This week I had my first medical appointment in the US. Having only experienced mandatory government regulated health coverage so far, I was in for quite a shock.
Before starting I have to say that my husband and I are on an expat healthcare coverage in the US. Compared to our local friends we have the luxury of having mostly no copay situation. Still as the healthcare cost in US are ridiculously high compared to Europe. A routine check-up at the physician without exam will cost an american 200$, a Frenchman will pay 25€ (around 30$) for the same service. With cost so high, you better check with your insurance ahead of the appointment and have a contingency budget for emergency medical cost, if not you have to choose between giving up basics necessities or get treatment.
Lots of staff and spa like look
When I went to my appointment, I was surprised by the amount of people working at the ophthalmologist practice. Before actually meeting with the Doctor you first have to meet with some paramedical staff who asks you all the questions and does some unnecessary testing. If you come for an eye infection, what the point of having your vision tested first! At the practice I went to, all the rooms had huge TV screens airing advertisement for medicines and surgery and the latest designer furniture. I guess that after hearing during your 20 minutes waiting about a lot of potential eye diseases patients are scared enough to say yes to a lot of unnecessary medical testing. During the two hours I spent there I saw 7 people working there (2 receptionist, 3 doctors assistant and 7 doctors). To give a comparison my sister is a pediatrician in France, she shares a practice with another doctor and they have only one assistant/receptionist. In Germany physician are allowed to perform more exams in house (e.g. Cardio stress test) and they typically have one assistant and sometime an apprentice to help with those tests but nothing compared to a US practice and you first go see the doctor before taking any exam.
Immediately after moving to the US, I was surprised that Pharmaceuticals companies are allowed since 1982 to advertise for their new prescription drugs on TV. Watching the commercial in US is a good way to learn about all possible sickness and drugs… from psoriasis to diabetic nerve pain. Without being hypochondriac I wonder how constantly hearing about potential disease and a long list of knows side effects affects the average american.
In all other countries except for New Zealand direct-to-consumers prescription drug ads are forbidden. The only health related adds in France are for Over the Counter products or done by government funded prevention campaign like for AIDS testing, about the benefits of vaccination or against unnecessary antibiotic prescription.
Patients choose their prescription and get discount
After a two minutes exam, my eye doctor asked me to choose between two medicine without giving much explanation on the differences in both course of treatment. I guess that american come to the doctor asking for the latest medicine seen on TV and he was just trying to assess the situation and see if he would have to deny a request for an appropriate medicine. In France or in Germany the doctor will directly recommend a medicine and write the prescription, there is only a limited room to ask for one specific medicine.
I was rattled by the fact that there was sample of free prescription drug as a giveaway along with a coupon to get it discounted at the pharmacy. Doctors in Europe are not allowed to advertise or give promotional offers on prescription drugs, if they do so, they break the profession honor code and can face consequences with the board of medicine.
At the end of the day I work for a big pharma company who wants to cash as much return as possible on the result of years of research (developing medicine take years of development and a lot of the research is abandoned midway). I am very well aware of the tricks of the industry to get doctors to prescribe our latest medicine. Doctors in Europe are free to prescribe whatever they think best for their patients or the one who will get them a nice reward from the sale team but the mandatory health insurances operate as a safety net to control that only the necessary and adequate treatments are prescribed and that our insurance payments stay affordable from birth to old age.
Just for information here is a graphic from the OCDE on the health spend per country are you ready to guess by how much the US leads the spending race ?