Even when I acknowledge that not everybody is equal I am true believer in giving everybody the same opportunities. I think it would be nice if everyone could also have access to the same level of healthcare regardless your incomes or the place that you happen to live in.
That is a nice ideal that I cannot avoid to have. However, I have had some experiences in both systems, that make me doubt about the feasibility of matching a good level of care with a public system. This is based only in my personal experience working in Spain and now in USA. I am not saying that all the hospitals are the same, but this is what I have seen and lived within the surgery world:
ACCESSIBILITY:
Public system: Anyone can go to the ER of a public hospital and have the same level of health care. If you are not citizen or do not have Social Security number you will be required to pay the bill. Anyone with Social Security Number or citizenship can make an appointment for a Family Doctor for free. This Doctor will decide about the need of having a specialist consult for free.
Private System: Anyone can go to the ER and have the same level of care. A copay will be required most of the times. Anyone can make an appointment with either family doctor or specialist. A copay will be required, likely.
ACCOUNTABILITY:
Public System: The patient belongs to the hospital. Whoever is working that day in that particular speciality or outpatient clinic is going to make the decisions that day regarding that particular patient. If it is an inpatient, the Dr. responsible will change with shifts. The surgeon who decides about the indication for a determinate procedure is not necessary the one who will perform it. Believe it or not, I knew patients first time the same day of the surgery that someone else had decided that I had to perform. My father, who lives in a different city than I did, had a surgery done by a Doctor he had never met before (or later).
Private System: There is a Doctor who is responsible for the patient. If he is not at the hospital when the patient comes, someone reaches him/her to consult. The Surgeon, who asses the patient give the patient the options to decide about his/her healthcare. I cannot imagine a surgeon, out of the setting of emergent surgery, knowing the patient for first time in the OR table.
QUALITY VS QUANTITY
Public system: As a surgeon you may have 40 patients between 8:00 and 15:00. An average of 10 minutes per patient of which 7 are spent in ordering the chart because more likely you do not know that patient’s chart from before.
Private system: You follow your patients. You know them unless it is the first visit. You run your schedule, so you take as much time as needed which any of them. If a surgery is needed you decide with the patient, which, when and how it will be done. You will make the follow-up later on and you will have to deal with any outcomes resulting of your decision.
TEACHING
Public system: 2 Attending Surgeons are scrubbed in any surgery. You can find a 5PGY General Surgery Resident as a second Assistant in a laparoscopic hernia. I am sure any surgeon reading this know what that means. There is no board. Nobody is going to asses how well (or bad) you train your trainees. In the hospital where I was trained residents were not allowed to have outpatients. I tricked the system by doing my follow-ups in the ER when I could… But I finished my residency without doing outpatients follow-ups.
Private system: Your residents and fellows are your pride. The way they are trained will speak not only about them, but mainly about the place where they learnt. They are evaluated for external committees. If they fail, you fail. You want them to be the best.
SALARY:
I will only say there is at least one zero of difference for a Surgeon in both systems. However, personally I would not mind that difference, If all the other went away.
I still think it would be nice merging the best of both systems. What do you think?
