An Interview with AJ Layon, MD. FACP
The UK’s NHS
The United Kingdom’s (UK) National Health System (NHS) is a tax-system funded socialized – meaning everyone in, no one out – locally-controlled system that covers citizens of the UK from birth to death. Much like the hope some of us in the United States have for the development of our health system, the NHS covers inpatient and outpatient care, some dental care, rehabilitation, some eye care, some long-term care, and so forth.
Access to the UK’s NHS is based on clinical need, not ability to pay. All individuals, irrespective of their nationality or immigration status, are eligible to access primary, emergency and compulsory psychiatric care, free of charge. While there are significant problems with the NHS post-COVID Pandemic, most of this appears to be related to underinvestment in the system primarily brought on by the ruling Conservative Party’s austerity policies.
There is health system reciprocity between the UK and some countries, such that the UK citizen, if he/she were to become ill, is covered by the NHS while in the second country. The United States is not one of those countries.
The USA “Health System”
The Commonwealth Fund’s series of studies on the comparative health systems of the 11 wealthy countries they chose to evaluate showed that the United States system was always in last place for essentially all the metrics followed – cost, quality, access, etc. – and the NHS was one of the top performers.
This is not to disparage the healthcare workers of the United States – physicians, nurses, pharmacists, physical therapists, Respiratory Therapists, Social Workers, administrators – I would, and have, argued that these people get up each morning and go to work intending to do their best. Rather, it is the system we have in the US – one, if I may say, that some in the British government seek to emulate and which should be opposed – a private insurance-based model with a large portion of the system being, effectively, for profit.
It is this issue, that really differentiates the systems in the UK and the US. Even the “not-for-profit” portions of the US health system are focused on their profit margins. Even in the not-for-profit sectors of our health system does one find administrators paid in the multiples of millions of dollars yearly as salary, while scrimping on the salaries of health workers and staff.
So, you are in the US and You Get Sick…
What to do and where to go depend to great extent upon the degree of one’s illness. The organization of the US health system is centered upon hospitals. Essentially all hospitals have emergency departments (ED) to which you may present yourself if you are unwell. Generally, though, if the illness seems to be relatively minor – and I am aware that one cannot always tell the difference – searching the internet or asking your hotel for the closest Urgent Care Center is likely the best initial step.
Urgent Care Centers
Urgent care centers (UCC) can handle minor medical and surgical issues. And while they are not as comprehensive in their ability to provide care as is an Emergency Department, they are acceptable for minor issues. They can perform minor laboratory studies and may have radiographic capability. Thus, minor cuts, sprains, breathing difficulties, and so forth are appropriate for UCCs.
If the issue is, after initial evaluation, more serious than the UCC can handle, they will assist you in getting to an ED.
Emergency Departments
These are always associated with a hospital, although there are “satellite” EDs that, while associated with the hospital, are physically distant from the latter. EDs are able to handle any medical/surgical issue that the hospital itself is qualified to deal with. So, in this sense the ED is really the optimal place to go. However, the wait times are often long and they may be significantly more expensive than is the UCC.
If the ED to which you present yourself is unable to handle your problem/illness, they will get you transferred to a center that can handle the issue. For example, not all EDs – especially in smaller hospitals – have access to onsite Orthopaedic or Obstetric services.
Is Finding a Private Physician Appropriate?
Unless you are staying at a very high-end resort, with its own, or access to, retained medical staff it is most unlikely that you will be able to get in to see a private physician. This is not likely to be an issue, however. The clinicians in most of our EDs are residency trained and board certified; they are able to handle most urgent/emergent issues. If the ED clinician feels you need some follow-up – say with an obstetrician if you are with child – they will designate one for you to call and the ED staff will assist you in making the appointment.
Payment
While the literature is not always clear on the issue of cost versus charges, the definitions are relatively robust. The cost of an ED visit is literally the cost to the institution for the infrastructure – building, lights, water, staff – that allows the institution to be open for the provision of services. The charges for an ED visit are what the institution uses to cover its costs plus the markup to provide it with its return on investment (ROI, margin, “profit”).
The average cost (standard deviation not given) for an ED visit in the United States is $530 with a range, depending upon region of the country, of $480-$650. The average charge for an ED visit – that is, what you or your insurance company will be asked to pay – is $4,773 for all ED visits (Treat and Release as well as admitted to hospital) (8). The issue we have here is evident in the numbers.
If I were to travel the UK and became ill, the physicians and nurses of the NHS would care for me as needed. I would likely have a bill of several Pounds when I left; the same is true in much of the EU. As that is not the case in the private, bottom-line driven health system of the United States, how should the traveler plan?
Travel Health Insurance
The only way to navigate the US health system – unless you are one of the 0.1% – is with health insurance. The UK Government has a useful web page detailing the questions to ask of British insurers when contemplating a trip to the US. The UK government points to the web site of the Association of British Insurers (ABI) which details issues to consider before traveling from the UK to the US. the British Insurance Brokers Association lists products that may be purchased. One of the issues to be carefully reviewed is what is covered and what is not covered by the insurance products; the ABI details this nicely.
Finally, in addition to health insurance coverage, you might – depending upon your age and “infirmities” – want to think about evacuation insurance. This is insurance that will get you flown to your home hospital in your country if something serious were to happen. It is extremely expensive to pay for this out of pocket, so consider the insurance.
Final Thoughts
I wish you a pleasant journey in the United States. Please make sure you have allocated time that will allow you the opportunity to meet and talk to some of the people of our country. It is a place of contrasts, so you may be surprised at what you hear when you get into a conversation, but we are – like most people – open and kind.
Finally, as someone who has worked for 50 years – YES! – attempting to develop a national health system in our country, I apologize to you for not having succeeded.
Good luck and bon voyage!
- About Dr. Layon
AJ Layon MD is an intensive care physician/anesthesiologist who has worked in surgical/medical, trauma, and burn ICUs in and out of the country for decades. His last deployment was with Médecins sans Frontières to Nigeria. He is an active member of Physicians for a National Health Program (PNHP.ORG) and JVP (JVP.org).
For More Information about Dr. Layon visit: https://ajosephlayonmd.com/
