- The public system goes from top-quality hospitals connected to the universities, to gradually worse hospitals in more distant areas. The quality of the public option is not uniform, and access varies depending on the area. I have seen people who waited 8 months to see an ophthalmologist. The government has implemented the family medicine program, which works great. Local small “posts” take care of communities and address their everyday needs: it works, and addresses what all medical students learn only on: preventive medicine is the most effective tool.
My message is: the family medicine program works well, the top-notch public hospitals work well (but are crowded), everything in between struggles and the patients (and doctors) suffer. It is hard to work with bad equipment, bad staff and low pay. The caveat is: why would the best doctors work for the university hospitals if the pay isn’t good? Because of connections, curriculum and access to a well-established highly selected community of physicians. One gains reputation here in the top public hospitals, to then sell this expertise and reputation in the private sector for a high price. So, next, the private option.

- The private option. The market is essentially free to open hospitals, clinics, offices and there is an insurance market for them. As far as I understand, it’s identical to the way things are done in the USA. There are subdivision in the private sector as well. The local big names in medicine treat their wealthy patients in luxury hospitals. Beneath that you’ll find a middle class that pays for private insurance and fluctuates on the differing scales of quality found in the continuum of private care, going from the inaccessible crème to questionable cheap private hospitals. From a physician’s perspective (especially if you work in ICUs or emergencies), these hospitals are where you make your savings. They pay for shifts and hire aggressively, our economy is growing, there is no shortage of jobs.

Medicine is the best paid profession here, if you perform the statistics based on what degree the person obtained. The public sector pays by a service table (say, an appendectomy will pay you X bucks), and this table exists to varying degrees from the private insurers (a bad insurance will also pay X a good one 2X a loved one 5X). Us mortals that work in ICU’s get hired by the hospitals and receive a salary.

I hope our country develops, becomes more equitable, and everything that happens in the US needs to serve as example. Health care and pensions are complex issues that cannot be looked at simply from the efficiency point of view, we need to develop a community-sense to take care of the sick and support the elderly. A society that is willing to allow families to go bankrupt in time of sickness needs to revise its values. But democracy is more important, and if we choose so, so be it.

Good luck!

The training in the US is wildly expensive, and I never quite understood the need to do a 4-year college to then pursue a 4-year MD, which is then followed by residency (where you will learn your daily chores). As far as I know, only the US and Canada share this system. Most European nations and here in South America have a 6-year MD followed by the residency (which again, is where you are actually trained).
I have often heard that the US-Canadia style produces more medical researchers, which I partially agree.

The cost of training will never change over there. The opposite of that happens in my country (Brazil) where MDs get their training for free and, if well-positioned in the market from start, dedicate their careers to the private sector without ever contributing back to the system that educated them: that’s unsymmetrical. A lot do work for the public sector, but those who inherit private practices basically get a free-ride form the government to then live like american doctors in the upper crust of the local elite.

When I observe how the private medicine here works, it’s identical to everything I read about american health care. I personally dislike the idea of a family going bankrupt, still having to bury their loved one (and then paying the bills). One quick anecdote: patient with larynx cancer was given an estimate of 250K for treatment and low chance of survival: he chose to not treat and leave the family with the money that would help the children’s education.

I personally oppose the idea of giving people the option of treatment versus bankruptcy. But we want to live in democracies, and if we chose so, so be it.

Don’t get me wrong, doctors need to be well-compensated, but we don’t need to become macroeconomic burdens on society.

I will anxiously watch how this all unfolds.

I’m happy to report that a change in employment to a large, publicly funded research institution has made a big difference in attitude for me. There are good things happening there and it is exciting.