My Great American Adventure – Learning about the healthcare system

How about this for a welcome then;  my first day at the Institute of Health Improvement, I arrived to find a note on my computer (yes, I had desk space and a computer allocated to me)  saying ‘WELCOME YVONNE’, a pot plant and a note from Joanne, the brilliant Senior Vice President that helped to arrange my visit.

I have to say it was a lovely welcome and something that I will remember to do in future if I have to welcome a new member of staff to the team.  Jo had also arranged for me to have a work buddy for the first couple of weeks of my visit as she was away in NZ on a conference, thoughtful or what. This meant that I was not wandering around like Billy-no-mates not knowing where to go or what to do. This I was told was standard induction procedure, impressive. On Monday mornings, the IHI have an all staff meeting, the team mostly made up of a young and vibrant group of thirty-something’s were welcoming and warm.  They were genuinely pleased to have me visit with them.

In at the deep end, I attended the new business meeting and a leadership meeting. Being ‘new’ in the NHS is bad enough and sometimes credibility comes with length of service and fact that you are a clinician (at least initially). This was different, different terminology and acronyms, and in a way a very different business. Yes, the organisation is health focused but it is also very business focused.  The IHI is a not-for-profit organisation, but still extremely mindful of costs. I admit it I had difficulty following some of the conversation. It made me realise that in full flow NHS people speak a different language too, we use so many acronyms and culturally based sayings, people from outside the NHS can’t but help feel excluded, another note to self, do not talk in acronyms, be inclusive.

I learned a lot on my first day ‘in the office’. Have you ever wondered how the American health care system works? I suppose in a vague sort of way I knew that people have to pay insurance premiums to get their healthcare.  One of the first things I had explained to me was that Americans see healthcare as a privilege not a right; Mmm, not sure I agree with that, however… To explain, Medicare is the federal government programme that gives health care coverage (health insurance) if you are 65 or older or under 65 and have a disability, no matter your income. Some of the taxes on your income when you’re working go toward Medicare.

Medicaid is different from Medicare, it is a state and federal programme offering health care coverage to people of most ages in certain groups (children and pregnant women, single parents, people with disabilities, and people 65 and over), but generally only to those with low incomes. Everyone else is expected to pay health insurance and most people get insurance through their employers.

So for example if you start to work for the IHI, you’d have an interview with HR colleagues to discuss your health insurance and be asked to choose one of two options. If you chose Health Maintenance Organisation (HMO) insurance it means you would have to go to a physician (like a GP) for any illness, he/she is the gatekeeper to all other healthcare and he/she will orchestrate your care. You would be expected to contribute towards the cost of your health insurance to the tune of $60 = £36.95 per pay period which is every 2 weeks, so £73.90 a month, that’s for you as an individual, if you have a family then you pay £190.90, a family consists of two adult and two children.

You might however chose Preferred Provider Organisation (PPO) which means you are free to choose which doctor you go to see, for this option you pay more £108 a month for individual care and £284 for a family. I have to add that on top of that you would also need to pay for your dental and eye care plans. In addition to this your employer pays a contribution to the premiums and for an organisation the size of IHI which has about 200 employees it comes to about £615,671.

Sobering or what, and I think it puts our own system into pretty positive perspective.