Rachel and Mike in Australia

Apologies to our faithful readers for not posting in quite some time!  There’s been a fair amount of excitement down under what with moving house, Mike teaching his first Uni class and heading to the States for work, and an unwelcome though ultimately benign introduction into socialized medicine.

Thursday evening about a month ago, Mike came home from work complaining of stomach cramps.  Around 10 pm, he asked me to figure out if we could see a doctor ASAP.  We had no idea how off-hours care works, but luckily, there was a 24 hour help number on the back of our insurance card.  After consulting with our insurance provider, and a short cab ride later, we arrived at Royal Prince Alfred Hospital (RPAH), and checked in with the nurse.

Australians pay a Medicare levee as part of their taxes.  This entitles all residents to basic medical care, including doctors visits, prescriptions, and hospital care.  Sounds simple enough, and the cost is surprisingly small: the medicare levee is only about 1% of the roughly 30% income tax rate paid by middle class Australians.  But of course it’s much more complicated in practice.   Australians who can afford it typically purchase their own private health care to supplement their public coverage.  This not only increases their level of coverage but gives them some flexibility in choosing their care.  Medicare covers doctors visits and various procedures up to a fixed, nationwide rate.  For instance, doctors visits are covered to the tune of $60 per visit.  But doctors are not obligated to charge that rate, and whether or not it’s true, the perception is that if you’re willing to pay more you can get better care.  Our doctor’s visits thus far have been $60 or $90, which seems surprisingly cheap compared to the U.S.

So what did all this mean for us waiting in the emergency room?  At the time, we had absolutely no idea.  We knew before coming to Australia that we would not be eligible for medicare and therefore would have to purchase our own insurance, which, dutifully, we had done.  But that’s about where our understanding of the system ended.  We ended up spending the night in the emergency room, which went much as you’d expect in a hospital back home.  Upon checking in, the triage nurse took a blood sample, had Mike deliver a urine sample (the Aussies say You-’Rhine), and told us to wait.  After a few hours we got to see the doctor (who introduced herself by her first name).  There was more waiting for blood work, then waiting for a chest x-ray and the results of that, and in the end, we got sent home at 6am the next morning with a diagnosis of “severe constipation” and a pile of laxatives.

By noon the next day, the laxatives had produced nothing and Mike’s pain was worse.  Long story short, we saw our GP who suspected appendicitis, Mike got a CT scan, which confirmed appendicitis, and that evening we checked back into the emergency room at RPAH (only about 12 hours after we’d left).   This time we didn’t have to wait long before Mike got moved inside to a bed in the pre-op area.

Australia has two kinds of hospitals, public and private.  RPAH is a public hospital, which means if you have medicare, you can get treated for free.  When signing up for health insurance, the insurance providers had horror stories about the waits and facilities at public hospitals, which of course is why you should pay for private insurance.  Turns out that private hospitals don’t have intensive care units, so if you’re having any major surgery with potentially life-threatening complications, they send you to a public hospital even with private insurance.  However, RPAH has all kinds of perks you can claim as a patient with private insurance - without private insurance clients, all the hospital’s money comes from the government, so they have a vested interest in attracting paying clients.  As a private client, you can request a particular doctor and private room among other things.  As they were wheeling Mike into the OR, one of the doctor’s indicated that the head surgeon would probably do the operation since we were Americans.  In the end, a resident performed a laproscopic appendectomy - good thing, too since the head surgeon would have probably charged well above the Medicare rate!  The operation went fine, and Mike spent a few anxious days in hospital under the naive assumption that as soon as the source of problem was removed he’d be back on his feet — he tried to equate the situation with taking a car into the shop.  We’re happy to report that he has fully recovered with nothing but three small scars to show for it.

We never did request a private room.  The hospital looked more or less like a hospital in the US.  The only big difference I noticed was the doctors’ dress code.  Weekends were casual, and I don’t mean business casual, I mean Aussie casual — one doc was wearing jeans and a t-shirt, which was a bit confusing from a patient perspective trying to figure out who the doc’s were.

With Obama in office, nationalization of health care in the States is back on the table.  If the Australian system is any indication of what to expect, then I’d say we’ll be okay.  Public hospitals will have poor patients and terrible food, and if you can afford it, preferential care will be available, but in the end people’s lives will be saved.  Between Rachel’s pulmonary embolism a few years ago and now Mike’s appendicitis, we probably would not be around to write this blog without the care we’ve received.

This entry was posted on Monday, April 6th, 2009 at 10:26 pm and is filed under Upside Down Living. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.