EclectEcon

When I arrived at the hospital last Monday morning, I was treated immediately. The on-call urologist explained things to me carefully and performed what seemed like logical tests to identify the problem and speed a diagnosis and treatment plan.

Later that day, I was informed that they (I never quite knew who, I was so doped up) had decided to blast the kidney stone to break it up so it would pass easily, and that I would be discharged until they could bring me in as an out-patient to do the blasting.

Hmmm. That didn't seem like such a great plan to me. First, I was planning to return to Canada the next Wednesday and would need an appointment well before then. Second, I wasn't too eagre to be walking around with this stone if it was likely to cause that much agony time and again.

It turns out that blasting time is a VERY scarce commodity, either because of a shortage of time on the blasting machine or because of a shortage of time with the consulting urologist. However, they managed to squeeze me in the next day for a blasting. I was grateful for that.

As I was being prepped for a preliminary electro-cardiogram on Tuesday afternoon, suddenly a doctor I'd never seen before (he turned out to be the chief/consulting urologist) came rushing into the ward and started ripping off the patches that had just been stuck onto my hairy chest. He said,

No ECG. We just have time on the machine now, and we'll lose it if we don't get down there right now.

So we went barreling through the halls, and they rushed me up onto the table. Then I overheard them say there were two stones: one in the kidney, which was causing no problem at the moment and the other, which they were going after. I raised a bit of a stink that they weren't going after both while I was there, but they said they simply didn't have time to do them both.

Wow. Acute care is fine, but preventive care isn't. The consulting urologist then told me I should get back to Canada as soon as possible. I felt as if he was feeding me a line about several things, mostly just to get me patched up enough to travel and then out of there.

A colleague at the castle complained to me yesterday that he has had kidney pain for several months and that the NHS doctors consistently try to give him a pill and send him away. He says he asks for kidney tests, and they say that he doesn't need them yet because his problem isn't serious enough to warrant them!

He was given the names of some private clinics that would do the tests if he really wanted them, but the tests would cost over $1000. He was quite upset, arguing that his taxes should cover the tests. My reaction: at least you have a private option; in Canada I'm not sure we do.

Overall, I was pleased with the initial treatment and diagnosis. Also, admission and discharge were extremely quick and simple -- no forms to fill out, no endless string of questions about who my insurer is, etc. But I was disappointed with the lack of follow-up and explanation as time went on.

And upon reflection, I am not so sure that this is a completely horrible way to run a "social safety net" kind of health care system. In effect, it says, "We will look after you if the condition is really desperate, but otherwise you're on your own." The incentives are a little screwed up, though, in that some people choose to wait until they're really desperate ("Hey, I paid my taxes and the NHS had better look after me!") rather than pay out of their own pockets for earlier care in the private market. Surely there must be private insurance available to cover the private segment of the market, but I didn't hear anything about it from my colleagues.

For more on health economics and insurance, see Brian Ferguson's blog, A Canadian Econoview. His recent postings here and here are well worth reading.