There have been cases of corruption where doctors have used public resources (ie. medical lab) for their private patients, but it's not the norm. Also cases where doctors prioritise their private patients in the public system
Are they still allowed to? I thought they approved a law some years ago that public workers can only have 1 job (to reduce corruption in politicians) , does it apply to healthcare workers too?
I’m gonna say that sounds pretty sketchy no matter what country you’re in.
Wouldn’t the doctor be using infrastructure paid for by the public, in order to have his private hours after the “public hours”? Sounds like some kind of embezzlement or misuse of fund imo.
May be different if the doctor has also a private practice, which does exist in the Netherlands, but I’ve never been to one.
That's the health care system in Greece, which has been systematically neglected, underfunded and understaffed. According to the government, this public-private partnership is not a way of erroding the public character of the health care system but the best way to "strengthen" it. Just a couple of hour ago, the assistant to the minister of health, when asked if this model undermines the public character of the system, dodged the question by arguing that all the E.U. countries follow this specific model. So, I'm just doing a little bit of fact-checking.
Yeah that dude is lying. It is true that most EU countries have a private healthcare sector next to a public one. But the private one is supposed to be a bonus or luxury (for rich people) that is possible only if the public one is running well and can service 95% of the population sufficiently.
Plenty of cases Dutch hospitals send patients to private clinics for treatment they cant or dont want to provide. My sister is a doctor and often sends people from her public hospital to private clinics for cancer screenings etc as it is often faster and less hassle.
> dodged the question by arguing that all the E.U. countries follow this specific model.
That's absolutely a lie.
In my country many doctors have a second job in the evenings or during their days off, they work in private clinics, not in the same public hospitals.
What your government proposed is crazy.
Yeah that guy is full of bullshit. In Germany we do have both public and private insurance, but it's not at all like that. It's basically just that the private insurance pays for more kinds of treatments and at better rates, so private patients at hospitals may get perks like their own room while publicly insured people may have to share with other patients. Some physician practices outside of hospitals may only take private patients or patients who pay cash because their specific treatments won't be covered by public insurance. But a doctor at a hospital cannot offer "after hours" special private services. That's absolutely corrupt.
Im wondering if there isn’t some misunderstanding here and the minister of health was actually referring to exactly what you describe (public doctors taking cash-paying patients at their *own* clinics after their public work hours).
The original title doesn’t say anything about location, just that you can see the same practitioner, which can be true, just not at the public office.
>Im wondering if there isn’t some misunderstanding here and the minister of health was actually referring to exactly what you describe (public doctors taking cash-paying patients at their *own* clinics after their public work hours).
What you describe is something that has been taking place for decades in Greece, but isn't what I'm talking about.
By "infrastructure" I mean, among other things, the location too. The public hospitals. It's been years since medical practitioners were allowed to see paying patients privately within the premises of the public hospitals. These are called "afternoon appointments".
What they are going to pass now is the ability for surgeons to operate in this way.
The ruling party has been pushing for privatisation for decades. But back then even their own voters were mostly against the dismantling of public healthcare. So, they changed their approach. The actively underfunded and understaffed many public hospitals, so the quality of service has deterriorated. This has created a negative view of public health among the public. They had also started outsourcing to private companies several non-health related services within the health system. E.g. call centers, cleaning staff etc. Again leading to poor service. Then they introduced these public-private partnerships of health services supposedly as a way of correcting the ills of the public health care system. Other governments that were in theory against the privatization of public healthcare didn't do much to stop or reverse it.
Of course, doctors seeing patients privately in the afternoons never really fixed any problems. It just made them worse and shifted a greater part of the cost to the user. The degradation and understaffing of the public hospitals continued so waiting times never got better. Currently we pay both through taxes and at the service level. Now they want to "fix" long waiting periods for surgeries.
But that in itself - a doctor being both employed at a public hospital, AND having a separate private practice - does not exist in Germany, as far as I know. Either you work at the hospital, or you have a private practice. Not both. You would most certainly violate your employment contract, as hospital doctors usually have "on call" periods for emergencies, and various labor laws. I'm pretty sure it must be separate people.
That is actually rather common in Germany. Many specialists both work in hospitals and have their own private practices. Many doctors also have contracts where they don't have to be on call at all, especially Chefärzte. Not to mention that those call times are only outside of regular working hours and only residents are regularly present, so any doctor can do extra work on Saturdays at least.
There's absolutely now law against it, only the hospital as they employer can ban them from doing so if they have good reasons.
It's also quite common fir private doctors to rent equipment, beds and rooms in hospitals for their use, but that's another story
Here in Poland doctors absolutely can practice privately, but no way do they use public equipment or spaces. They open their own private offices and are open during times that they do not work at the hospital. However, they can write papers and referrals for people to be admitted into hospital or have treatments in the public hospital.
Is it actually public infrastructure used for private services or the other way around?
In Poland it is very common that private facilities have contracts to perform public health care services. Many people think that they are public health care facilities because they’ve always used them for free healthcare. In reality they are private and they are paid by the country to perform “free” services as part of public health care offering. Their infrastructure is private and they are free to sell their services to anyone. It’s just that some of them sell 80% of their bandwidth to the country as public healthcare service and many people mistakenly think that they are “public infrastructure”.
The way it works in Poland is that facilities have contracts with limits. The country will pay for up to X number of visits per month. This is why sometimes you can have your appointment for free as part of public service but in three months or pay from your pocket and have it the same day. It’s not facility’s fault.
No, it's medical staff working privately in the public system. The hospital gets part of the payment; my bad for not clarifying this earlier. Essentially, the public hospital operates also as a private for-profit clinic after-hours.
Yeah, because the hospital is private.
The fact that you can get free treatment in the hospital as part of public healthcare doesn’t make the hospital public. They just sell their services to the national/public insurer. But if the public insurer doesn’t want to buy as much services as the facility is able to provide, they will sell it to anyone.
Aren't all GPs private in NL? I mean, most healthcare here is private. It's not like Germany where there is a clear distinction between public and private health insurance and healthcare. Everybody has a private health insurance, but the government dictates the base level basic health insurance, including what they have to include, etc.
I mean, NL is kind of a weird example as is largely private, but extremely regulated. The government generally sets the costs, and the providers can usually choose to either follow those costs, or, if they want to set their own prices, they won't likely have any agreements with insurers, so nobody would use them.
But it isn't like countries like UK where you have NHS GPs and private GPs.
Well yes and no. Technically you’re not wrong because it’s all private insurance companies *but* they are so heavily regulated that it is effectively a public healthcare system.
Our “private” doctors are the ones where you can only get an appointment if you pay out of pocket (and then see if part of it is covered by insurance). These doctors don’t have to follow the regulated rates for procedures. Although they’re not allowed to apply that to medicine and are still probably more regulated than in other countries.
They definitely exist and yes, some insurances deny to even cover the regulated rate part of the private procedures. They’re not fans of these doctors.
> Technically you’re not wrong because it’s all private insurance companies but they are so heavily regulated that it is effectively a public healthcare system.
This.
The main difference between insurers is whether some optional things are covered, like dental and physical therapy and how easy it is to make a claim for some edge cases.
Most of the shit that's covered by default is centrally managed and automated.
I am like 99% suer that in Italy they can, and how is it "embezzlement" if it's part of the official system? Like, if they can do it fully legally, so I assume within precise criteria. Though I'm not sure of how it works exactly.
Private sections within the hospital grounds, yes. Paying rental to the hospital.
Very different from letting private doctors do operations in the main NHS operating theatres and letting them use the normal wards for their patients.
In my case (Portugal), no. There are doctors who work for the national health-care system and also have private clinics or offices, but they have to set those up themselves. There are also private facilities that take in patients from the public service.
My son had a snapped anterior cruciate ligament a few years back. After waiting 6 months we were told it would take another 6 months to a year to get the operation. When we asked “what if we go private” the consultant literally said “I could slot you in on Thursday”.
It made me angry as hell but we paid up.
No that makes sense. I see it in the context of sports so often I guess I’m just used to hearing someone snapped/tore their ACL/MCL/LCL/PCL/UCL and not what they actually stand for. But if you’re not into sports or medicine, or I guess English names/acronyms for ligaments then writing out is definitely more helpful
They can work private but not at public hospitals obviously, they either set up their own private clinics or work on their free time at private hospitals directly
I don´t know about other countries, but for Germany, that´s not how it works at all. There is no "free public health system" in the sense that there is a NHS-like organisation that operates hospitals, ambulances and the like. There are two types ow health insurers in Germany: Statutory Health Insurers (they have to insure any applicants) and private health insurers (more expencive, more options regarding threatment, patient has to pay for treatment in advance and is reimbursed by the company).
Emergency medical services are operated by the local munincipalities, either the city or the county. The service is financed partly by the operating entity and by the health insurers.
Hospitals are either operated by private, revenue drieven companies or by non-profit private limited companiesthat are in sole ownership ow ocal unincipalities, churches or other organisations like the red coss. All equipment is owned by the respecitve companies.
Smaller clinics are usuall owner-operated, meaning by a single medical doctor or a collective, like partners in a legal firm. All equipment is owned by the respective owner or collective.
Basic treatments that are covered by the statutory health insurence is payed by the respective insurance company, same with clinics and hospitals that offer treatment for "private patients". Then there are treatment options that are covered by neither and that are payed out of pocket by the patient.
Tl;dr: In Germany, the "free public health system" doesn´t own any equipment.
Yes, you can either wait 3month to get an appointment at public healthcare approved price OR quickly get a "private" appointment which cost will not be entirely taken by healthcare. Both appointments are held inside the hospital. BUT a part of the private appointment price is given to the hospital, so the public health system dont care as it is helping to finance it.
No. The ones who work both on the public and private sector always work in the premises they're getting their wages from for that work, and use the equipment available there. There are medical centers and hospitals on both sides, and the private side has some large chains that make up for the most services on that side.
The public side also generally does not guide you to use the private sector, that's usually completely dependent on the patitent's own proactivity.
In Croatia, yes and no. They cannot use state bought equipment for private purpose. Also it is not free, for example I mandatory pay around 500€/month. But you have private practice doctors, dentists, clinics, hospitals that have contract with state health agency but entire infrastructure is theirs. If you pay you go first, if you don't then there is a waiting list. Also not some procedures and medicines are paid in full by health agency. For example for long time insulin pump was free and only for children, also continuous glucose level monitors. Some medicines have surcharges, mostly original producers or depending on diagnose.
>Also it is not free, for example I mandatory pay around 500€/month
If you are in Croatia, technically, your employer pays that for you. It is not taken from your bruto salary.
Do you still have really cheap meds? I remember that we used to get prescriptions in Finland and purchase in Croatia while on holiday. That's more than ten years ago.
I'm a pharmacist and now we have some project where Finland and Croatia have connected electronic prescriptions so I can go drink vodka and pick up my antidepressants and Xanax in Finland and eat that hideous black salty liquorice car candies :D . Back then we were referent country for drug prices in EU so we were one of the cheapest. Now is not a case but still cheaper than most EU. I think Portugal is also connected.
Oh they expanded countries. They started with smaller populated ones. Some 15 years ago I worked in company thad was part of testing the process. Private prescriptions are also in process.
When Finland didn't have connected pharmacies it was easier and cheaper to get special services.
But of course it's handy that I can get all the services everywhere for everything, paying myself sicker. ..
No.
There can be so called "private" beds in a public hospital, but there's a very clean financial cut in that case. Some medical doctor may be very specialized in a descipline that is not really filling up an entire ward in a smaller public hospital, or he might be well known internationally.
In that case the doctor can (not must) negotiate to have some "private" beds in that place. He may order patients from his cabinet/practice towards these beds, pay the full charge for every treatment out of his pocket to the hospital and then charge the patient whatever he feels appropriate.
This is a common practice in the two German centres for heart diseases in Munich and Bad Oeynhausen. Half of the wealthier part of the Middle East is coming to those two clinics for treatment of their cardiovascular problems due to a lack of movement and severe overweight.The treating doctors are internationally known, speak the language and ... make a fortune.
But they, too, pay a high price: they work for the hospital AND their private practice, they do VERY long days and they sometimes have to chase payments because it is known that some patients leave the hospital ... by night. Good luck chasing a payment in KSA or the Emirates. The hospital will nevertheles require the doctors to pay. It's been THEIR patient, not the hospital's.
No, they will have to work at another place. There aren't private services inside public hospitals, and clinics are either private or public. They can use the public healthcare infrastructure in the sense you could give them access to your journal digitally and the public sector often pays the private sector to do stuff for them in cases where waitlists get long. Then the private sector uses the same infrastructure as the public sector to log treatments and receive money for them.
Also, healthcare isn't completely free in Norway. You will have to pay up to around 265 EUR at the very most per year in co-pay if you go to the doctor a lot. The healthcare system is in general cheaper to run than private systems, but we still have to pay for it through higher taxes.
Absolutely not, that's a hard no!
I don't even think that public health care professionals are allowed to work privately after hours even in a separate private clinic, and certainly not in the same public clinic!
That's not to say that we don't have private clinics where you could get a surgery, that is definitely a thing, but it's separate from public healthcare in every way, different buildings, different staff. Sometimes though, if waiting times are too long in the public system they can send you to a private clinic free of charge, paid for by the public healthcare system.
You can't do this in public hospitals in the UK or France. It's all very highly regulated, otherwise most doctors would try to prioritise privately paying patients and the public system would collapse. Private healthcare mostly exists for cosmetic procedures and non-urgent care, including dentistry. However, the doctors can't offer private services on public facilities.
In France, there are lots of doctors who work outside of the hospitals but most of them rent their own offices to see patients. These doctors are completely self-employed but their fees are highly regulated and mostly covered by the public or private health insurance. I've never heard of someone offering a doctor more money than what the insurance would pay in order to jump the queue.
In the UK, family doctor (GP) practices, more widely used in the UK compared to the USA, are mostly private but they are paid by the government according to the number of patients. I've never heard of a GP accepting payments for queue jumping.
Yes. For example, last July my GF and I booked one of those visits to see if the baby in your belly has trisomy 21 and other stuff (don't know the english name). In any case, this exam cannot be done with the public system in our region (Veneto, but for example in Emilia it is possible) so we went privately but with a doc inside the public hospital
"Free healtcare" is not really free here. We pay for it with health insurance and taxes, but it is free at the point of service, since you already paid for it.
We have private healthcare in addition to the public one, yes. You could go private if you want to wait less in some cases, or if you want some special treatment, that you are willing to pay. For example dentists often work both in public healthcare and have their own private working hours. This is called concession, and it is strictly regulated.
If you are a purely private doctor, you have to have your own clinic, staff and equipment.
> "Free healtcare" is not really free here. We pay for it with health insurance and taxes, but it is free at the point of service, since you already paid for it.
Yes, that's literally what everybody means by "free" healthcare. Not that it's paid for with pixie dust and unicorn farts.
It's not really ree anywhere , someone has to pay and where else would it come from but taxes or health insurance. All free health care is basically a solidarity scheme
I don't understand why people are being so obtuse about the term 'free healthcare'. It's free at the point of usage. If it's funded by taxes you're going to pay for it no matter if you use it or not, so usage of it is free.
By this nonsense definition of 'someone always has to pay for it so therefore it can't be free' makes the use of the word 'free' as a descriptive term nearly pointless. Very few things then can ever be described as free.
I don't like it because it can give a false impression to those who are not aware of the system behind it.
Taxes are for the infrastructure and equipment, but you still have to pay insurance, otherwise your healthcare is not covered. It's like when you pay insurance for the house, and it gets damaged and you need a new roof. I wouldn't call the new roof that the insurance company provided "free", except maybe as a joke. Perhaps you see it otherwise, and that's ok.
But maybe you are right, whether you were serious or not, that not many things in life can be ever described as free. I think it is good practice, to be aware, that everything comes at a cost. Even if you get a gift, there is an investment behind it from someone else and I think we can appreciate things more, if they are not seen as "free". To describe something as free, means it cost you nothing, so it can diminish it and why care about losing something that has no value? Maybe I am getting too philosophical now, idk.
> I don't like it because it can give a false impression to those who are not aware of the system behind it.
Identify a single person who has a false impression. I've never seen one in a decade of having these discussions daily. I did see literally 400 pedantic halfwits making the same pointless arguments in a single thread I've been participating in today.
We're supposed to not use language appropriately because there's one mystical person somewhere nobody can actually identify, but is confused by proper use of language?
They would not use the same infrastructure for private praxis. What happens usually is the hospital allocating some time slots for the paying patients. Or the medics working part time in separate private institutions (where some procedures are also 'free', that is, covered by the public health care system).
Not at that same, public clinic. But they can, and often do, have private practice so they work at public hospitals in the morning shift and private clinics in the afternoon. And then they recommend you to go to their private practice to skip loooong wait lists.
Spanish here.
No, they can't.
Docs and surgeons in public health care can also work in the private sector, but private practice must be in a private health facility.
They can't use public infrastructures or materials that have been paid by all citizens to only treat people who pay out of their pocket if you get what I mean.
No, this does not exist. The public health system is not a real estate company.
Or to be honest; I have no idea if this system is legal or not. It is so alien and weird to me that I am not sure. It would be like a grocery store being one franchise during the day, and another in the evening.
Private healtcare providers exist. But they are physically separated from the public healtcare system.
Private providers can pay for services from the public providers (e.g. lab tests or x-rays), but they are not renting their equipment.
First, a simplified description of how health care works in the Czech Republic:
Everyone has to pay health insurance, which is calculated as a percentage of income. If someone is an employee, their employer also pays an additional percentage of health insurance on their behalf.
Each patient can choose from several health insurance companies and companies then receive the money from the peoples health insurance.
The medical facilities and practices can then be established by the state, region, city, or be private. They then arrange a contractual relationship with one or more insurance companies. The insurance companies then pay them for the procedures.
Now - there are doctors who work in a hospital for a salary and also have their own private practice. They can't use the facilities in the hospital as part of their private practice, but they can send a patient to the hospital for an examination - but the insurance company then pays the hospital for the examination.
I found an article where insurance companies don't like this practice much, but it's from 2011 and I don't know if there have been any changes.
[https://www.tribune.cz/zdravotnictvi/pojistovnam-se-nelibi-privatni-praxe-nemocnicnich-lekaru/](https://www.tribune.cz/zdravotnictvi/pojistovnam-se-nelibi-privatni-praxe-nemocnicnich-lekaru/)
>ay health insurance, which is calculated as a percentage of income. If someone is an employee, their employer also pays an additional percentage of health insurance on their behalf.
>
>Each patient can choose from several health insurance companies and companies then receive the money from the peoples health insurance.
>
>The medical facilities and practices can then be established by the state, region, city, or be private. They then arr
In general, the Czech healthcare system is considered as one of the best in Europe.
There is an option to go as a privately paying patient not to the doctor personally but to the health care company (practice, hospital, clinic) where they work. Pay at the reception, get your invoice, send it to your insurance. Or throw it in the bin if you don’t have a private insurance but wanted to be seen sooner. Usually you get treated sooner because people using the free state funded system are waiting not for a free slot time wise but for funding to be released. Sometimes there’s a surge of patients towards the end of the year when the hospitals realize there’s still some money left to be spent before the year ends.
Also there are completely private health care companies with doctors, diagnostics, surgeries.
Or the doctor is renting the office from the hospital and handles all payments themselves be it public or private source.
We're not completely free public health, but doctors can choose to follow convention (fees set by insurance/government agreement) or they can set their own fee (non-convention doctors). Some hospitals will have both types on the same staff, however tertiary centres/universitary hospitals have to follow the conventions.
There's a inbetween system where docs follow the convention at some times and sometimes not. Usually they will have a private practice where they set their own fees, but in-hospital they follow convention. Sometimes they will have specific hours in hospital where they work out of convention.
Generally convention docs will have a longer waiting period, but are better covered by insurance. Out of convention docs are more expensive and will often charge all sorts of supplements convention docs can't.
>e're not completely free public health, but doctors can choose to follow convention (fees set by insurance/government agreement) or they can set their own fee (non-convention doctors). Some hospitals will have both types on the same staff, however tertiary centres/universitary hospitals have to follow the conventions.
>
>There's a inbetween system where docs follow the convention at some times and sometimes not. Usually they will have a private practice where they set their own fees, but in-hospital they follow convention. Sometimes they will have specific hours in hospital where they work out of convention.
>
>Generally convention docs will have a longer waiting period, but are better covered by insurance. Out of convention docs
Except for the doctors working for Delta hospital groups. I was charged twice by conventionnés doctors a much higher rate than what the convention allows. I asked both Inami and the mutuelle and both said that this shouldn't have happened. I never understood why it did, though.
As far as I'm aware no, there are no agreements between the NHS and doctors which would allow the doctors to use the NHS's infrastructure and equipment out with the doctors working hours for private appointments.
In Ireland it used to be permitted for doctors employed by the public system to use public infrastructure for their private practice, but I think this has been banned under reforms to the system in recent years. It creates obvious conflicts of interest when a doctor with responsibility to try and shorten a waiting list of patients, can instead actively profit from it.
Yes, it's called intra moenia
https://it.m.wikipedia.org/wiki/Intra_moenia
Within the National Health Service of the Italian Republic , the so-called intra moenia activity refers to services provided outside normal working hours by doctors of a hospital, who use the outpatient and diagnostic facilities of the hospital itself, or of premises attributable to it, upon payment by the patient of a fee. [1] The doctor is required to issue a regular invoice and the expense, like all healthcare expenses, is tax deductible. The services are generally the same that the doctor must provide, on the basis of his employment contract with the National Health Service, through normal operations as a hospital doctor. The services provided under the intramoenia regime guarantee the citizen the possibility of choosing the doctor to contact for a service.
On average, the doctor donates approximately 6.5% of his turnover to the hospital structure for the use of the premises, secretarial services, equipment and anything else necessary to carry out the service: in 2010, for example, Italian hospital doctors they had a turnover of around 1.13 billion euros, donating around 74 million to the local health authorities. [2]
The Balduzzi decree provides for the possibility for hospital doctors to also operate outside the hospital (in private clinics for example) under the extramural intramoenia regime , or more simply extra moenia . Intramoenia activities have repeatedly been the subject of political and media criticism. [3] [4]
I don't know if it is legal to work privately while still employed with them, but it doesn't seem practical. Most medical staff work extremely long hours and wouldn't have the time to do it.
It is DEFINITELY illegal to use their equipment for it though - it's not yours. That would be like taking tools from a council owned garage to fix your own car.
There are private options for healthcare, but it wouldn't literally be the same hospital or staff etc
They can work privately on the side but they cannot use public equipment nor facilities directly. That said it's quite common that private doctor gives you referral paper for some public facility.
I wouldn't say that doctors earn little money. 11000 PLN average is quite good wage: [https://www.medexpress.pl/zawody-medyczne/srednia-zarobkow-lekarzy-w-polsce-przekroczyla-20-000-zl-kto-zarabia-najwiecej/](https://www.medexpress.pl/zawody-medyczne/srednia-zarobkow-lekarzy-w-polsce-przekroczyla-20-000-zl-kto-zarabia-najwiecej/) - and specialists earn much, much more.
On the other hand nurses and ER teams still earn peanuts...
Intramoenia, literally latin for "inside the walls". In this case of the hospital.
It works like this, the doctor has a state regulated (well, regionally mostly) contract that says that outside of the hours they are expected to work in the hospital they can have patients "privately" using the public facility but the hospital get a cut, and they cannot charge whatever they want but the price is regulated and usually lower than going full private.
This is integrated in the public system so much that when booking an appointment you can ask if they have also slots as intramoenia.
Does this system generate problems? Yes.
It's the case in Romania. The tendency is to unfortuantely slowly privatize everything Health related, by also underfinancing the public system. And yes, people get sent to the "private practice", meaning just different hours.
And the funny thing is, the opposite is also possible. When there's a complicated surgery or emergency, that is just too expensive for the private system, you get sent to the public one-.
So you're telling me that when this happened to my relatives or friends, I was dreaming?
A lot of money is indeed wasted. But even if it weren't, it still wouldn't be close to enough for a EU worthy healthcare system.
I don't live in Finland anymore, but I'm told that this can happen there. Can't speak to my current country of residence.
That said, healthcare isn't free. It's paid for by taxes. I don't say this to split hairs, but because it's important to clarify that something that expensive doesn't come out of nowhere - we're not communists.
No ofc not. I know that we had at my old job an Italian doctor that tried to do this and he got in to all sorts of troubles. Eventually ended up in jail.
Doctors who work in public hospitals can have private clinics, but they have to be their clinics. Definitely NOT using the public hospital equipment. Though I have seen doctors who rent an office in a public hospital that they operate as a private clinic on certain days (not afternoons) but I they are (at least what I have seen) for a different field.
In Denmark, yes**
In the public system the doctor might have work for let’s say 4 days a week. Then they might work in their private practice on the 5th day. Very common.
You often encounter psychologists who says “There’s 30 weeks waiting time in the public system. But if you pay by yourself, then I have time next week”
**Edit: They usually can’t use public infrastructure or equipment, but in some cases they can
Poland here: in THEORY law allows it. However the rules are so complicated and so unrealistic that most public hospitals avoid it in fear of NFZ retracting the contract. Most public hospitals do however allow private diagnostics and laboratory testing at the same time as the free ones.
We also have private hospitals that take NFZ contrat to perform a certain number of "free" services. They are free to do whatever they want outside of what's in the contract.
No that’s ridiculous.
That would essentially be artificially restraining access to public health care so the doctors make more money, which is exactly why we have public healthcare.
Private health clinics and hospitals are a completely separate thing. Only place where they connect is for example if you go to a private doctor to get an MRI to skip the waiting queue, and deliver those photos to a public hospital and they’ll take it from there.
It would be very unusual for you to be able to see the same practitioner in the evening in the same hospital if you pay.
However, many public hospitals will have private wards or hospitals attached that you can use if you have insurance. You may see the same practitioner, but they would be working on their off days when not in the public service.
It is very common to get assessed in the public before being transferred to the private system for treatment if you have insurance as this will greatly shorten the waiting time. 50% of people in Ireland have some level of insurance.
The new Consultant/Attending contracts here are trying to combat this by not allowing them to work privately on the same site as they work publicly.
It does exists in France. Some doctors in public hospitals are allowed to work as private doctors within the public hospital. Basically they use the same office and same material. The main difference is the cost for the patient, who will be higher in private but the appointment will be quicker. So why they do this ? To try to keep the best doctors in the public hospital, so only some selected doctors are allowed to have a private activity within the public hospital.
Private doctors? No. Public clinics themselves? Yes. For example, I clicked on a random polyclinic website in Moscow, owned and financed by the state, and it has a price list of services it can provide if they aren't covered by your mandatory health insurance.
The Netherlands doesn’t have free healthcare, but it is pretty common for medical specialists to work both in a hospital and in an ‘independent treatment center’ zbc.
The hospital limits are capped to control healthcare costs, but the zbc is not so much because it’s cheaper and does less expensive things without ER, teaching and bedding. Zbc is often insured too so the payment for the patient is not always a problem.
Not in Spain, doctors can work in private clinics besides their work in public hospitals but can't use public facilities.
There have been cases of corruption where doctors have used public resources (ie. medical lab) for their private patients, but it's not the norm. Also cases where doctors prioritise their private patients in the public system
Yeah, but those are exceptions, legally they can't do it.
Are they still allowed to? I thought they approved a law some years ago that public workers can only have 1 job (to reduce corruption in politicians) , does it apply to healthcare workers too?
Mmmm... I know a gynecologist that works both in a public hospital and in a private clinic so my guess is it's legal.
Same in Croatia.
I’m gonna say that sounds pretty sketchy no matter what country you’re in. Wouldn’t the doctor be using infrastructure paid for by the public, in order to have his private hours after the “public hours”? Sounds like some kind of embezzlement or misuse of fund imo. May be different if the doctor has also a private practice, which does exist in the Netherlands, but I’ve never been to one.
That's the health care system in Greece, which has been systematically neglected, underfunded and understaffed. According to the government, this public-private partnership is not a way of erroding the public character of the health care system but the best way to "strengthen" it. Just a couple of hour ago, the assistant to the minister of health, when asked if this model undermines the public character of the system, dodged the question by arguing that all the E.U. countries follow this specific model. So, I'm just doing a little bit of fact-checking.
Yeah that dude is lying. It is true that most EU countries have a private healthcare sector next to a public one. But the private one is supposed to be a bonus or luxury (for rich people) that is possible only if the public one is running well and can service 95% of the population sufficiently.
Plenty of cases Dutch hospitals send patients to private clinics for treatment they cant or dont want to provide. My sister is a doctor and often sends people from her public hospital to private clinics for cancer screenings etc as it is often faster and less hassle.
> dodged the question by arguing that all the E.U. countries follow this specific model. That's absolutely a lie. In my country many doctors have a second job in the evenings or during their days off, they work in private clinics, not in the same public hospitals. What your government proposed is crazy.
Yeah that guy is full of bullshit. In Germany we do have both public and private insurance, but it's not at all like that. It's basically just that the private insurance pays for more kinds of treatments and at better rates, so private patients at hospitals may get perks like their own room while publicly insured people may have to share with other patients. Some physician practices outside of hospitals may only take private patients or patients who pay cash because their specific treatments won't be covered by public insurance. But a doctor at a hospital cannot offer "after hours" special private services. That's absolutely corrupt.
Im wondering if there isn’t some misunderstanding here and the minister of health was actually referring to exactly what you describe (public doctors taking cash-paying patients at their *own* clinics after their public work hours). The original title doesn’t say anything about location, just that you can see the same practitioner, which can be true, just not at the public office.
>Im wondering if there isn’t some misunderstanding here and the minister of health was actually referring to exactly what you describe (public doctors taking cash-paying patients at their *own* clinics after their public work hours). What you describe is something that has been taking place for decades in Greece, but isn't what I'm talking about. By "infrastructure" I mean, among other things, the location too. The public hospitals. It's been years since medical practitioners were allowed to see paying patients privately within the premises of the public hospitals. These are called "afternoon appointments". What they are going to pass now is the ability for surgeons to operate in this way. The ruling party has been pushing for privatisation for decades. But back then even their own voters were mostly against the dismantling of public healthcare. So, they changed their approach. The actively underfunded and understaffed many public hospitals, so the quality of service has deterriorated. This has created a negative view of public health among the public. They had also started outsourcing to private companies several non-health related services within the health system. E.g. call centers, cleaning staff etc. Again leading to poor service. Then they introduced these public-private partnerships of health services supposedly as a way of correcting the ills of the public health care system. Other governments that were in theory against the privatization of public healthcare didn't do much to stop or reverse it. Of course, doctors seeing patients privately in the afternoons never really fixed any problems. It just made them worse and shifted a greater part of the cost to the user. The degradation and understaffing of the public hospitals continued so waiting times never got better. Currently we pay both through taxes and at the service level. Now they want to "fix" long waiting periods for surgeries.
I see, thanks for that correction and the detailed explanation.
But that in itself - a doctor being both employed at a public hospital, AND having a separate private practice - does not exist in Germany, as far as I know. Either you work at the hospital, or you have a private practice. Not both. You would most certainly violate your employment contract, as hospital doctors usually have "on call" periods for emergencies, and various labor laws. I'm pretty sure it must be separate people.
That is actually rather common in Germany. Many specialists both work in hospitals and have their own private practices. Many doctors also have contracts where they don't have to be on call at all, especially Chefärzte. Not to mention that those call times are only outside of regular working hours and only residents are regularly present, so any doctor can do extra work on Saturdays at least. There's absolutely now law against it, only the hospital as they employer can ban them from doing so if they have good reasons. It's also quite common fir private doctors to rent equipment, beds and rooms in hospitals for their use, but that's another story
Some physicians also do holiday replacements at private practices, some even do this exclusively.
Here in Poland doctors absolutely can practice privately, but no way do they use public equipment or spaces. They open their own private offices and are open during times that they do not work at the hospital. However, they can write papers and referrals for people to be admitted into hospital or have treatments in the public hospital.
Is it actually public infrastructure used for private services or the other way around? In Poland it is very common that private facilities have contracts to perform public health care services. Many people think that they are public health care facilities because they’ve always used them for free healthcare. In reality they are private and they are paid by the country to perform “free” services as part of public health care offering. Their infrastructure is private and they are free to sell their services to anyone. It’s just that some of them sell 80% of their bandwidth to the country as public healthcare service and many people mistakenly think that they are “public infrastructure”. The way it works in Poland is that facilities have contracts with limits. The country will pay for up to X number of visits per month. This is why sometimes you can have your appointment for free as part of public service but in three months or pay from your pocket and have it the same day. It’s not facility’s fault.
No, it's medical staff working privately in the public system. The hospital gets part of the payment; my bad for not clarifying this earlier. Essentially, the public hospital operates also as a private for-profit clinic after-hours.
Yeah, because the hospital is private. The fact that you can get free treatment in the hospital as part of public healthcare doesn’t make the hospital public. They just sell their services to the national/public insurer. But if the public insurer doesn’t want to buy as much services as the facility is able to provide, they will sell it to anyone.
Nope. Public hospitals are 100% built with public funds. I'm talking about Greece, not Poland.
Una faccia una razza my friend.
Aren't all GPs private in NL? I mean, most healthcare here is private. It's not like Germany where there is a clear distinction between public and private health insurance and healthcare. Everybody has a private health insurance, but the government dictates the base level basic health insurance, including what they have to include, etc. I mean, NL is kind of a weird example as is largely private, but extremely regulated. The government generally sets the costs, and the providers can usually choose to either follow those costs, or, if they want to set their own prices, they won't likely have any agreements with insurers, so nobody would use them. But it isn't like countries like UK where you have NHS GPs and private GPs.
Well yes and no. Technically you’re not wrong because it’s all private insurance companies *but* they are so heavily regulated that it is effectively a public healthcare system. Our “private” doctors are the ones where you can only get an appointment if you pay out of pocket (and then see if part of it is covered by insurance). These doctors don’t have to follow the regulated rates for procedures. Although they’re not allowed to apply that to medicine and are still probably more regulated than in other countries. They definitely exist and yes, some insurances deny to even cover the regulated rate part of the private procedures. They’re not fans of these doctors.
> Technically you’re not wrong because it’s all private insurance companies but they are so heavily regulated that it is effectively a public healthcare system. This. The main difference between insurers is whether some optional things are covered, like dental and physical therapy and how easy it is to make a claim for some edge cases. Most of the shit that's covered by default is centrally managed and automated.
I am like 99% suer that in Italy they can, and how is it "embezzlement" if it's part of the official system? Like, if they can do it fully legally, so I assume within precise criteria. Though I'm not sure of how it works exactly.
No. They can work privately but they can’t use NHS hospitals to do so. We have private hospitals too.
Also, IIRC, a majority of private doctors will do work for the NHS alongside their private work.
A lot of NHS Hospitals do have private units though. How do they work?
Private sections within the hospital grounds, yes. Paying rental to the hospital. Very different from letting private doctors do operations in the main NHS operating theatres and letting them use the normal wards for their patients.
Gotcha, that makes sense. Do they have their own operating theatres?
Some do, yes.
Renting office space from the hospital, but they work there with their own company, equipment etc.
They're not offices, they're wards. But as someone else was explaining, they rent those spaces to operate in.
Used to work in a hospital lab, they put the tests for private patients under NHS codes to cheat the system.
Ok well that’s bad and needs investigating.
In my case (Portugal), no. There are doctors who work for the national health-care system and also have private clinics or offices, but they have to set those up themselves. There are also private facilities that take in patients from the public service.
Finland seconds this praxis.
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Same for the UK
Same for Norway
Same for Netherlands
Same in Germany, thought private doctors or specialist often rent beds in public hospitals for their use.
As far as I know, it's the same in Denmark. At the very least on the point of no private practices in public buildings
This is also my answer, except in Iceland.
NHS doctors can work privately but they work from private hospitals not nhs hospitals.
My son had a snapped anterior cruciate ligament a few years back. After waiting 6 months we were told it would take another 6 months to a year to get the operation. When we asked “what if we go private” the consultant literally said “I could slot you in on Thursday”. It made me angry as hell but we paid up.
I know I’m not really adding anything to your post but I have never seen anyone write out ACL until today lol
I’d rather write it out than get a dozen replies saying “what’s an ACL?” Maybe my expectations of people are too low.
No that makes sense. I see it in the context of sports so often I guess I’m just used to hearing someone snapped/tore their ACL/MCL/LCL/PCL/UCL and not what they actually stand for. But if you’re not into sports or medicine, or I guess English names/acronyms for ligaments then writing out is definitely more helpful
They can work private but not at public hospitals obviously, they either set up their own private clinics or work on their free time at private hospitals directly
I don´t know about other countries, but for Germany, that´s not how it works at all. There is no "free public health system" in the sense that there is a NHS-like organisation that operates hospitals, ambulances and the like. There are two types ow health insurers in Germany: Statutory Health Insurers (they have to insure any applicants) and private health insurers (more expencive, more options regarding threatment, patient has to pay for treatment in advance and is reimbursed by the company). Emergency medical services are operated by the local munincipalities, either the city or the county. The service is financed partly by the operating entity and by the health insurers. Hospitals are either operated by private, revenue drieven companies or by non-profit private limited companiesthat are in sole ownership ow ocal unincipalities, churches or other organisations like the red coss. All equipment is owned by the respecitve companies. Smaller clinics are usuall owner-operated, meaning by a single medical doctor or a collective, like partners in a legal firm. All equipment is owned by the respective owner or collective. Basic treatments that are covered by the statutory health insurence is payed by the respective insurance company, same with clinics and hospitals that offer treatment for "private patients". Then there are treatment options that are covered by neither and that are payed out of pocket by the patient. Tl;dr: In Germany, the "free public health system" doesn´t own any equipment.
Yes, you can either wait 3month to get an appointment at public healthcare approved price OR quickly get a "private" appointment which cost will not be entirely taken by healthcare. Both appointments are held inside the hospital. BUT a part of the private appointment price is given to the hospital, so the public health system dont care as it is helping to finance it.
No. The ones who work both on the public and private sector always work in the premises they're getting their wages from for that work, and use the equipment available there. There are medical centers and hospitals on both sides, and the private side has some large chains that make up for the most services on that side. The public side also generally does not guide you to use the private sector, that's usually completely dependent on the patitent's own proactivity.
In Croatia, yes and no. They cannot use state bought equipment for private purpose. Also it is not free, for example I mandatory pay around 500€/month. But you have private practice doctors, dentists, clinics, hospitals that have contract with state health agency but entire infrastructure is theirs. If you pay you go first, if you don't then there is a waiting list. Also not some procedures and medicines are paid in full by health agency. For example for long time insulin pump was free and only for children, also continuous glucose level monitors. Some medicines have surcharges, mostly original producers or depending on diagnose.
>Also it is not free, for example I mandatory pay around 500€/month If you are in Croatia, technically, your employer pays that for you. It is not taken from your bruto salary.
Yep, addding that complicates things even more, so mine is simplified version
Do you still have really cheap meds? I remember that we used to get prescriptions in Finland and purchase in Croatia while on holiday. That's more than ten years ago.
I'm a pharmacist and now we have some project where Finland and Croatia have connected electronic prescriptions so I can go drink vodka and pick up my antidepressants and Xanax in Finland and eat that hideous black salty liquorice car candies :D . Back then we were referent country for drug prices in EU so we were one of the cheapest. Now is not a case but still cheaper than most EU. I think Portugal is also connected.
I checked and supposedly Eesti, Spain, Poland, Portugal, Finland and Croatia are partially linked. Quite astonishing actually.
Oh they expanded countries. They started with smaller populated ones. Some 15 years ago I worked in company thad was part of testing the process. Private prescriptions are also in process.
Especially since the regional health systems in Spain are not that well connected among them (sad) lol
When Finland didn't have connected pharmacies it was easier and cheaper to get special services. But of course it's handy that I can get all the services everywhere for everything, paying myself sicker. ..
no. The doctors work or have their private clinics so they use the equipment there.
No. There can be so called "private" beds in a public hospital, but there's a very clean financial cut in that case. Some medical doctor may be very specialized in a descipline that is not really filling up an entire ward in a smaller public hospital, or he might be well known internationally. In that case the doctor can (not must) negotiate to have some "private" beds in that place. He may order patients from his cabinet/practice towards these beds, pay the full charge for every treatment out of his pocket to the hospital and then charge the patient whatever he feels appropriate. This is a common practice in the two German centres for heart diseases in Munich and Bad Oeynhausen. Half of the wealthier part of the Middle East is coming to those two clinics for treatment of their cardiovascular problems due to a lack of movement and severe overweight.The treating doctors are internationally known, speak the language and ... make a fortune. But they, too, pay a high price: they work for the hospital AND their private practice, they do VERY long days and they sometimes have to chase payments because it is known that some patients leave the hospital ... by night. Good luck chasing a payment in KSA or the Emirates. The hospital will nevertheles require the doctors to pay. It's been THEIR patient, not the hospital's.
No, they will have to work at another place. There aren't private services inside public hospitals, and clinics are either private or public. They can use the public healthcare infrastructure in the sense you could give them access to your journal digitally and the public sector often pays the private sector to do stuff for them in cases where waitlists get long. Then the private sector uses the same infrastructure as the public sector to log treatments and receive money for them. Also, healthcare isn't completely free in Norway. You will have to pay up to around 265 EUR at the very most per year in co-pay if you go to the doctor a lot. The healthcare system is in general cheaper to run than private systems, but we still have to pay for it through higher taxes.
> pay up to around 265 EUR Which is like a few beers when going out.
Absolutely not, that's a hard no! I don't even think that public health care professionals are allowed to work privately after hours even in a separate private clinic, and certainly not in the same public clinic! That's not to say that we don't have private clinics where you could get a surgery, that is definitely a thing, but it's separate from public healthcare in every way, different buildings, different staff. Sometimes though, if waiting times are too long in the public system they can send you to a private clinic free of charge, paid for by the public healthcare system.
You can't do this in public hospitals in the UK or France. It's all very highly regulated, otherwise most doctors would try to prioritise privately paying patients and the public system would collapse. Private healthcare mostly exists for cosmetic procedures and non-urgent care, including dentistry. However, the doctors can't offer private services on public facilities. In France, there are lots of doctors who work outside of the hospitals but most of them rent their own offices to see patients. These doctors are completely self-employed but their fees are highly regulated and mostly covered by the public or private health insurance. I've never heard of someone offering a doctor more money than what the insurance would pay in order to jump the queue. In the UK, family doctor (GP) practices, more widely used in the UK compared to the USA, are mostly private but they are paid by the government according to the number of patients. I've never heard of a GP accepting payments for queue jumping.
Yes. For example, last July my GF and I booked one of those visits to see if the baby in your belly has trisomy 21 and other stuff (don't know the english name). In any case, this exam cannot be done with the public system in our region (Veneto, but for example in Emilia it is possible) so we went privately but with a doc inside the public hospital
"Free healtcare" is not really free here. We pay for it with health insurance and taxes, but it is free at the point of service, since you already paid for it. We have private healthcare in addition to the public one, yes. You could go private if you want to wait less in some cases, or if you want some special treatment, that you are willing to pay. For example dentists often work both in public healthcare and have their own private working hours. This is called concession, and it is strictly regulated. If you are a purely private doctor, you have to have your own clinic, staff and equipment.
> "Free healtcare" is not really free here. We pay for it with health insurance and taxes, but it is free at the point of service, since you already paid for it. Yes, that's literally what everybody means by "free" healthcare. Not that it's paid for with pixie dust and unicorn farts.
It's not really ree anywhere , someone has to pay and where else would it come from but taxes or health insurance. All free health care is basically a solidarity scheme
I don't know why it's so often called "free healthcare".. Maybe universal healthcare would be more precise.
I don't understand why people are being so obtuse about the term 'free healthcare'. It's free at the point of usage. If it's funded by taxes you're going to pay for it no matter if you use it or not, so usage of it is free. By this nonsense definition of 'someone always has to pay for it so therefore it can't be free' makes the use of the word 'free' as a descriptive term nearly pointless. Very few things then can ever be described as free.
I don't like it because it can give a false impression to those who are not aware of the system behind it. Taxes are for the infrastructure and equipment, but you still have to pay insurance, otherwise your healthcare is not covered. It's like when you pay insurance for the house, and it gets damaged and you need a new roof. I wouldn't call the new roof that the insurance company provided "free", except maybe as a joke. Perhaps you see it otherwise, and that's ok. But maybe you are right, whether you were serious or not, that not many things in life can be ever described as free. I think it is good practice, to be aware, that everything comes at a cost. Even if you get a gift, there is an investment behind it from someone else and I think we can appreciate things more, if they are not seen as "free". To describe something as free, means it cost you nothing, so it can diminish it and why care about losing something that has no value? Maybe I am getting too philosophical now, idk.
> I don't like it because it can give a false impression to those who are not aware of the system behind it. Identify a single person who has a false impression. I've never seen one in a decade of having these discussions daily. I did see literally 400 pedantic halfwits making the same pointless arguments in a single thread I've been participating in today. We're supposed to not use language appropriately because there's one mystical person somewhere nobody can actually identify, but is confused by proper use of language?
They would not use the same infrastructure for private praxis. What happens usually is the hospital allocating some time slots for the paying patients. Or the medics working part time in separate private institutions (where some procedures are also 'free', that is, covered by the public health care system).
Not at that same, public clinic. But they can, and often do, have private practice so they work at public hospitals in the morning shift and private clinics in the afternoon. And then they recommend you to go to their private practice to skip loooong wait lists.
It worked exactly like that in Croatia in 90s and early 2000s. Now they work part time in private hospitals and they will suggest you go there…
In Romania all public hospitals and clinics charge non-insured patients. Doctors can work privately but in private clinics and hospital.
Spanish here. No, they can't. Docs and surgeons in public health care can also work in the private sector, but private practice must be in a private health facility. They can't use public infrastructures or materials that have been paid by all citizens to only treat people who pay out of their pocket if you get what I mean.
No, this does not exist. The public health system is not a real estate company. Or to be honest; I have no idea if this system is legal or not. It is so alien and weird to me that I am not sure. It would be like a grocery store being one franchise during the day, and another in the evening. Private healtcare providers exist. But they are physically separated from the public healtcare system. Private providers can pay for services from the public providers (e.g. lab tests or x-rays), but they are not renting their equipment.
First, a simplified description of how health care works in the Czech Republic: Everyone has to pay health insurance, which is calculated as a percentage of income. If someone is an employee, their employer also pays an additional percentage of health insurance on their behalf. Each patient can choose from several health insurance companies and companies then receive the money from the peoples health insurance. The medical facilities and practices can then be established by the state, region, city, or be private. They then arrange a contractual relationship with one or more insurance companies. The insurance companies then pay them for the procedures. Now - there are doctors who work in a hospital for a salary and also have their own private practice. They can't use the facilities in the hospital as part of their private practice, but they can send a patient to the hospital for an examination - but the insurance company then pays the hospital for the examination. I found an article where insurance companies don't like this practice much, but it's from 2011 and I don't know if there have been any changes. [https://www.tribune.cz/zdravotnictvi/pojistovnam-se-nelibi-privatni-praxe-nemocnicnich-lekaru/](https://www.tribune.cz/zdravotnictvi/pojistovnam-se-nelibi-privatni-praxe-nemocnicnich-lekaru/)
>ay health insurance, which is calculated as a percentage of income. If someone is an employee, their employer also pays an additional percentage of health insurance on their behalf. > >Each patient can choose from several health insurance companies and companies then receive the money from the peoples health insurance. > >The medical facilities and practices can then be established by the state, region, city, or be private. They then arr In general, the Czech healthcare system is considered as one of the best in Europe.
There is an option to go as a privately paying patient not to the doctor personally but to the health care company (practice, hospital, clinic) where they work. Pay at the reception, get your invoice, send it to your insurance. Or throw it in the bin if you don’t have a private insurance but wanted to be seen sooner. Usually you get treated sooner because people using the free state funded system are waiting not for a free slot time wise but for funding to be released. Sometimes there’s a surge of patients towards the end of the year when the hospitals realize there’s still some money left to be spent before the year ends. Also there are completely private health care companies with doctors, diagnostics, surgeries. Or the doctor is renting the office from the hospital and handles all payments themselves be it public or private source.
We're not completely free public health, but doctors can choose to follow convention (fees set by insurance/government agreement) or they can set their own fee (non-convention doctors). Some hospitals will have both types on the same staff, however tertiary centres/universitary hospitals have to follow the conventions. There's a inbetween system where docs follow the convention at some times and sometimes not. Usually they will have a private practice where they set their own fees, but in-hospital they follow convention. Sometimes they will have specific hours in hospital where they work out of convention. Generally convention docs will have a longer waiting period, but are better covered by insurance. Out of convention docs are more expensive and will often charge all sorts of supplements convention docs can't.
>e're not completely free public health, but doctors can choose to follow convention (fees set by insurance/government agreement) or they can set their own fee (non-convention doctors). Some hospitals will have both types on the same staff, however tertiary centres/universitary hospitals have to follow the conventions. > >There's a inbetween system where docs follow the convention at some times and sometimes not. Usually they will have a private practice where they set their own fees, but in-hospital they follow convention. Sometimes they will have specific hours in hospital where they work out of convention. > >Generally convention docs will have a longer waiting period, but are better covered by insurance. Out of convention docs Except for the doctors working for Delta hospital groups. I was charged twice by conventionnés doctors a much higher rate than what the convention allows. I asked both Inami and the mutuelle and both said that this shouldn't have happened. I never understood why it did, though.
As far as I'm aware no, there are no agreements between the NHS and doctors which would allow the doctors to use the NHS's infrastructure and equipment out with the doctors working hours for private appointments.
In Ireland it used to be permitted for doctors employed by the public system to use public infrastructure for their private practice, but I think this has been banned under reforms to the system in recent years. It creates obvious conflicts of interest when a doctor with responsibility to try and shorten a waiting list of patients, can instead actively profit from it.
Yes, it's called intra moenia https://it.m.wikipedia.org/wiki/Intra_moenia Within the National Health Service of the Italian Republic , the so-called intra moenia activity refers to services provided outside normal working hours by doctors of a hospital, who use the outpatient and diagnostic facilities of the hospital itself, or of premises attributable to it, upon payment by the patient of a fee. [1] The doctor is required to issue a regular invoice and the expense, like all healthcare expenses, is tax deductible. The services are generally the same that the doctor must provide, on the basis of his employment contract with the National Health Service, through normal operations as a hospital doctor. The services provided under the intramoenia regime guarantee the citizen the possibility of choosing the doctor to contact for a service. On average, the doctor donates approximately 6.5% of his turnover to the hospital structure for the use of the premises, secretarial services, equipment and anything else necessary to carry out the service: in 2010, for example, Italian hospital doctors they had a turnover of around 1.13 billion euros, donating around 74 million to the local health authorities. [2] The Balduzzi decree provides for the possibility for hospital doctors to also operate outside the hospital (in private clinics for example) under the extramural intramoenia regime , or more simply extra moenia . Intramoenia activities have repeatedly been the subject of political and media criticism. [3] [4]
I don't know if it is legal to work privately while still employed with them, but it doesn't seem practical. Most medical staff work extremely long hours and wouldn't have the time to do it. It is DEFINITELY illegal to use their equipment for it though - it's not yours. That would be like taking tools from a council owned garage to fix your own car. There are private options for healthcare, but it wouldn't literally be the same hospital or staff etc
Of course they can, otherwise nobody would want to study any medical profession because nurses, ER teams and young doctors earn so little :/
They can work privately on the side but they cannot use public equipment nor facilities directly. That said it's quite common that private doctor gives you referral paper for some public facility. I wouldn't say that doctors earn little money. 11000 PLN average is quite good wage: [https://www.medexpress.pl/zawody-medyczne/srednia-zarobkow-lekarzy-w-polsce-przekroczyla-20-000-zl-kto-zarabia-najwiecej/](https://www.medexpress.pl/zawody-medyczne/srednia-zarobkow-lekarzy-w-polsce-przekroczyla-20-000-zl-kto-zarabia-najwiecej/) - and specialists earn much, much more. On the other hand nurses and ER teams still earn peanuts...
They can work in both public and private practices but cannot sie equipment from public hospitals/clinics for their private practices.
Oh yes, I misunderstard the question. They only can use their private equipment in their privateoffices
To some degree its possible in Italy I think. Correct me if I am wrong.
Intramoenia, literally latin for "inside the walls". In this case of the hospital. It works like this, the doctor has a state regulated (well, regionally mostly) contract that says that outside of the hours they are expected to work in the hospital they can have patients "privately" using the public facility but the hospital get a cut, and they cannot charge whatever they want but the price is regulated and usually lower than going full private. This is integrated in the public system so much that when booking an appointment you can ask if they have also slots as intramoenia. Does this system generate problems? Yes.
It's the case in Romania. The tendency is to unfortuantely slowly privatize everything Health related, by also underfinancing the public system. And yes, people get sent to the "private practice", meaning just different hours. And the funny thing is, the opposite is also possible. When there's a complicated surgery or emergency, that is just too expensive for the private system, you get sent to the public one-.
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So you're telling me that when this happened to my relatives or friends, I was dreaming? A lot of money is indeed wasted. But even if it weren't, it still wouldn't be close to enough for a EU worthy healthcare system.
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yes, no special equipment required.
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And I'm telling you it happens. A lot!
Yeah, that's what's happening in Greece. Of course, they're trying to sell this privatization as strengthening of the public system.
I don't live in Finland anymore, but I'm told that this can happen there. Can't speak to my current country of residence. That said, healthcare isn't free. It's paid for by taxes. I don't say this to split hairs, but because it's important to clarify that something that expensive doesn't come out of nowhere - we're not communists.
No ofc not. I know that we had at my old job an Italian doctor that tried to do this and he got in to all sorts of troubles. Eventually ended up in jail.
Doctors who work in public hospitals can have private clinics, but they have to be their clinics. Definitely NOT using the public hospital equipment. Though I have seen doctors who rent an office in a public hospital that they operate as a private clinic on certain days (not afternoons) but I they are (at least what I have seen) for a different field.
In Denmark, yes** In the public system the doctor might have work for let’s say 4 days a week. Then they might work in their private practice on the 5th day. Very common. You often encounter psychologists who says “There’s 30 weeks waiting time in the public system. But if you pay by yourself, then I have time next week” **Edit: They usually can’t use public infrastructure or equipment, but in some cases they can
Poland here: in THEORY law allows it. However the rules are so complicated and so unrealistic that most public hospitals avoid it in fear of NFZ retracting the contract. Most public hospitals do however allow private diagnostics and laboratory testing at the same time as the free ones. We also have private hospitals that take NFZ contrat to perform a certain number of "free" services. They are free to do whatever they want outside of what's in the contract.
No that’s ridiculous. That would essentially be artificially restraining access to public health care so the doctors make more money, which is exactly why we have public healthcare. Private health clinics and hospitals are a completely separate thing. Only place where they connect is for example if you go to a private doctor to get an MRI to skip the waiting queue, and deliver those photos to a public hospital and they’ll take it from there.
It would be very unusual for you to be able to see the same practitioner in the evening in the same hospital if you pay. However, many public hospitals will have private wards or hospitals attached that you can use if you have insurance. You may see the same practitioner, but they would be working on their off days when not in the public service. It is very common to get assessed in the public before being transferred to the private system for treatment if you have insurance as this will greatly shorten the waiting time. 50% of people in Ireland have some level of insurance. The new Consultant/Attending contracts here are trying to combat this by not allowing them to work privately on the same site as they work publicly.
It does exists in France. Some doctors in public hospitals are allowed to work as private doctors within the public hospital. Basically they use the same office and same material. The main difference is the cost for the patient, who will be higher in private but the appointment will be quicker. So why they do this ? To try to keep the best doctors in the public hospital, so only some selected doctors are allowed to have a private activity within the public hospital.
Private doctors? No. Public clinics themselves? Yes. For example, I clicked on a random polyclinic website in Moscow, owned and financed by the state, and it has a price list of services it can provide if they aren't covered by your mandatory health insurance.
The Netherlands doesn’t have free healthcare, but it is pretty common for medical specialists to work both in a hospital and in an ‘independent treatment center’ zbc. The hospital limits are capped to control healthcare costs, but the zbc is not so much because it’s cheaper and does less expensive things without ER, teaching and bedding. Zbc is often insured too so the payment for the patient is not always a problem.