At the clinic

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.


About Fletcher DeLancey

Socialist heathen and Mac-using author of the Chronicles of Alsea, who enjoys pondering science, politics, well-honed satire (though sarcastic humor can work, too) and all things geeky.
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12 Responses to At the clinic

  1. xenatuba says:

    Yep, it did look like misplaced decimal points to me. Hope everything is OK (although if you felt well enough to go tidy up and return, it sounds more routine than an ER visit usually is).

  2. oregon expat says:

    We’re good, thank you — just happy to be somewhere more comfortable than a clinic waiting area full of coughing people.

  3. Cathy White says:

    My first thought, when reading that your Dad had been charged $400 for a thirty second interaction, was fraud , plain and simple.

    • oregon expat says:

      Actually we are wondering about that as well, esp. in light of the recent investigative report in TIME magazine on hospital billing fraud. But the very fact that $400 could be considered a reasonable charge if the doctor DID examine the patient is still rather boggling.

      • WPesqvta098 says:

        6 years in and I still don’t get it.
        I recently had a couple of experiences with people close to me and exams that were performed and then ordered to be repeated more than once, for no reason made evident to mere mortals. I can’t state with full certainty that the professionals handling it did not have valid reasons to do so. But we know how much is charged for lab tests and exams in the US and we know that many times they happen not because they are really necessary but because clinics and labs know that either you or the insurance company will pay for them.

        I lived 40 years with the Portuguese system and, besides a couple of serious occurrences when I was a kid, I have never really had to use it for myself (lucky me, I am starting to need a bit more healthcare in the country where you can easily go bankrupt because of it). The Portuguese system is very far from perfect and the waiting times for some non-life threatening cases (even if severely diminishing the quality of life) can be exasperating. But the US one is mostly a constant outrage. I refuse to call it healthcare because that it is not. Health business is a more accurate description.

        • WPesqvta098 says:

          (I don’t know how this comment ended up being posted under this nickname – full disclosure: the name is the password I *was* using for my account 🙂 – but this is Paulo/kepler20f, for what it’s worth. Note to self: coffee first, comment later.)

  4. Jason Cleaver says:

    And this is why I love the UK. We have free healthcare, including A&E.

  5. Cathy White says:

    Accident and Emergency, ie ER, Casualty etc.

  6. João Brandão says:

    My son was born at our local public hospital. Total cost: Not 1 cent.

    A few years ago, my grandmother broke her ankle and being an old lady end up staying in the hospital quite some time. About a month give or take a few days. Total cost: about 50 euros.

    Unfortunately this government and the past fake-left governments are trying really hard to completely destroy something that is above all else, our right. Nothing is more important than health.

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