A day at the hospital

How does it compare to the 3 previous events in the US? Different process, same level of care, different looking everything, with things like tests faster than the US. All in all not a bad experience and one that left me with some confidence if I needed more I would be at least as well off as the US.

We got excellent care at the ER in Salzburg, it was clean, serene and quiet. They started by putting a charge on our Amex and then followed up with a bill a few weeks later.

However something happened, perhaps they were using some kind of bulk mailing service because one day there was an email saying why haven't you paid your bill? What bill we said. And naturally a few days later two bills appeared at once, with a third the next week.

Just a couple hundred upfront and a couple more to settle the balance. And our travel insurance actually paid most of it without complaint!

Well, first of all, Mr. E, I'm very glad that the results were good and that you are over the worst of it. I hope the meds kick in and finish their job soon!

That is very interesting about your treatment. I will be curious to find out what your actual bill is. Who carries your local insurance? Is it specifically for health insurance? For the most part, my health is taken care of well with Medicare, and I can't remember the last time I had to pay out-of-pocket for something. But there are a few things that Medicare won't cover and I have toyed with the idea of going to someplace like Hungary for that, since I would have to pay out-of-pocket.

I have an expat Medical policy with Allianz. So far has paid 100% of everything and I see quite a few doctors and frequently. And a few out patient procedures.

Prior to the move, i got a number of things done here that my US policy wouldn't cover, or my share would be the same as paying cash over here in a private clinic. For instance, a colonoscopy is $7000 in the US, under $500 here. My family has a history with colon cancer, and my US insurance only paid every 5 years. So I came here for it in between.

Dental has been a bargain too.

The small, routine, outpatient stuff you can do private. The big stuff puts you in the public system and today was my first experience with that.

Wow. Glad you are OK. Hospitals are disconcerting enough places without the extra layer of not knowing the language. But, in some ways, it must be reassuring that you can navigate if you must.

That must have been scary, even though you had been through it before.

I thank you for posting. It's an important reminder that stuff happens, especially as we get older, and you may very well end up in an environment where English isn't widely spoken.

Best wishes for your health. Nice that you can get the best of two worlds. As you well know “Europe” and the European health care systems are variable from country.

Glad you have a good relationship with Allianz (per your reply to my post a few days back) and Hungarian care.

Thank you for posting this. I have concerns about what would happen if we have medical issues outside the US. It has happened twice (Italy and Cuba), and both times we had excellent care. Now that my husband is on Medicare, I need to double check what his international coverage is through his medi-gap plan.

I'm glad you are through the worst of it.

stay well young man

I am glad you are okay Mr E and got the care you need. That has to have been unnerving to go through that with only some staff who could speak English. I admire your resilience and hope you stay well.

I appreciate all the well wishes. This is a chronic thing of many decades so I mostly ignore it when it lets me.

I had a couple of things I wanted to convey.

• First, health care here, and I presume in most of Europe (the world) is totally foreign to an American. There is great comfort in familarity even if its not the "best" system. So be prepared for differences and relax, no one is going to let you die.
• Second, people are universally good and kind and I guess I should have made more emphasis on how the staff, and even the taxi driver, worked with me despite the language barrier. Often with smiles and a little laughter. We got through it together.
• And finally, different doesnt mean worse. Look past the differences and judge the outcome.

Then, know you had a cultural experience that few can compete with. Its a learning experience and a good one.

There is another account of a local hospital vist from about a year ago. The poor woman had a collapsed lung. I havent been able to find it. If someone does, post a link on here. A collection of these things tells a much better story.

I had a kidney stone that required two hospitalizations, one surgery with general anesthesia and a lot of diagnostics.

I am on the public healthcare system, but also have private global insurance through my employer. Because my situation was an emergency, I was placed in one of the public hospitals for my care. Everyone was willing to speak English with me given my medical German leaves something to be desired, especially when in pain.

I got a bill in the mail at the end of it all for 30 Euros, which was for my meals. That was it.

Here you go Mr E

https://community.ricksteves.com/travel-forum/hungary/living-as-a-temporary-local-for-9-days-in-the-surgical-wing-of-a-budapest-public-hospital

Emily, I am not working here, so I am not on the public health care system (it is paid for with the payroll taxes). A minimum wage person pays almost as much in health care taxes as I pay for a private medical insurance policy. Thats why I am expecting a bill. Food isnt free here either. Nor is it available if you read that link Nigel was kind enough to post. So thats a pretty interesting difference.

Thank you Nigel

I can understand why people might be reluctant, or even fearful of, using foreign medical services, especially in the developing world. (I could tell you stories about east, west and southern Africa that would easily curl your hair.) But Europe is a completely different story. Yes, there can be language barriers, as Mr. E points out, but usually someone on staff can help, and there is of course Google translate. Several years ago, while on a transatlantic cruise, my husband had a health event that would have been fatal had we not been pulling into Tenerife. There was no time to be reluctant and think about anything other than immediate care, no matter what it was. Turned out it was excellent, and nearly free (ambulance fee from port to hospital was our only expense, covered by travel insurance). He required a few days in hospital, and to this day still talks about it as one of his more pleasant travel experiences, the quality of care was that good.

I think that for most people some sort of health insurance is advisable, especially if your US plan doesn't cover you overseas. But we feel that if it's good enough for the residents/citizens of wherever we are, it's good enough for us. They live there, and yes there are fatalities and errors, but no worse than here. Same thing for evacuation. I can see where it might be advisable to be transferred to a more equipped hospital, though. For evacuation back to the US, no thanks, local care will do. If we're sick or broken enough to require emergency transport to the US, we'll probably die before we get there anyway.

I think that for most people some sort of health insurance is
advisable, especially if your US plan doesn't cover you overseas.
But we feel that if it's good enough for the residents/citizens of wherever we are, it's good enough for us.

I don’t know every country, here at least, the national healthcare services are not intended to be free for tourists. Its for the locals. So everyone should expect to have to pay something.

As for being good enough for them good enough for me, that’s an excellent attitude. But Americans may have to be happy being in a ward with 3 other patients, no curtains, no food (you might need a friend or pay a nurse to go buy you something), no pain meds unless absolutely essential (but again the doctor will write a prescription and someone can go and get it filled for you, at your cost of course), no toilet paper potentially. None of this is "bad" its as much cultural differences as anything else.
But good enough for the locals living on $9.000 a year, good enough for everyone. Maybe? Maybe Not?

They live there, and yes there are fatalities and errors, but no worse
than here.

I would suspect within tolerable limits, but in some countries the doctors in the public hospitals are very young and without a lot of experience. See, in some cases they are doing the mandatory service for the free medical education that the got, then when that is done they leave to where they can make better money.

Same thing for evacuation. I can see where it might be advisable to be
transferred to a more equipped hospital, though. For evacuation back
to the US, no thanks, local care will do.

If it were serious, the travel medical generally has low limits and at some point you will want your US insurance to take over. For that you may have to be in the US. Then for a lot of us our support groups, family, etc become important to our wellbeing. So getting home can be important for that alone.

If we're sick or broken enough to require emergency transport to the
US, we'll probably die before we get there anyway.

The better policies will ship you home if it is only because you need to be hospitalized and you would prefer to be hospitalized in your home town. It isn’t always about being at death’s door.

Mr É glad to hear that you got good ER care in the public health system. I haven’t been a patient yet(!) but have accompanied others to ERs in the UK and IT. Even in Rome it was difficult finding English speaking people but we got through it with a lot of gesturing in 2001. In the UK a big difference I noticed was the lack of personal care things in the room for the admitted patient.

Mona, at least here people don't try and pretend they speak English, when they really don't..... unlike the UK.

It is important to remember that the quality and cost of healthcare is a big political issue at elections in at least the countries of the EEA. So you can expect that facilities will be as good as they can reasonably afford given their economic situation. Every European politician knows the golden rule - don't stick your finger in healthcare unless you are going to improve it, because otherwise it will cost you votes. So I would not have any qualms about emergency treatment in Europe.

If you have not already discovered it, Google translate on your phone will work for conversations, documents and notices via the phone camera. Learn to use it before hand.

I’m happy to hear you had a good outcome. Thank you for sharing your experience. I’ve only had to seek medical care in a very small town in Germany and I was very impressed.

The lady at Triage and I did back and forth with the phones and google translate.

Americans often say they want free helth care like there is in "Europe," and ths was just a reminder that Americans dont really understand what they are asking for. Actually its sort of a meaningless attitude because there is no standard in Europe. I suspect that if you were to take those Americans on my journey, and explain how much they would have to pay in taxes, they would change their minds. Nothing wrong with the system here; these are cultural differences and trade offs in non-essential frills to make it more affordable is all. The outcome here I suspect stacks up against the same in the US very well.

Mr. E, I'm just now seeing this post. I am thankful that you are doing better and hope you continue to do so.

I am so glad that you are feeling better and that this was a good experience for you. You did a real service for others describing your experience.

I've had excellent care and follow-up care, fewer drugs prescribed and my test numbers improved. As you mentioned, it can be barebones. I am amazed at the efficiency, the number of scans, x-rays, etc that technicians can do in an hour. There's no chitchat. No paper gowns. No comfy chairs. You are called, you prepare, you follow orders, finish, sit and wait while the doctor types up the results for you to take back to your GP or specialist. Results are also sent electronically. It's no nonsense and efficient. That's how they manage to treat a whole population.

We do have meals included and probably toilet paper even in the public hospital system.

Sherry, thank you. I'm fine.

Elizabeth, pretty much describes it here too. You know most Americans are going to want shinny and comfy and ..... The hospital I went to would get terrible reviews in the US. But the truth is the care was excellent. In most ways as good as the US, in some ways maybe a little less, but overall equivelent in the outcome. I do know for elective things here the wait can be substantially longer than in the US. I also know that for non-elective but wont kill you for 3 months, you might wait 3 months where as in the US it is counted in days or maybe weeks.

Mona, at least here people don't try and pretend they speak English, when they really don't..... unlike the UK.

Was that your experience in the UK? Remember that English is the native language here. It's not so much people pretend to speak English to dupe you. They try to speak English to get by in an English speaking country because they have to, even if they're not fluent. I can't think of time I've met a stranger in a service - type situation and them not be able to communicate in English. Remember your privilege rocking up at a Hungarian hospital and having everyone try to accomodate you not having much language before they even know what's up.

I suspect that if you were to take those Americans on my journey, and explain how much they would have to pay in taxes, they would change their minds.

I think you'd have to work the figures pretty hard to convince me that what the average European pays in taxes in contribution to their healthcare is even remotely equivalent to a half decent US health insurance policy, especially if you include copays. I think the main point is the universal access, whether you're rich or poor.

Just a friendly dig; I'm glad you're doing better health - wise!

The language comment was more me ribbing my English friends ... we do it to each other constantly. I forget maybe the world doesn't share our humor. :-)

The health care costs debate is as much would the American be comfortable with the Hungarian system even if it were 20% less expensive. What did surprised was how much minimum wage people here pay on medical tax. Pretty sure it's more than what a US min wage worker would pay.

The language comment was more me ribbing my English friends ... we do it to each other constantly. I forget maybe the world doesn't share our humor. :-)

Ah fair enough. I thought it was something people who don't get along with multicultural London might say; "them immigrants... not speaking English" type of thing.

The health care costs debate is as much would the American be comfortable with the Hungarian system even if it were 20% less expensive. What did surprised was how much minimum wage people here pay on medical tax. Pretty sure it's more than what a US min wage worker would pay.

The private vs universal health care debate is a big one for sure. It is just what you're used to. Claudia of this forum had an experience in London recently. Her care seemed to be more or less ok for something relatively minor, but I felt she was silently freaking out at how different it was here because she was too polite to say :) She'd have to speak to that herself. I found it interesting when Claudia had a bit of a wild goose chase around hospitals to find one with the emergency room. Not every big London hospital has ER. It sort of brought home how here it's about the provision and where that covers geographically, whereas ER in the US is probably quite a good revenue stream for someone's corporation (or a number of them) so every hospital wants to have one.

I'm surprised if healthcare is unusually expensive in Hungary. It's strange how here virtually nobody could tell you how much of their taxes go towards health. It's completely free at the point of service, so loses some of that transparency that you get in other European countries with what is essentially a state subsidised private system.

Ah fair enough. I thought it was something people who don't get along
with multicultural London might say; "them immigrants... not speaking
English" type of thing.

No, my ribbing with my English friends involves the King's English being bad English (said by someone who has a Texas accent).

On the health care a working stiff in Hungary has 14% in payroll tax for medical. The US worker has no medical tax an probably free or close to free insurance ... but yes, some out of pocket. Not saying one is better than the other ... more like we should understand more fully what we ask for.

No, my ribbing with my English friends involves the King's English being bad English

Does anyone speak "the King's English?" Are you saying British English (the original and best) is bad compared to American English? :)

I don't think the UK's system around the NHS would be even slightly applicable in the US. Don't you think the US could look at somewhere like Germany, France or the Scandinavian countries? Just slanting it ever so slightly back in favour of the people rather than the corporations might not be a bad idea imho (what do I know though?)

In general, I'm pretty happy with the NHS care I get. My GP is relatively easy to reach and has been consistent for years. I haven't needed hospital care ever (touch wood). I think I got lucky in a well funded NHS Trust (City and Hackney), as it must be one of the biggest in terms of demand nationally because of the density and diversity of population. Care can be more patchy across the UK, just by the luck of the draw where you live possibly.

In 2017 a persistent, really annoying cough and flagrant case of something that looked like pink eye drove me to visit a pharmacy in Lyon. The pharmacist recoiled when she saw my eye, said I needed to see a doctor and gave me the name and telephone number of an English-speaking doctor in the area. I called and made an appointment for the next day. When I arrived at the doctor's office, I walked in to find no one there except the doctor. I doubt that would ever happen in the US, where we tend to push as many work tasks as possible onto lower-paid people. There was no receptionist, no nurse. The doctor apparently did everything. She spent a good bit of time with me, taking a medical history, prescribed the necessary medications and wrote out a bill for 25 euros, which I paid on the spot. The cost of the drugs at the pharmacy was about 25 euros as well.

I've been thinking about the different approach to medical-office staffing ever since that experience, including what it might mean for the cost of delivering medical care.

acraven our system has become so complicated and convoluted that I bet a third of the cost is in overhead staff.

I won't defend our system. I've been getting routine private care here foylr going on 15 years. The same as you report ... well my clinic does have a receptionist. Been put to sleep for 2 procedures and had one I wish I had been asleep for. All for about 25% of US cost. But here there is a big gap between a private out patient clinic (for wealthy Hungarians and expats) and the public hospital for the masses.

I thought I'd make a note about France's universal health care system.

It's not just available to workers whose taxes pay into the system. It's available to all legal residents who live in France on a regular basis, after three months of residency. The French government wants non-citizen residents to enroll in the system because doing so is viewed as making you "more French" and using the universal health care system is part of being French.

Integration into French life (language, culture, civic involvement, health care) is very important: in fact, the bureaucratic entity that all new residents have to meet with shortly after arriving to live in France is OFII: Office français de l'immigration et de l'intégration.

We've had hospital visits where the cost upon departure is zero. The most costly one thus far (after more than a decade in France) was when we owed 85 centimes (a bit less than a U.S. dollar). That was because my wife used the room phone to call me to bring her some warmer socks. The walls of the hospital were too thick to get a cell signal through. Also -- I should add that the reason for this outcome is that we both have a supplemental insurance plan to cover gaps in France's universal system. Nearly everybody in France does and the cost is reasonable and very highly regulated by the government, as one might imagine.

I sort of overly generalized about here.

If you have a work visa, you are on the national system. Its "free". Nothing to suplement or add to. Just plain no charge.
If you are on a short term non working visa like mine (3 years) you are more of a long term tourist so no national coverage and you are required to have insurance. I do, its not expensive.

If you are a premenant resident, working or not, you are on the national system.

Next year I will need to covert to business residency and for that I will be on the public system. But do I want to be? I will maintain my private policy.

This I believe is still the poorest country in the EU and the quality of the healthcare facilities shows that. The facilities, not the doctors or the equipment. Thats all pretty good. The quantity of facilities is also somewhat limited so a lot of people in the waiting room.

But like many socalized systems, the socialized system is only for the less than wealthy.

For the wealthy there is a private system. Cutting edge, state of the art, and for minor things its where i go and my insurance pays 100% no questions asked. And they pay direct to the clinic. I said my insurance was reasonable, but thats relative. Its still more than the after tax minimum wage here, but less than what I paid in the states when I still had other than medicare, but more than my current medicare policy and the taxes a minimum wage person pays for medical is greater than what a US citizen making only minimum wage would pay for insurance under the new subsidized system. Okay, I would have to see some more current US numbers for min wage earners, but I am fairly certain I am correct.

A point easily forgotten, is that in countries where there is an universal health system, the system has formidable bargaining power with health services and drug providers, and that keeps prices low even for services outside the system. Most private services will price themselves at, say, 10% or 40% or 60% more expensive than the social service or they would be out of market, but the base price is controlled.

I never thought about what happens when tourists have a medical emergency here in Germany.

In connection with a completely different topic, I recently became aware of this young couple and their YouTube channel (https://www.youtube.com/@TypeAshton). The two are US citizens (so I think they still have their US passport but not sure about that) and live near Freiburg. They talk in detail in various videos about the differences between the US and Germany. To be honest, I have to admit that I have only seen a few videos so far.

Her mother, who lives in the US, had to go to the hospital as an emergency patient during a visit in Germany. So I found the video in which mother and daughter later talk about it (a lot about the costs more at the end of the video) more than educational for me: https://www.youtube.com/watch?v=G-p1nP6hH6U

Of course I can not check whether what is said there is true, but maybe it is interesting for one or the other.

lachera, they can also force down the costs of salaries for healthcare workers, provide more basic services because the is no competition for sales, eliminate law suits for malpractice, eliminate the need for expensive malpractice insurance and huge payouts to patients when the wrong leg gets cut off. Lots of differences.

Mignon, thank you!