h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

I'm a law student, and as I was reading about cases that use cost spreading as a justification for holding defendants strictly liable for injuries. Of course, we're a nation with a lot of lawyers, but we don't have universal health coverage.

On one occasion, I twisted something at work. After it didn't go away, I went to my doctor to check it out. The doctor stopped me as soon as I mentioned work, because I would need to see a worker's comp doctor. On another occasion, my daughter was hurt at the babysitter's, and my insurance company started asking questions about where she was hurt to try see if they could get something from the babysitter's insurance.

If you live in a country where healthcare is provided by the government, is the government able to recover losses due to negligent acts? If you have a single payer system, does the government just take the hit?

In NZ we have Accident Compensation from ACC, a govt department that administers and pays payments for injury. It's no fault compensation, meaning the govt doesn't try and recover costs from anyone. It means we don't have a culture of suing (you can sue for other reasons like defamation, but still, it's not a common thing).

If you have an accident while you have a job you will get 80% of your earnings for the time you can't work, plus possibly a lump sum payment. ACC pay for part of most injury related medical treatment, even things like sports injuries.

Everyone who earns income from wages or salary pays fees to ACC via the employer or self employed people pay direct (so you don't pay from other kinds of income, and people who dpn't have earnings still get cover. It's a tax not and insurance). I have no idea if those contributions get close to covering ACC's budget. ACC also do education and health and safely promotion.

In Germany if you are injured at work (or school) or on the way to work (or school) and you have an accident you can call an ambulance or whatever if it's that bad.

But you have to tell the doctor who treats you that it's work/school related and if there is a doctor locally who handles the work/school related accidents you usually have to go there. There's a lot more paperwork (for the healthcare provider) to complete and the work/school place have a lot of paperwork too.

The patient, generally doesn't have any extra hoops to jump through unless they were clearly negligent.

Employers have to have insurance for that and, ultimately, the insurance company have to pay the medical etc bills.

In the UK you just get treated, no questions asked.

My guess is that the government, or whoever, have (probably correctly) surmised that if they had a policy of trying to recover the cost of treatment, the only people who would come out of that game ahead would be the lawyers.

Sometimes if you're hurt when it's not your fault, some ambulance-chasing scumbag will give you a ring and try to get you to sue the at-fault party for compensation - but that's money that goes straight to you (and him, of course...). None of it gets to the medical services.

There's an "honour" tradition with certain emergency services. I had a free trip in an inshore lifeboat once (embarrasingly, I was only up to my chest in water by the time they picked me up). The lads in the boat station got a crate of beer out of that. Several of my paragliding buddies have done fundraising work for the air ambulance after getting free trips in that (one of them went in it twice in one day!). But none of that was mandatory and I doubt their individual efforts covered the cost of their rescue.

Sometimes, very very rarely, you'll hear of some particularly stupid individual being pursued for the cost of their rescue or treatment - but that's a once-in-a-few-years thing.

In the UK you get treated, but if you were in a road traffic accident you will be charged via your insurance company.

"An example of NHS charges

A patient had an accident on 10 September 2009 and was:

taken by ambulance to Accident and Emergency to hospital A where they were treated as an outpatient
transferred and admitted to hospital B for seven days
transferred again to a specialist unit in hospital C for ten days
All three ambulance charges would be recoverable – a total of £513. In-patient treatment at hospital B and C (a total of 17 days amounting to £11,815) would also be recoverable. The Certificate of NHS Charges would be for £12,328. Out-patient treatment at hospital A is disregarded as it is superseded by the in-patient treatment.

Had the injury led to 100 days treatment at hospital C, the NHS Certificate would show a total charge of £74,878 capped at £41,545. The ambulance charge is incorporated in the recovery, subject to the NHS capped tariff amount."


http://www.dwp.gov.uk/publications/specialist-guides/technical-guidance/z1-recovery-of-benefits-and/7.-the-law-nhs-charges-part-2/

Re post 5: I had a definite WTF moment with this one so I did a little digging...

Part 1 of that same document (http://www.dwp.gov.uk/publications/specialist-guides/technical-guidance/z1-recovery-of-benefits-and/7.-the-law-nhs-charges-part-1/ ) says:

For personal injury compensation claims with a date of incident on or after 29 January 2007 Part 3 of The Health and Social Care (Community Health and Standards) Act 2003 applies (“The 2003 Act”). A person is liable to pay the NHS charges if they make a compensation payment in consequence of any injury suffered where the injured person has:

- received NHS treatment at an NHS hospital, and or
- been provided with NHS ambulance services

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And in the section on exemption from payment ( http://www.legislation.gov.uk/ukpga/2003/43/schedule/10 ):

Any payment made to the injured person by an insurer under the terms of any contract of insurance entered into between the injured person and the insurer before the occurrence of the injury in question.

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So I'd read that as - You have an accident on your own - you're not responsible for the payments, neither is your insurance company...

You have an RTA and someone else is responsible - you're not liable to pay, your insurance company isn't liable, however, the other guy (via his insurance?) IS liable for NHS charges.

Sorry, I maybe wasn't clear enough when I referred to road traffic accidents.

There's an interesting case ongoing with substandard cosmetic breast implants.

The governments (of Scotland, Wales and Northern Ireland) have found that they've had to agree to the removal of the implants in some cases, either because the private clinics fitted them have already gone (ahem) bust, or say they couldn't handle the workload (presumably meaning while continuing to stay in business).

I'm thinking - hang on - surely even the clinics that have now ceased training had liability insurance?

I'm pretty sure you get a bill for the ambulance after a RTC, although only 'pretty' not '100%'.

"you get a bill for the ambulance after a RTC"

Nope. Not in the UK, in my recent experience.

I had a crash. Entirely my fault - turned right across an oncoming vehicle I hadn't seen. Wrote off the car, very slight injuries to the two children in the back of the car I was driving. Free trip in ambulance to casualty for the three of us. Never saw a bill.

Yup. My brother-in-law knocked down a child. He was pretty upset about it. Then the bill came in...

(possibly NHS trusts differ in their efficiency.)

I was taken ill on a train (on the way back from a h2g2 meet in Koblenz) with a suspected heart attack () and was put in an ambulance and spent 3 days in hospital (nothing to do with my heart)

Got a bill for my contribution to the ambulance & hospital stay (EUR 10 or so for the ambulance, EUR 17 or so per night hospital)

was taken to hospital with suspected (turned out not to be) gall bladder thing - no bill for ambulance but received small bill for 4 nights in hospital which I forgot to pay, and never got a reminder so I didn't because I had 0 money in the bank at the time.

Gruesome #2 was knocked off her bike and schlepped off in an ambulance but we got no bill. Mind you I had to fight with the other car's insurance company to get money to get her a new bike - which was a write off - and it was only when my legal insurance got involved that we managed to get anything at all (but that's a whole other story). I presume their insurance also covered the ambulance (she was ok)

I have to say, if I required a trip in an ambulance through my own fault or someone else's, and some desk jockey saw fit to send me a bill, I'd be very tempted to send them a copy of my latest pay slip with a big thick black ring drawn round the "National Insurance Contribution" line and the words "Paid in full every month for the last 20 years - you're welcome" on it.

Yell you could try - but if the accident was your fault and it involved driving a car, good luck renewing your insurance.

Meh. Creeping privatisation, I know. Suck it up.

I don't see that anyone should have to "suck it up" without a comparative reduction in NI so that you could use the balance to take out private health insurance.

The mechanism of claiming back through insurance companies is really interesting, because

1) It gets the systems and processes in place for the NHS Trusts to claim back the money

2) No-one cares

No-one cares becuase the Insurance Companies just add the costs onto premiums, it's just another actuarial cost in the underwriting equation. And we don't care beacuse we don't know why our premiums have gone up; we may not even notice they have.

Bustards.

Ben

As a Brit I was horrified when having been injured at work in Australia my doctor kept calling me in every two days (so he could get some workers comp money) and then sent me to a physio (a Scot) who was honest enough to tell me I just needed to rest the injury for a few days (going to the doctors was making yt worse, and then explained how corrupting compo culture is.
I hope the UK government doesn't go down that slippery slope or we'll end up like the US were health care cost twice as much and life expectancy is lower than the UK.

I can't remember being charged for ambulance trip when I was hit by a car (concussion only, inside my own car), I think I just only paid about 200 SEK (£20) per night. Same thing giving birth, seeing a specialist, seeing a gp, whatever. Children up to 12 get free care.

What you pay for medical care isn't really an issue. What is troublesome is the long waits, for non-lethal conditions, and the bureaucratic mess when the different regions can't agree if a person is covered for treatment in the other region...

I'm happy with the system here. It's not perfect, but darn near. And nowhere near other systems I've heard of.

And if you're hurt at work? Doesn't matter where you go for help. Get the help you need, get the injury documented, and then the financial bit gets settled in time. Usually...