments that don't get approval are usually those that have a poor return. Note that it's usually the whole treatment that gets approved / denied rather than particular patient (or it is approved for a particular subset of people).
The other issue is capacity - so for instance, if there is only a limited capacity to perform MRI scans, then triage is required.
It's worth mentioning that in the UK you can still pay for private treatment, and thus avoid any queues. You can also buy insurance to pay for private treatment.
I know this is tongue in cheek, but all these countries also have private health options, so it’s not really a genuine argument against it anyways. If you were too poor to afford good coverage in the US, you wouldn’t be able to afford the private coverage in other countries either, but for rich people, private insurance is easily obtainable, for relatively cheap too, since they compete with “free”.
They aren't outright denied, just backlogged for years. Need a hip replacement in the UK, and you're a smoker? Good luck trying to get it within a year.
Because it turns out that healthcare is a service, and just making it "free" doesn't magically make it immune to scarcity.
