What It’s Like When You’re an American Using Britain’s NHS
By Jim Edwards
I’ve spent half my life in the US and half of it in the UK, so I’m used to both countries’ healthcare systems. I recently returned to London after 20 years in America, and after a few doctors’ appointments I’ve come to see the NHS through American eyes.
The National Health Service is, as all Americans know and fear, a completely public “socialized medicine” system. It’s dramatically different from the US’s patchwork system of private providers and insurance companies.
I’ve now used both systems for about two decades each, so I feel I have a pretty good handle on the main contrasts.
“This Rolls Royce isn’t moving fast enough!”
The context here is that the NHS just released its most recent stats on accident and emergency room waiting times. The headline number is that 84% of patients are seen within four hours. In the UK, this is regarded as a huge failure – the standard the NHS is supposed to meet is 95% of patients in four hours. The UK media went into a fury about it, and some hospitals have begun postponing and rescheduling some non-emergency procedures in order to get those waiting times down. In the US, having sat in many an ER waiting room for hours at a stretch, the idea of a hospital seeing nearly 9 out of 10 patients in four hours would be regarded as a miracle. Bear in mind that within that four-hour period the NHS doctors are triaging patients: If you get hit by a bus, you’re going to see someone instantly. If you broke a finger because you fell over while drunk at the pub, you’re probably going to wait at the back of the line. It’s not like people are literally bleeding to death while they wait for attention (although the British media loves it when it finds individual cases where that has happened).
So my overall impression is that currently, the Brits’ complaints that the NHS isn’t hitting that 95% mark is akin to saying, “This Rolls Royce isn’t moving fast enough!”
Show up when you’re told to – or else.
The first major difference from the patient’s point of view is what happens when you call your doctor for a routine appointment. My specific health issue was that I thought I was going slightly deaf, and wanted it checked out. I’m a dual US/UK citizen, so I qualify for NHS treatment. Here’s what happened to me.
In America, you call your doctor and request an appointment when it’s convenient for you. They might ask you what’s wrong with you, presumably to make sure it’s not something that requires immediate treatment. But basically, it’s first come, first served, regardless of how important it is. Usually, you can pick an appointment time that’s convenient for you if it is not an emergency.
In the UK, I was given an appointment whether I liked it or not. I called and leave a message. Within an hour or two a nurse practitioner called me back and asked me a few questions about my problem over the phone. Then they said: Come in at 9am on Thursday. There was no choice over appointment times – the assumption is that if you’re ill, you’re going to come to the doctor when they say.
At first I found this jarring. In America, I get to choose when I see the doctor! In Britain, I better show up when I’m told. But the appointment came quickly, as the local health authority in London has targets it needs to meet. Ultimately, I saw the logic of it: This is a public health system. It needs to manage its costs and services. If you’re really sick, you’ll show up. If you only want to show up when it’s convenient for your schedule, then how sick are you, really?
America is worse at on-the-day care.
In America, I’ve always had a long wait to see my doctor. I have read many a back issue of Newsweek in my primary care / general practitioner (GP) doctor’s office. I’ve sat there for an hour playing with my phone while the doc sees patients in the order they were booked.
 back issue 过期的报纸或杂志。
 primary care初级保健。初级保健医生又称全科医生（general practitioner），区别于专科医生（specialist）。
In the UK, I showed up at 9am and was seen instantly, at the Waterloo Health Centre. For an American, this was bizarre: My butt barely touched the seat in the waiting room before my name was called. Turns out my doc and her staff are serious about patient scheduling.
This was one reason I became convinced that the NHS way of scheduling is superior: You might not get the time or date that you want, but once you’re in, you get seen super-quick.
There is basically no paperwork with the NHS.
There is a load of paperwork for patients in the US. This is easily the worst aspect of US healthcare – the billing paperwork. If you’ve ever had any health issue that required more than a simple doctor visit, you will know that it precipitates a seemingly never-ending series of forms, bills, and letters. You can be paying bills months, years later. And it’s almost impossible to correct a billing error. It’s stressful. I developed an intense hatred for health insurance companies in the US because of this.
 precipitate 使突然陷入（某种状态）；使突然发生。
There was close to zero paperwork in the NHS. I filled in a form telling my doc who I was and where I lived, and that was pretty much it. The only other paperwork I got was a letter in the mail reminding me of my next appointment. They sent me a text reminder, too, which no American doc has ever done. It was incredibly refreshing.
A long wait for NHS treatment...
I then made an appointment with a specialist at the Guy’s and St Thomas’ Hospital in London. In the US, I’ve always been able to see a specialist within a few days. Score one for America. In the UK, they said “we’ll see you in January.” It was late November, six weeks or more away. This was a shock.
I comforted myself with the assumption that the staff had made a decision that my condition was likely not life- or health- threatening, and had moved me to the back of the line. It was frustrating. Ultimately, I also needed to change my appointment because I had to leave the country on business, and this was quite difficult to do. I had to call a few times, basically to catch the hospital booking staff at the right time of day, in order to do it. I wished Guy’s and St. Thomas’ had an online system for this, but they don’t – just a bunch of people answering phones, most of whom don’t have access to the right appointment schedule.
It was that appointment system again: You’re booked in according to their priority, not yours. The big lesson with the NHS is, it’s a lot easier to just show up when you’re told.
The cost to the patient is much cheaper in the UK, obviously.
So how much did all this NHS care cost me? £0. Nothing. Zero. I paid not a penny for some top-notch healthcare. There is no such thing as a “free,” of course, but the per-capita cost of healthcare in the UK (paid by the government via tax collections) is generally lower than the US, according to the World Health Organization. Americans spend $8,362 per capita on healthcare annually, the Brits spend $3,480. Here is a breakdown:
 breakdown 细目。
· Doctor visit: £0
· Specialist: £0
· Diagnostic test: £0
· MRI: £0
· Total: £0
Typical US prices
· Doctor visit: $100
· Specialist: $150
· Hearing test: $72
· MRI: $1,000
· Total: $1,322 (Total payable by the patient in cash, or typically 90% from insurance and 10% as a patient copay.)
· 总计：1322美元（患者可用现金全额支付，或者选择90% 保险加10%自付。）
 = copayment 共付额，指被保险人用于就医或配药所支付的固定费用。