Thursday, June 10, 2010

The Austrian health-care system

  Turns out yes, I was sick.  In fact, I had three things going on, according to the doctors I saw at the hospital this morning.  One, I had acute gastroenteritis.  Two, I had a bad reaction to a vaccine (for tick-borne meningitis) that I got about a week ago.  And three, the inflammation caused by 1 and 2, and the muscle tightness caused by the fever I was running, conspired to send my back muscles into a state of seizure.  Fun fun fun.  My fever broke last night, and this morning when I went to the hospital they dealt mostly with my back (but did take a blood draw to confirm that I didn't have meningitis).  Dealing with my back entailed a very nice fellow giving me, using only his thumbs, more pain than I would have believed possible; but it seems to have worked wonders.  I'm starting to get used to the idea that I can turn my head without pain, and that I don't have to flinch every time the bus goes over a bump.

  So let's review this.  Wednesday I decide I need to see a doctor; roughly two hours later, I am seeing a doctor, even though I am out in a sleepy little town outside Vienna.  He recommends that I get outpatient care at a hospital in Vienna; less than 24 hours later, I see a gastroenterologist, a neurologist, and a physical therapist, all in the same visit, and receive physical therapy that very moment, on the spot.  None of this involved emergency care; this is the normal pathway for health care in Austria.  None of this required an appointment.  I got massive amounts of face time with the doctors treating me; when the doctor wanted a blood draw, for example, she just *drew the blood herself*!  Imagine!  She didn't leave the room, let me wait 15 minutes to have a nurse draw my blood, and then reappear after another 15 minutes!  I got to ask all my questions, and there was none of the time-to-get-out-of-my-office-now pressure that you feel from U.S. doctors.  And I can confidently state that it will all cost less than the equivalent care in the U.S.  Uh, remind me again why so many Americans are so attached to our medical system?  Yeah.  I don't pretend to know what the right solution is; but it seems pretty clear that the system we have is incredibly bad, and we shouldn't be putting band-aids on it, we should simply be replacing it.

  The drugs I got prescribed are also cross-culturally interesting.  Neither is available in the U.S.  One, a painkiller called Novalgin (metamizole), is an NSAID similar to ibuprofen in its effects.  Here it is one of the first choices for a prescription painkiller; in the U.S. it has been illegal since 1977.  The U.S. ban is (according to Wikipedia, read about it there) based on somewhat questionable science, which is unfortunate because the drug has many advantages compared to ibuprofen and acetominophen (paracetamol).  The other, a muscle relaxant called Myolastan (tetrazepam), is a benzodiazepine derivative with unusually mild sedative and hypnotic properties, while retaining its relaxant and anti-anxiety effects.  Sounds great, right?  I'm not sure why this one isn't used in the U.S., although the possible side effect of "toxic epidermal necrolysis" doesn't sound that pleasant.  Anyway, the point is: I had always assumed that differences in what drugs were used between the U.S. and Europe had mostly to do with speed of approval (the U.S. being much slower than Europe, which has its pros and cons), but apparently that is not the case.  We are really medicated very different on our different sides of the Pond.  Which means that, pretty clearly, one side of the Pond or the other is not basing its drug approval and prescription decisions on the best available science.  Want to bet which?  (I'll give you a hint: in which country do pharmaceutical companies spend more money on lobbying?  Still too tough?  Here's another hint: which country's Supreme Court just declared the right of pharmaceutical companies to spend unlimited amounts of money on political advertisements?)

  Well, that's enough blogging about health care.  Thought this perspective might be of interest to some.  I'm still curious to experience the (much-lauded, much-reviled) Canadian health-care system firsthand, but I haven't yet had the need.

  My roommate here, a fellow from Malawi, is such a sweetheart that he cooked me dinner.  He said I was "a patient" and I needed to be fed.  Sheesh.  Just when you start thinking humanity isn't worth the saving, somebody comes along and reels you back in.

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