Socialized Medicine: Worse Care, or Worse Coverage?

Yesterday my youngest daughter was hit by a bus, as a pedestrian (in a cross walk), head on – which then left the scene.

Here’s how the experience went, in Israel, with socialised medicine (for Americans – this is the equivalent of the Democratic cry of “Healthcare for All!”).

– After being struck, Hatzalah was called.  Hatzalah is the (now Israel nationwide) volunteer emergency response service – meaning people who come running or by ambu-cycle with first response medical equipment.  The idea here being that dealing with emergency stabilisation in the first 10 minutes significantly increases survival rates.  Hatzalah is a volunteer service and a charity service – donations make it happen (no personal or government cost).

– A Hatzalah responder arrived within a few minutes, evaluated her and called an ambulance for transport.

– It took a while for the ambulance to arrive through city traffic.  The Magen Dovid Odom (Red Star of David national ambulance service) medics re-evaluated her (unfortunately Hatzalah and MDA don’t play well together, so there is no integration between their data or cross trust in their evaluation costing extra time) and transported her to Ichilov hospital.

– There was a not insignificant delay in the ambulance entering the hospital because the hit Israeli TV show Fauoda was filming there at the time.

– The triage at Ichilov ER evaluated her, noted she could stand up, and sent her (with broken bones and possible internal injuries) to walk down to Ambulatory ER and wait in an extremely crowded inner city ER waiting room with 50-100 other people waiting for their coughs to be seen or wounds to be stitched.

– 2 1/2 hours later, sitting with a likely broken limb and in partial shock, she was seen by an ER “surgeon” who, without doing more than asking a few questions and taking notes (no examination, neuro check, or even taking blood pressure or temp – but I guess those had been done in triage so no reason to check later if she wasn’t passing out or seizing, right?), sent her off to x-ray.

– X-ray was great, had her in and out in 5 minutes.

– She waiting another 2 1/2 hours to be seen by an orthopaedist, at which point I had a yelling match with the overloaded nursing staff about the wait time and signing her out and taking her to Hadassah Ein Kerem in Jerusalem (an hour away), assuming we’d be seen faster traveling an hour and waiting there than in Ichilov.  After demanding to sign her out and being told to suck it up, look at the crowd, or fine – here’s the sign out paper be prepared for the national system to demand you pay (where normally they don’t) because you left without medical permission – after going through that she was magically called 3 minutes later.

– The orthopedist cast one limb and evaluated her other areas as bruised not broken.

– Back to the ER “surgeon”, who this time we didn’t wait for but barged into his room after his previous patient walked out.  Asked about a neuro check, “she’s conscious and CT’s are loads of radiation for a young person – so no” (and socialised medicine means no MRI because they are too expensive unless the person is showing obvious symptoms), about pain control for her severe head pain (she struck her head), “take a Tylenol or Advil”, he signed her out and told her to follow up with an orthopaedist in a week through her (national) HMO.

Israel has a modern first world medical system – the equipment the orthopedist was using was world class – and he did some live action x-rays on the spot with equipment I’ve never seen before.  But healthcare for all cost controls mean facilities are run AT CAPACITY, and where in the U.S. she would have been in an MRI in 30 minutes, in Israel an MRI is not an option due to the cost except in severe situations – and a CT (readily available) has reasons to avoid.  Pain control is a bit of “suck it up buttercup”, both because of cost control and national attitude.

ER’s are ER’s, and I’ve been in good ones and bad ones in the US and, with this experience of a not-so-good-one, in Israel.  But the obvious difference is in the US they throw lots of tests at the problem to make sure a variety of bad things isn’t happening, in Israel they use basic diagnostic techniques – which will miss the 1:100 or 1:1000 situation – to avoid test costs.

Thank G-d, my daughter is banged up moderately and has a fractured or broken limb, but doesn’t appear to have suffered life threatening injury.  In the U.S. I would be comfortable saying “yep, she’s ok” and waiting for the $5,000 in deductible bills to arrive of the $15,000 hospital bill.  In Israel I’m not comfortable saying that all is ok – but no hospital bill will arrive, only an ambulance bill (for $150) which can then be forwarded to the HMO to take care of… and she will be covered by Social Security Disability for her lost work time (Bituach Leumi) and by the national vehicle accident coverage for any medical bills not covered by the HMO (in Israel they combined all the insurance companies medical coverage into a national plan that covers medical costs for anyone hit or injured in vehicle accidents).

So which is better?  Better care, or better coverage?  It’s iffy – for basic care, stitches, broken bones, normal illness – I find better coverage with it’s reduced cost concerns to be much better.  But when things get more serious you run into wait times, effort to prove need, and it’s hard to get more costly services, treatment or medicine – extra approvals, extra wait.  Sometimes that is merely annoying, in this emergency situation it was… distressing.

I don’t know much about the hospital facilities in Tel Aviv, but for ER services I didn’t think much of Ichilov.  In Jerusalem I’ve had good experiences in Hadassah Ein Kerem, and adequate experiences in Shaare Tzedek (though Shaare Tzedek is usually overcrowded).