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March 22, 2010

Comments

Jeanne

For those living/who have lived in Brazil: have you ever used the public system? Yes.

Do you have private insurance?
I had private insurance when I was living in Brazil.

Are you happy with the care you get?
Private insurance worked OK for me. Public health care didn't. I waited all day long to see the doctor for 2 minutes, and then he prescribed me a drug that was no long available in the market.

Would you make any changes to the health care system, if any?
Better "customer care", more doctors and more hospitals.

Account Deleted

For those living/who have lived in Brazil: have you ever used the public system? Do you have private insurance? Are you happy with the care you get? Would you make any changes to the health care system, if any?

Yes, a lot of times I have used the public system.
I've got private insurance payed for by my employer.
Private: good, but not awesome. Public: bad.

Changes I'd do:
No public system, but public hospitals.

Andrew

I have lived under both systems. I had private insurance in the US (through the company I worked for). Premiums were low, but the deductible was high. This was frustrating, but the care we received (including birth of our first son and several emergency room visits) was ALWAYS first-rate.

My first visit to a Brazilian emergency room (sunstroke from spending too much time at the beach) was a nightmare. The ONLY good thing about that visit was that it was free. I was taken to the hospital in the back seat of a Volkswagen Beetle. At first I was not given a bed, then they found one for me in the hallway. The disinterested nurse put the IV tube in the wrong place in my arm, and it swelled up until I looked like Popeye.

Currently we have private insurance. Our second son was born in a clean Brazilian hospital. The only complaint I have with that event is that the hospital staff were SO intent that I fill out the paperwork that I actually missed the birth. In the medical system here, bureaucracy is king.

Our most recent emergency-room visit was also a nightmare. People in all kinds of medical conditions sprawled out everywhere, no waiting room, a line so long that, had we stayed, we would probably have been there long into the night (it was about 2pm when we arrived). Fortunately, my son's symptoms disappeared and we beat a hasty retreat.

I know it is hard for Americans to fathom this kind of situation, but the good news it that in a few short years you will be experiencing it yourself!

A3maniac

For those living/who have lived in Brazil: have you ever used the public system? Do you have private insurance? Are you happy with the care you get? Would you make any changes to the health care system, if any?

I had something of a "public option" in Brazil, which was financed by the State of RS. It was paid insurance, but the price was symbolic. I always got excellent care from them, but some of my family members went with public only, and were always well treated.

The only "change" I would recommend in Brazil is one that also applies to the US, that is, to have policy decisions informed by health care professionals and scientists.

For those living/who have lived in the US: do you have health insurance? Are you happy with the current system? Are you satisfied with the care you get? What do you think about the reform? What changes would you make to the current system, if any?
I have private health insurance in the USA, which I have to purchase privately, since the small business I work for does not provide it. I am very unhappy with the current system. People complain about SUS in Brazil, but the wait period to see a doctor here rivals the one from SUS - and it's always a generalist, even for conditions I know I've had before, and that require a specialist. This makes me waste both time (going to the doctor's twice, and waiting to see the specialist) and money (I have to take 2 days off work, and co-pay twice), not to mention the very valuable time I am taking away from the actual doctors themselves.

What I would change: You can choose your doctor (as you can in Brazil), prohibit denial of coverage/termination of contract due to pre-existing and "non-disclosed" conditions (which is normally due to an error filling the form, not malice), regulate price increases, public option for healthcare coverage, etc.

Jim Shattuck

I live in Brazil. Private health insurance gives you a class above in coverage. I use the word class on purpose. Public hospitals and clinics are crowded, but not necessarily of less quality (in urban areas) -- you have to advocate for yourself.

My partner has leukemia and is being treated by the public National Cancer Institute in Rio. We could not be happier. (Although visiting a public cancer facility has its assaults on your senses.) The quality of care is top shelf. -- and FREE! --

This cancer facility is available to ALL Brazilians - not just those with insurance. (and free!) In the USA we would be out of luck without a sweet insurance plan.

There are plusses and minuses, but if I were poor and had to choose - give me Brazil.

Priyanka

"For those living/who have lived in the US: do you have health insurance? Are you happy with the current system? Are you satisfied with the care you get? What do you think about the reform? What changes would you make to the current system, if any?"

I have insurance through school, and it is pretty good, but I am also pretty healthy so I don't use a lot. I used to be on my paretns insurance, which was very cushy, but I sometimes had to wait a long time to see the docotr. I think that the wait times are underestimated in the US.

I think that the reform was a good first step, but more needs to be done. Mainly, this bill does very little to control costs or reduce wasteful spending. That needs to be a priority, hopefully one Obama will address directly and not push on to his successor. This will definitely affect the national debt, another rapidly burgeoning problem.

For those who have lived in both countries, what could each country learn from the other's system? Which one do you prefer?

I didnt have insurance in Brazil, but getting care was still very easy, I went to Hospital das Clinicas in Sao Paulo the one time I really needed care and I got treated very easily. I did not have to wait a long time, but I think it helped that a Brazilian friend helped me schedule the appointment. Since I was making an English teacher's salary, the medicines ended up making a pretty big dent in my salary that month, which was one time I missed my coverage that I had in the US. However, the meds were probably cheaper than they would have been if I payed full price in the US.

Overall the experience was positive. The biggest thing I noticed was that the hospital was not as nice in terms of decor etc as a US hospital. I think that that is a point of excess spending that the US engages in that Brazil does not, hospitals are very spartan and funcitonal in their appearance. I think that could be a difficult adjsutment for the US to make, but not a bad one.

Ashley, the Accidental Olympian

I have had the worlds WORST experience with health care in the US. While I was under my parents care from ages 0-18 I never gave a lot of thought to the system we had, but once I moved out of state and was no longer covered, suddenly it was a high priority issue.

I've used university health care plans (don't dare go anywhere else but the university or you'll pay full price!), emergency only coverage, low income state run coverage (nothing says fun times like homeless people in the waiting room), out of pocket care (COSTLY!), and employer covered insurance.

If throughout the time since I was 18 I could have been apart of one plan, one doctors group, one system, one damn provider I wouldn't have had to get three pap smears in one year when each time I got new coverage I was forced to jump through the pap-hoops over again before I could get a prescription!

My biggest beef with my employer covered plan currently is that although they actually cover therapy, I had to fill out all sorts of information to prove this was a NEW condition with them, and not a pre-condition I failed to report. I'm terrified in thinking that if I get a new job, or a new plan that this next provider will refuse to cover me because I apparently have a pre-existing condition of 'mental instability'. If you find a plan that will cover therapy, are you supposed to never leave them?

If nothing else changes from this bill but the refusal of companies to use the pre-existing condition line on patients I will consider it a step in the right direction.

WOW. Can you tell this topic gets me fired up? I just wrote a damn novel!

RogerPenna

Brazilian public system varies a lot from place to place, and from public hospital to public hospital.

most brazilians with money will use the private system, and I think the same could be in the US too.

the big question should not be about people who have private insurance, if they used the public system and if they thought it was good.

the question is what would happen to probably something like a hundred million brazilians (or more) that are not covered if we had no public system.

Eduardo Sant'Anna

Hi Rachel,

Unfortunately I think your survey will only show how similar both Brazilian and American healthcare systems are. i.e.: public system far from good enough and most "fairly well-off" people having private cover. On the private cover, the quality will obviously vary because it will depend on the level of service one is paying for - or how much of it is being subsidized by the company they work for. In Brazil you can get private cover where only some hospitals are included and you need to pay extra for many things... or you can get one where you can be treated in any top hospital and almost everything is cover without extra charge, including air ambulance (helicopter).

To truly get a different perspective you would have to look into other countries' system, such as Canada or UK, where the private system almost doesn't exist. Many pros and cons there...

My 2 cents.

PS: Also... you will probably find not many Brazilians reading your blog that use the public system on a regular basis. If you are reading this blog it means you have regular Internet access, you have good English skills and you have some interest in local/foreign affairs. Hardly the profile of someone that has no private cover in this country... despite recent statistical improvements in social and digital inclusion. :-S

rodrigo

I live in Brazil and I currently use private services that classify as good quality, but I have used public services and there is great variation in terms of quality of services. In general the south have more large specialized public hospitals that receiving people from all over the country to treat complicated cases.

Leonardo Werneck

I agree with Eduardo's point. Brazilians who lived abroad, have regular internet access, good English skills and interest in foreign affairs are part of an urban elite that IBGE would call "classes A/B". And the vast majority of that group can afford a private health plan. We don't have many issues regarding our heath, as doesn’t the urban elites in the USA, I guess.

The problem is: what about the other 80% of the population? I live in Brasilia, where the public system is one of the best in Brazil, and I can say that SUS is far from perfect, but at least it exists. If you can't pay for private doctors, are currently unemployed or even if you are homeless, you can go to a free public hospital and get some kind of help, even if not a 1st world one.

I always thought it was bizarre that Americans didn’t have any kind of free public medical support, since Canadians have it and all Europeans I know about also do. It’s like a country not having a public education system, or police forces, for example. How can a society rely only on private security or schools? Not even the most conservative right wing politician in Brazil talks about privatizing the public heath system. How can Republicans be against it?

Eloisa

@Eduardo Sant'Anna
The two systems are very different. Whereas for non-life-threatening diseases, the public system in Brazil generally sucks, if you have something like cancer, or Aids, or if you're hit by a truck, in the case you live in a big city, you're going to get care and you're not going to go bankrupt, even if you don't have private insurance. Ideally, the system should provide good care for all, and this is its aim. But it does not have enough resources.
Furthermore, comparing the two systems seems unfair, considering that Brazil is (still) a developing country and is A LOT poorer than the US (GDP US: 14 MI / GDP Brazil: 1,4 MI). The US is the ONLY industrialized country in the world that does not have a public health care system. And people are protesting it? Talk about false class consciousness!

Bruno

Hi,

I have been reading your blog for quite some time now and I find it very interesting.

I live in Brazil and I do have private health insurance. If I have to do exams or routine check ups I will always go directly to private clinics which I qualify as good (sometimes outstanding). Most of them have good facilities, machinery and staff.

About public hospitals: In Brazil if you suffer any kind of accident (say car accident) you are immediately taken to a public hospital by a fireman. Although public hospitals area usually crowded and lack staff/facilities, the medical team is usually top, better than private doctors.

This situation is explained because the public doctors need to pass several exams against thousands of other doctors to be able to work in one of those hospitals. Their objective is also different. They only have to take care of your wounds/sickness. Private doctors usually want you to come back several times, because each time you go back you have to pay once more.

My two cents: I believe having public health care is a must. You cannot let people die or suffer because this is another basic human right like food, water and education, however if you do have money (private insurance) you must have the option of having a better or more personal experience.

ali la loca

I've received great care in both Brazil and the US, although generally much cheaper in Brazil.

I've also found ease of access and immediate "atendimento" linked to who you know and how much you are able to pay. My husband's uncle is a doctor, so through him we can get in with any specialist we might need, generally within a day. We use this "benefit" for our caseira (house-manager) in Rio as well, who would otherwise face monstrous waits at public hospitals and clinics. We've had many experiences where she'd have to wait in hours-long lines or not be treated for 1-2 weeks for something like a bladder infection because she didn't have the connections/status to get an appointment and was at the mercy of the overscheduled practitioners at the public clinic...but once you get an appointment, quality of care is top-notch.

Interestingly, my health insurance here in the US will only cover $3 for my monthly birth control (it costs $70), leaving the remainder for me to pay out-of-pocket. Walking into any pharmacy in Rio, I can get the same pills for about half the price with no health insurance coverage at all.

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