I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: Bajanne on October 13, 2005, 12:05:06 PM
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Rerun, I am doing as you suggested and starting a new thread concerning the cost of dialysis. I am still staggering from your quotations - "my fistula was $25,000 and my Hickman Catheter was $13,000". I could not believe when the surgeon quoted $3,100 for my graft and the hospital quoted $1,300. And it only cost that because I went to another island to do it. My Hickman Catheter was done for free.
They have not started to charge us for dialysis as yet, and I am hoping they don't get around to it for a while. But the hospital which was government run, now is under a statutory board, so I don't know what is going to happen. How much of the cost of your operations did your insurance cover?
I would like to hear from others what the cost are like where they are.
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Rerun, I am doing as you suggested and starting a new thread concerning the cost of dialysis. I am still staggering from your quotations - "my fistula was $25,000 and my Hickman Catheter was $13,000". I could not believe when the surgeon quoted $3,100 for my graft and the hospital quoted $1,300. And it only cost that because I went to another island to do it. My Hickman Catheter was done for free.
They have not started to charge us for dialysis as yet, and I am hoping they don't get around to it for a while. But the hospital which was government run, now is under a statutory board, so I don't know what is going to happen. How much of the cost of your operations did your insurance cover?
I would like to hear from others what the cost are like where they are.
Luckily In America Social Security covers 80% and my secondary insurance covers the other 20% I have been on dialysis for over 11 years and I have never paid a penny for any treatment or surgery. However I have heard of people in America who have a PPO for insurance and they go bankrupt because of having to pay for dialysis. That's why HMO's may not be the best, but for me I have NEVER had to pay a penny.
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For me, I use the VA so it doesn't cost me anything but time. Plus, I also file a travel claim 3 days a week since my condition is considered "service connected". The travel claim is a whopping $6.00/trip.
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In America, Epoman is right, Medicare does kick in. But, for me, it won't kick in until the 3 month waiting period is over. I guess they want to see if you can take it!! ;D ;D Then my insurance is primary (Pays 80%) and Medicare is secondary (Pays 20%). Then after 30 months (don't know where they came up with that) the coverage flip-flops and Medicare pays 80% and my insurance becomes secondary and pays 20%.
So, without Medicare at the beginning, you may have to pay 20% of all bills. That could wipe you out financially in just one surgery. I am under an HMO, which is basically a health care organization who contracts with certain doctors and hospitals. If you go to a doctor not contracted with them, they don't pay as much. If you stay with-in the contracted doctors they usually cover everything. I think the hospitals and doctors look at what insurance you have and if it a good one they go for the jugular.
If you ask in advance how much a procedure is..... they can never tell you. My scenario to them is.... "How would you like it if you went to the grocery store and got a gallon of milk and the cashier said he didn't know how much it would cost and they would just bill you. When you get the bill it is $845." Medical Costs here are outrageous.
People may say that they didn't pay anything... insurance covered it. But, you know what? Someone paid it. Whether it is the insurance company or the tax payer... someone is paying WAY too much for our dialysis treatments and our surgeries.
What is the answer?
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You would be very suprised at the difference between the cost to medicare vs. the cost to the private insurer. Typically under Medicare, dialysis costs about $133 per session and EPO is $10 per 1,000 units. That very same service by a Davita clinic to a privately insured patient costs $888 for dialysis and $107 per 1,000 units of EPO. That's one of the reasons insurance rates are so high.
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You would be very suprised at the difference between the cost to medicare vs. the cost to the private insurer. Typically under Medicare, dialysis costs about $133 per session and EPO is $10 per 1,000 units. That very same service by a Davita clinic to a privately insured patient costs $888 for dialysis and $107 per 1,000 units of EPO. That's one of the reasons insurance rates are so high.
Hey welcome to the board! Do me a favor and go to the "Introduce Yourself" section and make a new thread to tell us about yourself.
Also I love hearing numbers information like that. Welcome to the board but please go introduce yourself.
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I'm hitting this subject again because I received my Explanation of Benefits (EOB) for my trip to Spokane for Christmas where I dialyzed twice. $6,718.74........... You do the math. :P
I'm not worth $10,000 a week to keep me alive! And speaking as a tax payer.......Neither are YOU! My GOSH that is nuts!
The expensive thing is Epogen. In one of the above posts they talk about the costs differences with Medicare and Private pay for Epogen. I get 15,000 units a time. I'm going to ask my Dr. why I have to have so much. If 5,000 units keeps my blood count to a level that is sufficient, why give me 15,000......... is it "MONEY?" >:D
The Government would be better off to pay our families $100,000 if we denied dialysis!!!
And I'm speaking for myself here, but good grief some people in my center don't even know where they are!!!
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I got a pleasant and timely surprise from my insurance company last week. I had claimed for the dialysis that I did in Barbados - 3 sessions x $300. I thought they would have refunded 80% and maybe taken out my deductible for this year - 100, so I was expecting about $620. Well, first of all, it took so long. I filed since late December. But this is what made it pleasant - the check was for $900!! the entire sum. This made it timely - I got it just as I was to take my new car out of customs and the customs bill was $969!! How's that for timing!
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Thank GOD I live in one of the few 'civilized' countries that have hospital care mostly governement controlled.
Patient health care comes first, not profits. As ReRun says, in the end _someone_ pays.....so if you all pay thru
taxes, it will, in the end, be cheaper for everyone. If you have to have even a %age thru insurance companies,
there's a huge roll-on effect: as seen above - if the hospitals/surgeons see a good insurance company, they
rub their hands & bump up the cost....the insurance company has to make a profit for its share-holders,
so they bump up the premiums....so everyone's hit both ways. And big salaries/profits are made by a few. :o
Sometimes I think in the USA & elsewhere it's the HYPOCRITICAL oath the docs take, rather than the
Hypocratic!! ;) ::)
....for me this all means I haven't paid a cent. I would have been prepared to buy the Fresenius machine I
usse @ home, if it had come to that for home haemo. I think this even applies in some UK local health
authorities (?) ...but anyway, I didn't. It's worth $16500 (about$US11000) & is 'mine' for as long as I need it.
Queensland Health & my particular unit @ P.A. are great as far as I'm concerned! :)
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I've been lurking around since my last post, been reading about the costs both monetarily and just life style and such. I'm wondering, you can answer if you want or not, how many people feel it's all worth it. I'm not in the same shape most of you all are in, yet, but I'm beginning to believe it just doesn't sound like something I want to put my extended family through . Sure I'd miss seeing my grandkids grow up but then they wouldn't have to watch me deteriorate like I've seen other people do. Sorry to be so down, but I really am at this point considering all my options. Thanks for the area to talk about things you can't talk to your family and non-internet friends about
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Puppy, it is worth it to see your grandkids grow-up if you are having quality of life. I'm having quality of life, but it just pisses me OFF at the cost! I do not like being taken advantage of. If I could make a statement like on "60 Minutes" where they would watch me die because I refuse dialysis because of the cost, I would do it. BUT, if I quit dialysis now because of the COST, no one will care!
You hang in there! ;)
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I've been lurking around since my last post, been reading about the costs both monetarily and just life style and such. I'm wondering, you can answer if you want or not, how many people feel it's all worth it. I'm not in the same shape most of you all are in, yet, but I'm beginning to believe it just doesn't sound like something I want to put my extended family through . Sure I'd miss seeing my grandkids grow up but then they wouldn't have to watch me deteriorate like I've seen other people do. Sorry to be so down, but I really am at this point considering all my options. Thanks for the area to talk about things you can't talk to your family and non-internet friends about
I'm speaking just as a family member of someone on dialysis...
It's not a burden to me to help or care for my husband. I don't care how much it costs, how much time it takes, whatever inconvenience it is, he is worth it. I'm sure your family feels the same way and would be brokenhearted and devastated if you chose not to continue. There are so many advances in medicine happening, you don't know what's just around the corner. I hope you can stay strong and work through things.
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Pup,
I think that at one time or another we all have the same thoughts as you are having- but I have to admit that this PD is not near as life-altering as I had anticipated it to be. I hook up every night, go to sleep with the cycler programmed and in 9 hours I wake up and am done with dialysis and the day is mine to do with as I wish. You aren't a burden to anyone, as long as you can hook up the bags to your machine and empty the waste water in the morning yourself. I can travel, I can visit my grandkids, I can garden, and do most all things- I just have a little tube in my abdomen...I do give myself a shot once a week, also no big deal, to keep my anemia at bay. Please, please ask questions, get answers, know all your choices, so you can make an informed decision- that is what I did, even though my Neph. wasn't exactly for it. It is our body, we can make our own choice. Good luck and write again.- Anja
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Anja,
What do you mean "even though my Neph. wasn't exactly for it"? Please expand on this. I curious what he wanted you to do. ???
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Puppy, it is worth it to see your grandkids grow-up if you are having quality of life. I'm having quality of life, but it just pisses me OFF at the cost! I do not like being taken advantage of. If I could make a statement like on "60 Minutes" where they would watch me die because I refuse dialysis because of the cost, I would do it. BUT, if I quit dialysis now because of the COST, no one will care!
You hang in there! ;)
Thanks for the input everyone. But that's what I'm talking about the quality of my life. It just seems that today is always worse than yesterday in how i feel and what I'm able to get done. I seem to be at the midpoint at about 18% function, not bad off enough to get real medical help, just bad enough to get nothing accomplished anymore. I am lucky in that the company i work for is very understanding, but it's like in the post about stupid things people say to you, I must look really bad because every day somebody(s) telling me I look bad. Always something you want to hear.
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Ahah!!!!! SO you're functioning @ 18%, 'Pup, & therefore not on any form of dialysis!???
...if so then many of us will know how you feel...the Oz phrase is 'ratshit!' ;)
You are in the process of 'sliding downward', which they don't seem to be able to do
much about until you actually need dialysis.
I didn't really realise that IgaN was dragging me down. With the sickness every morning
(I knew I wasn't pregnant! :) ); the 'fall-over' weariness & certain other 'discomforts'....
well to be honest I thought I might've had the "Big C' in some (presumably terminal) form.
So in fact, I was quite relieved when I eventually ended up in hospital & found out the real
deal ::) ...then unfortunately, I spent a year on P.D. & in my case, it just did not work.
During that year, I wasn't sure whether it was all worth it either. I was so low anyway, when
I went in for my first catheter surgery, I thought dying under the anaesthetic was as good an
option as any :o ...same with the 2nd op., ... same when I went in with rapid heartbeat
...same with my fistula ops.
BUT!!!!!...once I got onto haemo, I started to pick up. O.K., so I still feel 'ratshit' for a few
hours after haemo, but later & on the alternate days, I feel good! Well...not bad for a 57y.o. ;D
SO...hang in there 'Pup - whichever method (P.D./H.D.) works for you, it should have you
climbing back out of the 'pit' you are currently unfortunately sliding into. ;)
...if you're a drinker, enjoy a few beers or glasses of wine, while you're still not on fluid restricts.!
;D
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Bear is right. You feel like "ratshit" now, so when they put you on dialysis and you upgrade to mousepoop you are thankful! ;D
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"Mousepoop"???? :) Oh! I'm way above that now ReRun. I would say up to "bovine excreter"...but everyone I know
would say I've been full of that for years... ;D
My wife says she knew I was getting better when I started to heckle the telly & get 'cheeky' with her.....after 2 years
of near-silence, she reckons! ::)
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Rerun,
My Neph. is more for the hemodialysis route than the PD- And since my dad is on hemo, and doesn't fair too well (b/p issues and washed-out after treatments) I wanted badly to try pd and have been so extremely fortunate that it is working so well! But , had it not been for the internet, I would not have known I had choices other than hemo. Anja
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Rerun I really like that term "mousepoop" makes me laugh ;D
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In America, Epoman is right, Medicare does kick in. But, for me, it won't kick in until the 3 month waiting period is over. ...
The director at the Atlanta DaVita clinic told me that if you start training for home dialysis during that first three month period, Medicare will pick up the cost of the first three months. Medicare has finally figured out that home dialysis saves them money in the long run and do this as an incentive. Every dialysis center should be familiar w/ the procedure of back billing for the first three months -- if they're not, then they can call Medicare for instructions.
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Actually, that has always been the rule. 20 years ago when I first started, I had to do home dialysis because I lived 2 1/2 hours away from a major medical facility. Medicare started immediately for my home dialysis. OK then I was transplanted for 17 years......
So, this time I was told I had a 3 month waiting period. I am in clinic this time. So, I get my card (finally) and it had a start date of 9/1/2005........ It should have been 12/1/2005..... Plus they started the premium back in September too and my first bill was something like $600. So, I called them and they said that because I was on dialysis before (20 years ago) that there was NO waiting period this time!!! WTF SO, now I have to notify my insurance and all the Dr. etc that Medicare was indeed my secondary those 3 months!
I'd like to find the "dumb ass" that told me I had a 3 month waiting period!! >:D
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In the beginning I had no insurance so I applied for Medicare and Medicaid and paid all the bills for the work ups on my own. 28 and no job, it tore thought my savings then I got benefits but did not qualify for Medicaid. So I ended up paying 20% went even further into debt and collections. I got a transplant very fast (before I knew what was really going on) and went back to work right away. I paid $1000 deductables a year and more for drugs and co-pays, never really dug out of the hole. Three years went by and I was starting to make some headway at restore my credit and financial situation when my kidney rejected. I was put back on dialysis and continued to work for about a year and a half still the bills were overwhelming, my company's insurance company denied my claims every quarter and I had to call and straighten them out (I think they did this on purpose to see if they could get out of paying the bills). i came to a place where working was not "working" for me any longer so I left and took the COBRA coverage almost $500 a month. Between the Ins. company denying bills and me not working any longer I have gotten deep and deeper into debt, thank god for my family they have helped me very much. I cannot afford and apartment let alone a house have no assets, credit cards.. etc. nothing someone normally my age (36) should be working on. No 401K or retirement plan (if I get that far). It is depression and a constant battle with the government and insurance company's to pay bills. I spend at least a couple hours a week trying to work it all a out. I recently went back to work because I could not afford to live on Social Security and pay my medical bills, I know I should not be working now it drains me and I feel tired all the time, also I have no time to myself 8-5 M-F Dialysis M-W-F 5:30-10. This truly has been the hardest part of being sick to me, all my financial goals have gone up in smoke and there is no easy solution!! I too looked at my bill for dialysis it was in the range of $29,000.00 a month CRAZY, I say give me the money I go have a good time for a couple of weeks then die... at least I'll have fun for a couple of weeks right??? Well that is my rant....
Geoff
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I received a billing statement from my Nephrologist's Office today.
The last one I received was April 2005.
4/5/05 Office Visit Established PT Charges $150 Payments $110
11/1/05 Hemodialysis Charges $475 Paid 273 (I have no idea what this is for)
1/1/06 Dialysis 1 visit per month Charges $370 Paid $167
2/1/06 Dialysis 2-3 visit per month Charges $465 Paid $456
3/2/06 Hospital Visit Charges $100 Paid $97
3/7/06 Dialysis 2-3 visit per month $370 paid $166
4/1/06 Dialysis 2-3 visit per month $465 paid 209
5/1/06 Dialysis 1 visit per month $370 not paid yet.
What a racket. For 3 minutes if their time they charge $370 and get $166? AND that is PER Patient.
I don't know why I posted this except the cost of dialysis makes me nuts.
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I received a billing statement from my Nephrologist's Office today.
The last one I received was April 2005.
4/5/05 Office Visit Established PT Charges $150 Payments $110
11/1/05 Hemodialysis Charges $475 Paid 273 (I have no idea what this is for)
1/1/06 Dialysis 1 visit per month Charges $370 Paid $167
2/1/06 Dialysis 2-3 visit per month Charges $465 Paid $456
3/2/06 Hospital Visit Charges $100 Paid $97
3/7/06 Dialysis 2-3 visit per month $370 paid $166
4/1/06 Dialysis 2-3 visit per month $465 paid 209
5/1/06 Dialysis 1 visit per month $370 not paid yet.
What a racket. For 3 minutes if their time they charge $370 and get $166? AND that is PER Patient.
I don't know why I posted this except the cost of dialysis makes me nuts.
You get 3 minutes :o Damn what do you guys talk about that takes that long ??? Your doctor must have ALOT of free time to be wasting that much time on you. Damn 3 minutes, WOW. He must be one nice doctor. Your lucky!
;) ;D
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I honestly dont know how people can afford to pay for dialysis unless you have a very high paying job or you have a big hunk of savings? I can barely afford to pay for my meds and thats only about $50 a month! I am so greatful that everything else is free. I have asked this question before but never got an answer. Im not being rude, I am just intruiged.
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I don't even think Bill Gates could live very long paying for dialysis. The cost is horrific and uncalled for. OMG, dialysis has been around for 46 years! It is not new and the machines don't keep changing "that" much anymore. I think we'd be appalled to know how less it "really" cost.
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I don't even think Bill Gates could live very long paying for dialysis. The cost is horrific and uncalled for. OMG, dialysis has been around for 46 years! It is not new and the machines don't keep changing "that" much anymore. I think we'd be appalled to know how less it "really" cost.
ya!!
That is what scares me! I am canadian but want to marry an American! But the problem with that is the cost! I worry so much because with me being lucky enough to live in such a great country that I don't pay for hospital stays ever or any surgeries no matter what .. I still ended up having to claim bankruptcy when I lost my kidney transplant! Man I got so depressed because I worked 9 long hard years at that job and was up for a promotion and then the transplant rejected and I lost everything! 12-hr shift job gone! Promotion gone! Bills .. stack up (power, water, rent, credit cards, car payments, etc) .. now I live in a subsidized-apartment and have no car and don't work and am on disability (did take 9 months to get accepted for that though so I had to temporarily go on Welfare which I did not like)...
I hear how there is no coverage in the States and it makes me scared! I mean .. if I ended up with all this happening financially here then DAMN!! What would happen to me in the STATES!?!?!? :o
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Well, the new hospital board is kicking in. The hospital is no longer directly under the Ministry of Health. There is now a Health Care Board in charge.
Some weeks ago, I had a visit from a lady with a clipboard. I had to let them know my insurance details. Dialysis will no longer be free - my insurance will have to pay for it. My problem with that, is that this means that when I stop working for the government, I will no longer be covered and will be unable to start a new insurance because of my pre-existing problem. That means I will have to return to my home country where health care is free.
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In the US if you work for the Government and retire on disability you health coverage continues. The government still pays their share of the premium and your share comes directly out of your disability check. The problem with that is insurance premiums keep going up and my disability check doesn't. It will get me sooner or later.
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I think the most costly thing so far, has been the toll on my mind and body. I'm not ashamed of what the monetary cost of keeping me alive is, its about time I can enjoy some of the tax dollar's I paid when I was able to work.
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Medicare becomes your primary insurance after six months in the United States for dialysis patients. You have a copay that is going up to 100 bucks a month if you have private insurance and are on Part A, like I am. They pretty much pay for everything. I have a copay for medications and the monthly premium for part A. They say they will pay for a dialysis patient up to three years after transplant, then they say you better have a job and insurance. What fun!
Katherine
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Medicare becomes your primary insurance after six months in the United States for dialysis patients. You have a copay that is going up to 100 bucks a month if you have private insurance and are on Part A, like I am. They pretty much pay for everything. I have a copay for medications and the monthly premium for part A. They say they will pay for a dialysis patient up to three years after transplant, then they say you better have a job and insurance. What fun!
Katherine
Katz, Medicare becomes primary after 30 months on dialysis unless you become age 62 in the mean time.
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That is what i heard too, 30 months. Almost half of my disablility check goes to my medication, i hate that... So all you who get free meds, if you have any extra's just slap 'em in the mail and i shall dispose of them properly ;)
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Yeah well I been at it more than 30 months so mine became primary awhile ago. You all are probably right. I am costing the government a friggin fortune.
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and you are worth every single cent girlfriend, I THINK WE ALL ARE....
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And then sometimes at home care is needed. Just checked on that for my father. $17 dollars an hour, minimum 3 hours a day.....so thats what, at least(AT LEAST) $51 dollars a day for care. The blood thinner shot he got at the hospital Friday night was like $10,000. CRAZY
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wow ... I get heperin at high doses in my dialysis treatment .. it would be expensive for me in the STates :(
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The CNAs who are doing our home care such a laundry and cooking for my hubby earn 19 an hour.
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Well damn, i do more than that for MY hubby, shit, i am hittin' him up for a raise dammit....
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hahahahah I hear that goofynina!
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Medicare becomes your primary insurance after six months in the United States for dialysis patients. You have a copay that is going up to 100 bucks a month if you have private insurance and are on Part A, like I am. They pretty much pay for everything. I have a copay for medications and the monthly premium for part A. They say they will pay for a dialysis patient up to three years after transplant, then they say you better have a job and insurance. What fun!
Katherine
Does the government ever look at anything and determine what is the most cost effective way to go instead of what is the cheapest in the short run? Having a transplant fail because a person can't afford the antirejection meds is certainly NOT cost effective. It may save a little for the few months or few years between the time they stop taking the meds and when they get very ill and go back on government paid dialysis. The patients and their families suffer the consequences, and the medical facilities have to cope w/ patients who shouldn't be there. Stupid, stupid, stupid!!
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It's a complicated subject. I have mixed feelings. My father's neighbor here in Atlanta gets free rides back and forth to dialysis(thanks to the State of Georgia). She lives with her son in a 250K + house. But my father has to pay for the ride. Don't get me wrong --- I don't "wrong" her from taking the free ride. Just kind of doesn't seem fair .....just because my father has a couple of assest......and she was smart enough to put all hers in her sons name. Just the whole system is "not fair" but neither is life and neither is having to go on dialysis. Like I said , mixed feelings on the whole thing- this subject could get deep!
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We are able to get the ambulance to dialysis and appointments for free. But it has to have the doctors consent. I dont do it anymore as I am able (just) to get the bus. If I am unwell I will certainly get the ambulance, as theres no way I could walk to the bus stop.
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In Canada it is different. In my province I have what is called O.H.I.P. (Ontario Health Insurance Plan) so all my care is paid for (not medication or transportation however). Then on top of that I have O.D.S.P. which is disability (but not through a pension plan .. I am not old enough for that kind) which pays for a taxi cab service for me (but since I am "on account" I am not allowed to ask for a certain driver which sucks because at times I have a hard time with the van doors and the driver will just look at me and say "pull it harder" when I just got out of dialysis and feeling very weak with a bp of 96/54 ...) and I get my meds paid thru Disability and just pay a co-pay per med of $2 (which in the USA is what? ... $4? lol).
Anyway, people get mad at me because I have it "easy" but then I retorn "I worked 9 long years trying to get ahead before I lost my transplant! I went to College trying to get ahead!! And you say I don't deserve this because why? My transplant failed before I was able to get that promotion that would have gotten me coverage thru work and given me that pay raise I have been working extra hard for for many years??"
People get me mad when they judge others.
If you can get care I say GOOD FOR YOU!!! I AM GLAD YOU ARE LUCKY ENOUGH!!
I had to claim bankruptcy .. couldn't keep renting the house I was in and now live in a tiny one-bedroom subsidized apartment building and lost my car since some old lady totalled it when she ran into me because didn't see my right in front of her. She is still driving while I am stuck with the non-door-opening cabbies while I had a clean driving record for 16 years!!
(sorry for my rant :-[ )
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(sorry for my rant :-[ )
Not at all. This is what this site is for. You have certainly been through the mill. It is a tribute to the human spirit that you are still fighting and going on. My encouraging thoughts are with you right now.
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(sorry for my rant :-[ )
Not at all. This is what this site is for. You have certainly been through the mill. It is a tribute to the human spirit that you are still fighting and going on. My encouraging thoughts are with you right now.
Thank you :)
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I thought I would give a little roundup of costs here in France and how things work.
Anyone with kidney failure will have that indicated on their Social security record as a long term affliction. This means that 100% of the costs involved with the afflication will be covered.
In clinic dialysis session cost is about 320 euros/405 USD
Which represents approximately 3840 euros/4860 USD monthly
PD supplies monthly delivery used to cost around 1400 Euros/1775 USD.
Patients on PD have two options:
-a nurse comes and helps do the setup each time
-the patient does everything himself.
I took the option of doing everything myself, otherwise that really defeats the purpose of in-home care.
Because of that I got about 320 Euros/405 USD monthly as a personal care allowance. It's not much but hey it's better than nothing especially when you're not working ... :-X
Medication and transportation is also covered 100%.
It is the norm for everyone to take either an ambulance or a taxi to go to dialysis.
If you want to come with your own personal vehicule that also gets reimbursed.
Now that I have had my transplant I have to continue going to follow up appointments in a city an hour and a half away.
I have been taking the train but I could go by taxi or ambulance and that would cost around 500Euros+ 650USD+ round trip.
Medical transportation is a very big business here and the companies tend to try and commit fraud.
It is expected that in the upcoming years there will be a tightening of medical transportation authorizations delivered by doctors as the yearly bill for the country is approaching 1 Billion Euros 1.30 Billion USD.
As a whole the social security system here has been in debt for years and years but it is progressively getting better for them as they are forcing doctors to prescribe generics and any form of cost cutting. But so far so good the quality of care has not dropped.
I much prefer the prospect of doing dialysis in France than in the US even if sometimes here they make it a little too much like assisted living. That being said I am still very p*ssed off I had to leave the US because of my health problems :(
Any ESRD patient can go through the procedure to become declared disabled. It is a very long and painstaking process. You have to go before a commission that reviews your case and that can take anywhere from 6 months to a year. The "good" thing is that by the time you have become declared, disability paiements are retroactive to the waiting period.
I personally have refused to try and go that route as I don't even think I could claim any money as I never really worked in France.
And the monthly disability they give you is ridiculously low ( 500 Euros or so 630 USD )but if you get a high paying job ( which I hope to get quickly in Switzerland which is 20 minutes away **fingers crossed ** ) they take it away ( not 100% sure about that ).
If declared disabled you can also get help with your rent.
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Thanks for sharing that with us. Very interesting the difference from country to country. In my home country, Barbados, everything is taken care of, healthwise, if you use a public clinic. Even if you go to a private doctor, all medication is free if (a) your condition is chronic and the doctor prescribes medication from a book called the Drug Formulary (b) if you are under 16 or over 65 (c) if it is prescribed at a public clinic and the prescription filled at the hospital or clinic pharmacy.
The difference between public and private healthcare is the wait.
When I return home to live, my dialysis will be free, and if I have transportion problems, a van will collect me and take me back home but only if I am 65 and over.
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It's great to hear about all the people whose countries give them "no cost" healthcare.
It's not so great that most of the people working hard in those countries are paying around 50% in income tax, as well as VAT on many of the goods they purchase.
(I don't know that Canada is this way, but most of Europe is)
Those of you saying that you don't pay for your healthcare: YOU ARE. Thankfully your systems make your personal out of pocket expenses minimal - and that can be a God send. It's not free though - to anyone.
When I lived in Germany the income tax rate was at about 49% - I believe it is higher now. And when I'd go to the doctor, I might wait for several hours to see him.
I'm not Pooh-poohing these systems, just pointing out that there is no such thing as free-lunch. Someone pays for healthcare. In this country, insurance companies have sold the idea of "shared risk" to everyone, making us all think we can't possibly live without health insurance. A large pool of people pays in money, and statistically most are healthy. The insurance company then does their best to never pay a penny, and someone keeps the remainder. Even if they don't, they're able to make interest on your money as long as they can delay payment. Some companies in fact make most of their money "floating" it.
Those of then who are considered high-risk, are not allowed to join the pool of people who have agreed to share risk. What?! That doesn't make sense does it? no... but it's true.
Many of us who are chronically ill have only one shot to receive decent medical insurance: open enrollment either through our employer or a spouse's employer. Those of us who either own a business, or work for a small business, are sort of left out.
I certainly don't know what the answer is - it's a difficult issue. There will always be someone who thinks everyone in the world should have free healthcare, but the reality is that someone somewhere has to pay for it. Especially if we want companies to invest in research and develop new drugs and treatments.
Heck, I want free healthcare for everyone - but I don't know how to accomplish free anything for anybody.
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You are right, all working people pay a health levy - about 1%. But it is worth it.
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It's great to hear about all the people whose countries give them "no cost" healthcare.
It's not so great that most of the people working hard in those countries are paying around 50% in income tax, as well as VAT on many of the goods they purchase.
(I don't know that Canada is this way, but most of Europe is)
Those of you saying that you don't pay for your healthcare: YOU ARE. Thankfully your systems make your personal out of pocket expenses minimal - and that can be a God send. It's not free though - to anyone.
When I lived in Germany the income tax rate was at about 49% - I believe it is higher now. And when I'd go to the doctor, I might wait for several hours to see him.
Ya in my Province we pay 15% taxes .. oh wait it was just lowered last month to 14%!! Woot! but I would rather pay a bit all the time and have my health coverage guaranteed than get ripped off by health insurance companies in a country that knows it is in high demand because your health coverage is nill!!
Sandman keeps saying that I could get disability easily in the States or he can get coverage when I get over there even though I would rather him have coverage well in advance. I have asked my dialysis unit social worker to look into which dialysis units are best in the Philadelphia area and what is the best route to get coverage but she said she only knows Canada and not the States and told me just to research on the net but I have found very very little besides the typical "We are the best unit in the world! Come here!" type places...
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I dont really understand. How am I paying for my healthcare (surgery, hospital admissions, tests, appointments) when Im not paying for it? :-\
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I realize that the money in the end is always coming out of someones pockets ( the population in one way or another ).
Socialized care is very debatable.
But not to raise any controversies I believe the quality of care I am able to get here is superior than what I would have had in the United States. I am comparing my time with the clinics in the US and France and whenever I was in the US clinics I hated it.
This may come as a shocker to some of you and you might think I'm plain crazy with my stupid philosophical thinking but here goes. I am aware it raises a big moral dilemna.
Who is to blame or take charge of the seriously ill? The ones who did nothing wrong but live life and get hit with kidney failure, cancer, diabetes or what else.... the list is long.
Are they at fault? I think not
Said diseased person is innocent but why should they have to suffer more ( from a financial point of view ) than they already are when there is in essence no reason to blame them.
But at the same time, why should the cost of keeping these people alive come back to society as a whole?
Controversy controversy when you hold us close!
Sorry I ask myself too many questions and I need to stop reading philosophy books.
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I dont really understand. How am I paying for my healthcare (surgery, hospital admissions, tests, appointments) when Im not paying for it? :-\
taxes.
But at the same time, why should the cost of keeping these people alive come back to society as a whole?
Controversy controversy when you hold us close!
Sorry I ask myself too many questions and I need to stop reading philosophy books.
Well, that is why I think taxes are a good way like in my country because no one knows if they may get hit with ESRD or have a child born with it or something that leads to it as in my case! :( Since anyone can be hit at any time with any disease ... everyone should pay taxes ... it helps everyone in the long run. In my country I don't have to worry about the medical costs added to my already surmountable worries ..
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The GST is a tax that you pay on most goods and services sold or provided in Canada. In some provinces, GST has been blended with provincial sales tax and is called HST.
The GST/HST credit helps individuals and families with low and modest incomes offset all or part of the GST or HST that they pay.[/QUOTE
Jdat: you're right, it is a very difficult issue to discuss fairly. In the end, someone has to pay for everything, and none of us want to pay for things we shouldn't have to! :) It's difficult to establish "who" should have to pay for healthcare in society. I'm in a precarious position in that I'm fiscally very conservative, yet require help financially to be able to survive. It's hard to argue logically that I'm "owed" this, though who of us doesn't feel compassion for those truly in need?
It's a difficult issue - I hope everyone understands I'm just enjoying the discussion about it - in an effort to better understand, and possibly shift my own thinking. I'm not trying to argue with anyone.
Angie,
don't you also pay a VAT or some sort of consumption-based tax on all sellable goods?
Meaning, above and beyond sales tax, do you have another fee or tax associated with purchasing items (either domestic or imported)?
The tax is collected somewhere - I'd be curious to know without a VAT or consumption-based tax what your average sales-tax rate is across the different Provinces.
After reading about Canada's income tax on their website (http://www.cra-arc.gc.ca/E/pub/tg/t4133/t4133-e.html), it seems there is something similar to the VAT, though it is called the GST (Goods and Services Tax), and lower income families can receive a tax credit to offset its cost.
EDITED: Fixed Quote - Goofynina
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The GST is a tax that you pay on most goods and services sold or provided in Canada. In some provinces, GST has been blended with provincial sales tax and is called HST.
The GST/HST credit helps individuals and families with low and modest incomes offset all or part of the GST or HST that they pay.[/QUOTE
Jdat: you're right, it is a very difficult issue to discuss fairly. In the end, someone has to pay for everything, and none of us want to pay for things we shouldn't have to! :) It's difficult to establish "who" should have to pay for healthcare in society. I'm in a precarious position in that I'm fiscally very conservative, yet require help financially to be able to survive. It's hard to argue logically that I'm "owed" this, though who of us doesn't feel compassion for those truly in need?
It's a difficult issue - I hope everyone understands I'm just enjoying the discussion about it - in an effort to better understand, and possibly shift my own thinking. I'm not trying to argue with anyone.
Angie,
don't you also pay a VAT or some sort of consumption-based tax on all sellable goods?
Meaning, above and beyond sales tax, do you have another fee or tax associated with purchasing items (either domestic or imported)?
The tax is collected somewhere - I'd be curious to know without a VAT or consumption-based tax what your average sales-tax rate is across the different Provinces.
After reading about Canada's income tax on their website (http://www.cra-arc.gc.ca/E/pub/tg/t4133/t4133-e.html), it seems there is something similar to the VAT, though it is called the GST (Goods and Services Tax), and lower income families can receive a tax credit to offset its cost.
Every Canadian Province has their own taxes on top of the GST (Goods and Services tax). Quebec has the forementioned HST (I believe it is Quebec since that was not a quote of mine) and in MY province we pay PST (Provincial Sales Tax).
I don't know what VAT is.
EDITED: Fixed Quote - Goofynina
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The VAT is a "Value Added Tax" - it's a consumption based tax.
Basically there are two times you can tax people:
When they make their money, and when they spend their money.
Taxing at the back end, (consumption based tax) encourages saving, as you pay less up front in taxes, and more when you spend it.
Here we pay a high federal income tax, plus a state income tax (unless you're in Oregon is it?), plus a sales tax (state, city, and county).
The Government would make much more if they abolished the federal income tax, and charged either a consumption based tax (just a high sales tax), or a flat rate tax for everyone.
The point is that we pay for our healthcare, whether up front or not.
Just like here in the U.S., many think that because they don't personally write a check for their health insurance, it's free from their employer. They don't realize that the employer has already figured this into their salary.
How do you find the Canadian standard of care? I've traveled all around the U.S., and even out of the U.S. (Bahamas) for dialysis, and have had very different experiences in each clinic. This is the reason I try to do as much of it myself as I can.
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The VAT is a "Value Added Tax" - it's a consumption based tax.
Basically there are two times you can tax people:
When they make their money, and when they spend their money.
Taxing at the back end, (consumption based tax) encourages saving, as you pay less up front in taxes, and more when you spend it.
Here we pay a high federal income tax, plus a state income tax (unless you're in Oregon is it?), plus a sales tax (state, city, and county).
The Government would make much more if they abolished the federal income tax, and charged either a consumption based tax (just a high sales tax), or a flat rate tax for everyone.
The point is that we pay for our healthcare, whether up front or not.
Just like here in the U.S., many think that because they don't personally write a check for their health insurance, it's free from their employer. They don't realize that the employer has already figured this into their salary.
How do you find the Canadian standard of care? I've traveled all around the U.S., and even out of the U.S. (Bahamas) for dialysis, and have had very different experiences in each clinic. This is the reason I try to do as much of it myself as I can.
Taxes in each province is different in Canada. But in my Povince it is only 2 taxes that equal a total of 14% (7% + 7% ... used to be 7% + 8%).
But I rather be taxes then be sick and suddenly be screwed because you can't afford your health care.
I like my care here. I have no real complaints .. just things that could make it better. And EVERYONE here gets EQUAL care because we don't pay out of pocket right there.
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However it is paid for, costs are inflated for most if not all medical services and not REAL costs. I think the US medical system is basically broken, but that is just a personal rant.
I'd pay the taxes to know people could get what they need, and felt that way BEFORE chronic disease struck our family. That said I suspect most of the developed world is paying more than they really ought to have to pay while exorbitant profits are made. Meantime, preventative health care is neglected. And research is guided entirely too much by "profit"...
I could go on, but I'll spare everyone... ;D
Mom 3
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I think research has to be spurred on by profit, because research takes money, and for people to put money up, they will want money back.
There's nothing wrong with profit. I agree that greed has run rampant, but I don't think adapting a "profit is bad" mindset is the answer. It's people's desire to succeed that spurs innovation and research in these areas.
My Brother in-law is an eye doctor, and has so many restrictions places on him by the insurance companies. It's ridiculous - Here we are in a privatized, free market, and he can't charge what his time is worth. He either has to do work for free, or not spend the time he wants to examining patient histories and writing letters to their other physicians. His time is worthless in the eyes of the insurance company, they only want to compensate for the eye exam itself.
A doctor who is willing to take pride in their work and do the better work than the other doctors should be able to make more profit - there's nothing wrong with that in my opinion. But when he HAS to charge a certain agreed upon amount or face losing all Medicare patients (for example) there is something wrong. Some eye doctors in our area (consequently the really good ones) have moved to private-pay only practices. They can't get paid for their time if they take insured patients, so they take only patients who will pay out of pocket for their superior service. So where's all the money going? It isn't going to the doctor who's paying six figures a year in malpractice insurance. It's going to the insurance provider, who is not only making interest on all that money, but cutting down their risk at the same time by getting rid of the patients who actually cost them.
Contrary to popular belief, in the U.S. people in need of emergency treatment are treated - regardless of their insurance coverage. We have between 10 and 15 million patients in the U.S. proving this right now, who aren't even American citizens.
Our system is broken, or at least not nearly efficient enough. But the answer isn't government intervention or more insurance. If people would gravitate towards MSAs and HSAs (Medical/Health Savings Accounts) they would be saving their own money for insurance coverage, and be building equity in it. Meaning that they're making the interest on their money rather than someone else, and can someday start withdrawing what they've accumulated if they've been healthy.
Again, I'm not sure what the best way to go about it is.
I think everyone deserves healthcare, but I also think that like anything else, if you want to pay for better service you should be able to. That doesn't mean that the poor people get sub-standard care, it means that if "customer service" is important, I should be able to pay more and go to a "ma and pa" establishment - just like any other industry.
As for drug companies and their profits - the solution is simple (in my very ignorant opinion)
Start their 17 year patent when the drug comes to market, not when they first file for the patent (or make the patent period longer). They spend so much time bringing the drug to market, that often times they only have 5 or 6 years to make back the $500,000,000.00 that they invested in its development. With exclusivity only lasting for a few short years, they have to charge WAY too much for the drug. Give them longer to recoup the money they put in, and I think they could bring things to market for a lot less, without the fear of joe-schmoe drug company creating the generic and profiting from all of their research.
Anyway - that's a long winded way of saying: Thank God we're all alive and healthy enough to sit here and talk about this.
Good Vibes to all of you :)
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This may come as a shocker to some of you and you might think I'm plain crazy with my stupid philosophical thinking but here goes. I am aware it raises a big moral dilemma.
Who is to blame or take charge of the seriously ill? The ones who did nothing wrong but live life and get hit with kidney failure, cancer, diabetes or what else.... the list is long.
Are they at fault? I think not
Said diseased person is innocent but why should they have to suffer more ( from a financial point of view ) than they already are when there is in essence no reason to blame them.
What about the drug addicts or alcoholics or those illnesses that are self inflicted? They deserve the same health care as ESRD or Cancer? I think NOT! Most ER rooms are full of people who can't pay, and who are in there due to preventable causes. I don't know the answer, but if I'm waiting to be seen and Druggie Dave is waiting to be seen, I'd like to be first.
As far as costs go, who determines what a "Profit" is. More than it cost to make, but how much over the top? I'm sure every Doctor thinks he should make more. How Much More? That is the question.
I hate it when I try to keep costs down like saying "I don't need such and such lab" and the nurse says "Well, you have insurance don't you?" Like it is free! Someone is paying for it.
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I totally agree with you about "druggy dave" Rerun. I have seen a few get in before me in the ER, they get their little box of pills and piss off, like no tommorow. Yet I go in there, with #$%#@ peritonitis and end up waiting 10 $#%# hours to even be looked at by a doctor. They just dont know enough about renal, and it shits me because there are tons of renal patients there. The past few times Ive been in and self diagnosed a high K, I got straight in. I just hope if I had no idea what was wrong in that situation, that they wouldnt make you wait all day.
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But if we start thinking like that where do we stop? ???
Most diseases have a life style component! If we err as a society or individuals is it not better to err on the side of compassion? Who has not done something that they know is against their health or failed to do something that might improve their health? Something they know they should do?
Drug addiction is an extreme, but it doesn't happen in a vacuum and it is a sign of terrible suffering on the part of the person. Happy people with good lives might experiment a little bit but they don't become addicts to drugs or alcohol (a legal drug!) Where you find abuse you usually find factors beyond that person's control, like a history of child abuse, early poverty neglect, untreated mental illness etc.
Mom 3
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Contrary to popular belief, in the U.S. people in need of emergency treatment are treated - regardless of their insurance coverage. We have between 10 and 15 million patients in the U.S. proving this right now, who aren't even American citizens.
Our system is broken, or at least not nearly efficient enough. But the answer isn't government intervention or more insurance. If people would gravitate towards MSAs and HSAs (Medical/Health Savings Accounts) they would be saving their own money for insurance coverage, and be building equity in it. Meaning that they're making the interest on their money rather than someone else, and can someday start withdrawing what they've accumulated if they've been healthy.
in my case, I am a Canadian BORN into Kidney Failure so any Health Coverage I would have to BUY I would be turned down for because of "Pre-exsisting Health Problems". ... But yes, I am a Canadian who must seek info about American Coverage because I am inlove with an American.
Maybe it will all work out somehow but people keep telling me how Canada is better than the US when it comes to health care .. why would I ever want to leave. But then someone said that the only ones saying this are the ones who aren't American citizens and the ones who flee to other countries are originally from the other countries anyway. (Correct me if I am wrong as I might have offly quoted this person wrong).
I totally agree with you about "druggy dave" Rerun. I have seen a few get in before me in the ER, they get their little box of pills and piss off, like no tommorow. Yet I go in there, with #$%#@ peritonitis and end up waiting 10 $#%# hours to even be looked at by a doctor. They just dont know enough about renal, and it shits me because there are tons of renal patients there. The past few times Ive been in and self diagnosed a high K, I got straight in. I just hope if I had no idea what was wrong in that situation, that they wouldnt make you wait all day.
In Canada Dialysis Patients who go to the ER automatically get in before EVERYONE else.. The dialysis nurse told me this and I put the theory to the test when I went in and sure enough, as soon as I said, "I am a dialysis patient" They said, "Oh! Okay, this way!" and brought me RIGHT in ;D (I knew someone who was in the waiting room and she wanted to know how come she was waiting for hours and I come in and get to go right in lol)
Could this be just another reason why I should stay in Canada?
But if we start thinking like that where do we stop? ???
Most diseases have a life style component! If we err as a society or individuals is it not better to err on the side of compassion? Who has not done something that they know is against their health or failed to do something that might improve their health? Something they know they should do?
Drug addiction is an extreme, but it doesn't happen in a vacuum and it is a sign of terrible suffering on the part of the person. Happy people with good lives might experiment a little bit but they don't become addicts to drugs or alcohol (a legal drug!) Where you find abuse you usually find factors beyond that person's control, like a history of child abuse, early poverty neglect, untreated mental illness etc.
Mom 3
You are right there
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In Canada Dialysis Patients who go to the ER automatically get in before EVERYONE else.. The dialysis nurse told me this and I put the theory to the test when I went in and sure enough, as soon as I said, "I am a dialysis patient" They said, "Oh! Okay, this way!" and brought me RIGHT in ;D (I knew someone who was in the waiting room and she wanted to know how come she was waiting for hours and I come in and get to go right in lol)
Could this be just another reason why I should stay in Canada?
Pretty good observation but the reality is, the more severe and life threatening your problem is, the less time you have to wait. See, hospitals in the US take it's ER patients according to how life threatening your problem is AND, how much can you pay for medical services.
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See, hospitals in the US take it's ER patients according to how life threatening your problem is AND, how much can you pay for medical services.
That last part is the part that sucks ... I have always been poor :(
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Yeah, im not exactly wealthy either. ::) But you make do with what is available to you.
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Our ER also has the triage system which works well, but a lot of the time they seem to accept people in who should be sent to a GP.
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I'm sorry but what is a GP?
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GP = General Practitioner
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I think research has to be spurred on by profit, because research takes money, and for people to put money up, they will want money back.
There's nothing wrong with profit. I agree that greed has run rampant, but I don't think adapting a "profit is bad" mindset is the answer. It's people's desire to succeed that spurs innovation and research in these areas.
Contrary to popular belief, in the U.S. people in need of emergency treatment are treated - regardless of their insurance coverage. We have between 10 and 15 million patients in the U.S. proving this right now, who aren't even American citizens.
1.
While most of the medical innovation today comes out of research done in the United States, very little of it is used in the country itself because of this for profit model. New equipment and updates means trimming on profits and for profit clinics do not want to see a drop in that margin.
( I posted this in a thread a while ago. (Why is State-of-the-Art ESRD Technology Better Outside of the U.S.?):
http://www.aami.org/publications/HH/ESRD.Leypoldt.pdf
The main issues pointed out in the article preventing advances in the US are:
Regulatory Constraints, Educational Constraints and Economic Constraints ( for profit companies are the main issue preventing progress State side) on on Advanced Technology. )
2.
The theory of the medical code of conduct dictates that under no circumstances shall they refuse care to a patient but I will be one to attest that this is purely theoretical.
I was denied care on several occasions while living in the United States ( I am a US citizen btw ) because I had no insurance and I wasn't able to make a deposit for a couple hundred dollars.
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As I understand it, they have to "stabilize" or get you to the point that you won't die immediately if that is feasible. That doesn't really constitute "care" as most of us would think of it!
Mom 3
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I am just worried that if I go to the States will I be screwing myself? I am from Canada.
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in my case, I am a Canadian BORN into Kidney Failure so any Health Coverage I would have to BUY I would be turned down for because of "Pre-exsisting Health Problems". ...
This is only true if you are looking at private plans. If you marry your gainfully employed love, or obtain gainful employment yourself chances are you'll wind up able to get insurance under what's called "open enrollment".
As for ER's treating only those in the most need, this is at least partially true.
Having worked in the ER, and having worked in Triage I can tell you that this rule logically only works if the person in front of you is in worse shape. In other words, it's not as though they put you to the side just to wait for a potentially worse off patient.
Walk into most ER's in America in the middle of the afternoon, and you will find waiting rooms full of illegal immigrants waiting for their free healthcare. Most injuries will be construction related (at least here in the wildly growing West), and not life threatening.
We have a Lebanese friend whose father just escaped Lebanon to come here after his dialysis clinic was destroyed by Israelis. He is not a U.S. citizen, and only has insurance coverage in Lebanon. While he's not being waited on hand and foot, he is receiving periodic dialysis, and it is considered "emergency care".
ER's are concerned first and foremost with the urgency with which the care is required. Yes there is attention paid to the patient's ability to pay, but this comes later. It's silly to think that they wouldn't address this issue, as they are a business and need to be paid for their services.
It's not as though they will send you away with dangerously high potassium (for example) without dialyzing you because you're not "covered".
EDITED: Fixed Quote - Goofynina
Might want to look again goofynina, it's not fixed right yet. - Epoman
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The theory of the medical code of conduct dictates that under no circumstances shall they refuse emergency care to a patient.
Sorry, I had to fix that.
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in my case, I am a Canadian BORN into Kidney Failure so any Health Coverage I would have to BUY I would be turned down for because of "Pre-existing Health Problems". ...
This is only true if you are looking at private plans. If you marry your gainfully employed love, or obtain gainful employment yourself chances are you'll wind up able to get insurance under what's called "open enrollment".
Well he doesn't have any insurance yet so I didn't know how easy it would be to get and for me .. in my job .. they turned me down for their insurance because of my "Pre-existing Health Problems"... :-[ :( :-\