Flexo just wrote a piece yesterday entitled “Would you travel overseas for cheap surgery?”, and that’s as good an introduction to any for what I’m about to write. Truthfully, I’m not sure I’d be able to answer Flexo’s question without being forced to choose in a real situation.
Having just spent over two weeks in Spain, I had the chance to observe first-hand some of the differences between the Spanish and US healthcare systems. Some of what I observed might be specific to the town or hospital where I was in northwest Spain, and things might operate differently in, say, Madrid, for instance.
Here, in no particular order, are some observations that struck me, from a necessarily American perspective, I’m sure:
- Spain has a public/national health system. It also has private hospitals. If you use a public hospital, all expenses are covered, but wait times to see doctors are longer. If you use a private hospital, the health system doesn’t cover your costs, and you either pay for services out-of-pocket or through a private insurer, if you have one (much like in the States). Private hospitals and clinics are smaller, so serious health problems such as things related to neurosurgery or oncology, for example, must be seen in a public hospital.
- I was able to spend multiple nights in the hospital with my mother-in-law sleeping in a recliner chair next to her bed. I’m pretty obviously Asian, and not a blood-relative, but no one ever questioned whether or why I ought to be there. I walked in and out of the hospital, ward, and room at will. I can’t imagine this happening in the States (especially now with all the bioterrorism alerts, no doubt). In the intensive care unit, there were regular visiting hours, and you could enter in two-by-two once the nurse called the patient’s name, but those were the only rules. In some wards, there were strict visiting hours. In my mother-in-law’s, things were strikingly casual. Family and friends could visit at all hours except when the doctors did their rounds, at which point the nurses asked relatives to leave.
- As far as I could tell, there was no dedicated doctor assigned to my mother-in-law, which surprised me greatly. Medical consultations with family were done every Tuesday and Thursday between 11:30-1:30, and you stood in the hallway, asking out loud who was the last in line, and taking the spot behind them, awaiting your 15 minutes with the doctor who was doing the consulting that day. Her surgery was done by a team/duo of neurosurgeons, whoever happened to be assigned that day to surgery. Similarly, there was always a doctor on duty at night for the ward that, as far as I could tell, rotated as well.
- We believe that my mother-in-law was able to get admitted to the hospital and then to surgery sooner because one of the neurosurgeons there was a friend of my sister-in-law. Otherwise, she might have had to be admitted to the hospital but put in a room in a different ward unrelated to neurosurgery, wherever there was room to spare. Similarly, after my father-in-law was dissatisfied with the curt, 5-minute discussion the surgeon gave us immediately after my mother-in-law’s operation, we were able to call him up and discuss the matter over coffee. If we didn’t have this connection, I’m not sure what other options would have had to speak with a doctor.
- For whatever reason, everything in the hospital seemed very casual. Patients who could walk moved in and out of their rooms and wards, as did doctors and nurses. The funniest or strangest thing I saw proved how addicted to smoking Spain is as a country. There would constantly be groups of people (again, many nurses and doctors included) milling around the entrance to the hospital smoking cigarettes. There were also patients in hospital robes, IV and IV stand in one hand, cigarette in the other, smoking outside. I wanted to take a picture of this unbelievable scene but unfortunately never got the opportunity to do so.
- I found out that the doctors had based their decision to operate based on an MRI that had been taken a few months earlier, by a completely different doctor not at the hospital. As my father-in-law told my sister-in-law’s neurosurgen friend, this is not normal procedure in other countries. The neurosurgeon replied that it was quite standard practice in Spain, and another MRI would have revealed the same thing, so in other countries, this practice was probably done in order to charge more money to patients. He might have a point: the surgery went well, and probably due to liability and malpractice concerns, any doctor in the US would have ordered a new MRI done before he decided to operate. But I think I’d want a newer MRI done before doctors decided a tumor was operable, even if I had to pay extra for it. Maybe I’m a biased American.
- It seems the culture in Spain is not to question doctors, or nurses, nor the answers they give. There’s really no sense of urgency sometimes, which I found a little disturbing. My mother-in-law received medications at regular intervals, but no one seemed to know the names of the pills she was taking. It’s also customary for doctors to discuss a patient’s medical situation with his or her family members but use euphemisms and omissions when discussing the medical situation with the patient. Doctors won’t lie to a patient, but they also won’t tell them what they’re facing. For example, my mother-in-law was told she had a lesion, not a brain tumor, and cancer was never mentioned. My understanding, if correct, is that Japan is also like this.
- Similarly, when I asked if there were cancer support groups for patients or family, I was told such things didn’t exist there. Generally, people have extended family and a support group of friends, so the concept of getting together with strangers to share personal health and worries is somewhat foreign.
- The hospital food brought in for the patient was pretty impressive. Northwest Spain is known for seafood, and there was an abundance of choices on the menu each day, from which the patient could choose lunch and dinner.
I’m not sure how all of the above compares with the US because I haven’t had any first-hand experiences here. Moreover, I come from a family of doctors (my grandfather and grandmother overseas, my father and cousin here in the States), so I’m sure whatever opinion I have of hospitals and healthcare here is not the norm. I will say that regardless of what country you’re in, for better or worse, it’s always beneficial to have connections in the medical field, as they tend to prove useful for getting better and accelerated treatment. As I write, we’re still waiting for an oncologist to call and schedule an appointment to see my mother-in-law, so we’re back in the waiting phase of the Spanish healthcare system.
Would I go to Spain for healthcare? It’s hard to say for sure, but based on my experiences and understanding so far, my guess is that unless I were in dire straits and really could not afford healthcare here for treating a serious disease, or Spain had suddenly developed a miracle cure for something I were suffering from, I would probably personally opt to stay in the US.
This is probably also tempered by the fact that although I am sure there are horror stories in the US, I’ve personally heard far more terrible outcomes and abuses of the system in Europe than I have here. (For example, a friend’s grandmother was admitted to a hospital in Spain for a cold, and died two weeks later due to complications; in another case, there was only one doctor on call for over 100 patients in a hospital in Spain during Christmas because everyone else was off enjoying the holidays; and in Brussels, an American friend was appalled that he was required to receive general anesthesia when doctors fixed his broken nose.) My husband tells me that doctors in public hospitals in Spain have tenure once they’re hired, but I’m curious to find out what that means in the case of malpractice.
At the same time, I recognize that there’s a huge problem with the US healthcare system, in terms of cost both to patients and for doctors and, of course, provision. My cousin, an OB/GYN, pays $130K a year for insurance, which represents a nice chunk of his income, even if it is relatively high. I just wonder if there’s some way to find an optimal solution between what we have here and what’s available in Europe.