My apologies for missing two posts this week — it has been a busy couple of days. I spent much of Friday trying to find an international source of medication for one of our cats (more on that in a later post), and yesterday we had a minor medical emergency in the family. Of course, any medical issue on a weekend means going to the public health clinic, and as you can imagine, Saturday evening is just about the worst possible time one can choose.
The triage desk rated our case yellow, meaning not super urgent, and yellows can be line-jumped at any time by the arrival of a red, urgent case. We had six yellows ahead of us, and the woman currently at the head of the line had been waiting for two hours. We actually went home for an hour to eat and tidy up the things we’d left hanging in our haste to get to the clinic, and when we returned, our position hadn’t dramatically changed.
Once we got in, however, I was impressed by the clinic’s efficiency. First we went to a doctor, who entered data in the record that had already been created by the triage desk. She sent us to a nurse, who took care of the medical issue and then brought us back to the doctor, who entered more data and prescribed antibiotics. We were out the door and on our way to the pharmacy in a very short time.
The total cost was €15.45 for the clinic visit, and another €13.82 at the pharmacy. Any American reading this is going to think I misplaced the decimal points in those numbers (after all, this was the equivalent of a trip to the emergency room), but my thought was that the clinic costs have really gone up. My first trip to a Portuguese public health clinic was in 2005, and we paid a little over €4 then. Which is not to say that €15.45 is unreasonable, because obviously it’s not, but to have those costs going up so dramatically while people’s ability to pay is declining at a similar rate is a bad combination. To the many, many Portuguese who depend on public health services for all of their medical concerns, and whose incomes have been drastically cut or lost altogether, this represents a potential bar to health care.
On the other hand, when I look at this through an American’s eyes, I’m still wowed by how ridiculously affordable this is, and how efficiently the system works. My dad recently told me a story about the time he had to take Mom to the emergency room due to an awful gastrointestinal virus. They were seen by one doctor, and while waiting in their little curtained cubicle for further care, a different doctor stepped in and said, “You had a question?” No, they said, you must have the wrong cubicle. We’re waiting for Dr. X. The second doctor nodded and left.
When they received their invoice for that emergency room visit, they were shocked to find that the 30 seconds the second doctor had spent going to the wrong cubicle had been billed at $400. Regardless of whether he had actually dispensed medical knowledge or care, he had entered their cubicle and engaged with them. This was worth $400.
I was interested to note that in our clinic visit last night, the doctor was really more of an administrative figure, assigning the hands-on work to the nurses and providing the medical authority to prescribe medication. Her office had two examination beds in it, and I am guessing that if the situation had been more dire, she would have been the one to conduct the actual exam. But the system saves money by reserving the doctor’s services for cases that actually need it. Our case did not, and so we were handled almost entirely by nurses while the doctor’s office acted as more of a checkpoint.
All is well now, and we’re enjoying a quiet, rainy Sunday at home. Seems like a good day for a hot cocoa.