CLINIC ENVY
There are many things about Jerusalem that make life very difficult for the average New Yorker--many inconveniences and annoyances, but one thing that is sooooo much better is the medical system. I now have clinic envy-and hope that President Obama can bring this easy bit of life to America: the walk-in health clinic.
I arrived in Israel having hurt my foot in two falls just before I got on the plane to fly and with no time to check it out, assuming that I had torn ligaments. A few days after arriving, I got a terrible rash on my neck and decided that I had to check that out. So, I called a friend who lives in Jerusalem--and a friend who is visiting with three small children--and both recommended the same 'drop-in' clinic, Wolfson, in central Jerusalem. My friend with children had already been there four times in her first week of visiting, for four different ailments.
Honestly, this is an amazing thing for an American. You call in the morning, they give you an appointment with a doctor of family medicine--a good one, educated at the best medical school in Israel--you go there, the medical clinic is clean and neat and well run. There is a separate area for specialists and one for family medicine. They take any of the four national insurance plans that Israelis use (Israelis register into a compulsory national insurance plan) funded through progressive health insurance premiums paid by each resident, employers' health tax payments, National Insurance Institute funds, funds from the Ministry of Health budget and consumer participation payments. The insurance premiums are collected by the National Insurance Institute. Additionally, each Israeli gets a basic 'basket' of care and of prescriptions. They pay for anything above that.
I saw a family practioner who was able to diagnosis my foot and my neck--and while he said that it might be a good idea to give me x-rays for my foot, he also said that if they found a fracture, the treatment would be the same as if they didn't, so why bother with an x-ray right now. No extraneous tests! And, had I needed a specialist, I could have seen one at the same practice.
Even without using insurance (since I have no idea if my basic American blue cross plan will pay for this outside country visit), the bill cost me just around $100 and the bill for three prescriptions was under $20, in full--less than what I usually pay for a co-payment at home. When I told the pharmacist that I couldn't believe how cheap the prescriptions were, she said that most Americans she serves say the same thing.
Though the doctor is at a public clinic, he gave me his card and put all of my information in the system in case I have to come back for more treatment and he told me to call him if I need more medical attention.
Had I been home in NY, I would have had to go to two different specialists, after getting my general practioner to sign off. I would have, perhaps, had to wait for an appointment, and without insurance --if the specialists were out of network, I would have paid at least double, if not more, for the medical care.
There are so many examples in the world of health care done right. I can only hope that with health care reform, our country will become an example too. Meanwhile, I'm glad I got sick overseas.
Nice post, good points. But more important, travel safe and feel better!
July 12, 2009 10:45 AM | Reply | Permalink
Actually, you can be denied nonemergency treatment in the U.S. if you don't have insurance.
Thanks for the post.
July 12, 2009 11:01 AM | Reply | Permalink
That point can't be emphasized enough. A lot of doctors won't take your cash, they only want to deal with you through an insurance company.
July 12, 2009 11:24 AM | Reply | Permalink
Far be it from me to defend the American health care system, but no-appointment walk-in clinics are one thing the US system DOES have. In fact, recent years have seen widespread growth of these so-called doc-in-the-box clinics as an easy way to access primary care when your regular physician is unavailable or you are out of town. I personally have had very satisfactory experiences in these sorts of clinics in New York, New Jersey, Florida and California at various times (if you are in New York, Jo-Ann, try the D*O*C*S clinic on 34th and Park).
It seems to me that health care reform advocates do themselves no favors getting their facts wrong on the problems with American health care. Make no mistake, the system needs root-and-branch reform - but not due to no walk-in clinics
July 12, 2009 11:37 AM | Reply | Permalink
That's true Brad. In fact, the walk-in clinic may be more a sign of a problem than a solution. People who do not have a relationship with a primary care provider because they cannot afford regular care may use the walk-in clinic as a substitute. It's also not a very good way to prevent the widespread misuse of prescription drugs and the overuse of antibiotics.
July 12, 2009 11:46 AM | Reply | Permalink
This is unlikely. The cost of a visit to a walk-in clinic is about the same as a visit to a regular primary-care physician. The services provided are pretty much that same as well (if you have a serious issue, you still are probably better off going to an emergency room). The only difference is that it's set up for walk-ins. They'll accept cash or insurance, for instance and don't do things like physicals or other preventive care. I think you may be mixing this up with free clinics, which do primary care for indigent patients for little or no cost. The growth of those is indeed indicative of problems with the system as a whole.
Not sure what the connection is to antibiotics is. Presumably these clinics follow the same medical guidelines as others.
July 12, 2009 12:55 PM | Reply | Permalink
I'm not confusing the two. If you have a regular provider who has your complete medical history that provider is in a better position to give you appropriate medical care instead of just writing you a prescription for antibiotics unaware that you just had a prescription for a different antibiotic last month that didn't clear up your problem. But to have a regular provider for physical exams and regular follow up requires the money or the insurance to go to the doctor even when you are not acutely ill.
I'm not saying they don't have their place. I'm saying they don't replace a relationship with a primary care provider.
Great if you sprained your ankle. Not so great if you have a more serious medical condition. I'm thinking of a twenty-five year woman I know today. She's been in the ICU for two weeks with meningitis. Had she had a primary care doc she might had a vaccination or someone who might have done more than assumed she had little flu.
This quick fix, don't do the "unnecessary" test philosophy can be a killer and it isn't even cost effective.
July 12, 2009 1:10 PM | Reply | Permalink