So let me preface this post by saying that I am not an expert on medical care in the U.K., and that I am only writing on my own direct experiences for the past three months. I welcome any comments or questions by anyone who would care to. I’ll also apologize for the length and will try to be as succinct as possible.
Navigating the healthcare system here has been quite complicated at best, as I‘m sure I‘d find in any new country. There are many different levels and terminologies. There is the standard NHS level of care, which is free to all residents. NHS employs approximately 1.3 million people as one of the top five employers in the world. You can read more at the NHS website link or even Wikipedia, but basically their three core healthcare principles are as follows:
That it meet the needs of everyone
That it be free at the point of delivery
That it be based on clinical need, not ability to pay
To enter the system, basically one needs to register with a local GP and then you are assigned your NHS number. I began there, since I’ve heard that levels of care are dependent on your assigned NHS number if you reside here. I obtained a recommendation for a nearby doctor’s office (called “surgeries” here) and filled out the necessary paperwork in about a half hour. I left with a “meet and greet” appointment in about two weeks, and my NHS number arrived in about two weeks also. My only real experience with NHS thus far was a recent visit to a local hospital late on a Friday night – a bit of pregnancy complications. The end result was that everything was just fine, and luckily I was in no pain, having to wait in the waiting room about 1 ½ hours. I finally saw a obstetrician who checked me and gave me the option of staying overnight or going home. I did, however, observe many laboring moms to be who weren’t quite as comfortable, waiting for what I thought was too long to be given a labor room. My midwife commented that unfortunately this happens and there is a shortage of NHS midwives in the U.K. Let me also add that my wait in a Chicago emergency room in the States – with my husband’s eye injury – was probably longer.
Next on my list was finding a midwife, and I’ve heard coming from the States, I’d be more comfortable with private midwifery care. To clarify, if you are pregnant, and go to a hospital, you will likely see a midwife vs. an obstetrician, unless you are considered high risk. Midwives handle the majority of births in the U.K. But you will also probably share a recovery room with 1-2 other recovering mothers if you are in a NHS hospital. Alternatively, you can book a private hospital or private birth center, which is much like booking a hotel. At private hospitals you can even pick your room, bed size, other furnishings, etc. They expect you to pay in full, upfront, and if you happen to have health insurance, which it seems many people don’t, you are left to settle with them on your own. So my initial impressions are: it’s a great place to live if you’re comfortable using NHS (and about 90 percent of the population do); if you want to use the private system, you better start saving your pennies (err, I should say your thousands of British Pounds).
Wary of my first birth experience in a U.S. hospital, I felt my best chance of having a normal, natural birth was to seek out a birth center, with close proximity to a hospital should an emergency arise. I’ve luckily found one that seems like a great place to have a baby, and literally across the parking lot from a major NHS teaching hospital. I was assigned two midwives, who alternate my prenatal visits. The midwives will see you through your entire prenatal, birth experience, and post natal care to 6 weeks, and you can choose your birth place among your home, birth center or hospital, AND you can decide up until you are in labor (or even during) where to birth your baby. If you choose the birth center, then you can stay there as many or as few days as you like post-natally. Oh, and the midwives come to your house (or place of your choosing) for all prenatal visits, which has been wonderfully convenient!
Private doctors offices also sell what they call “memberships” and once a member, you use the facilities that they offer, which can be anything from primary care physicians to dentists to yoga and acupuncture. As I mentioned, the healthcare system is very much set up for people who don’t have insurance (thankfully we do), because how would I explain to my insurance company I want them to pay my monthly “medical membership?” I don’t know if employers here typically provide insurance (although I believe the good ones do), as I’ve seen many advertisements for private medical insurance that you would buy on your own.
So as I have a few more weeks of pregnancy, I’ll update again once I have given birth, on that experience in order to compare and contrast the U.K. with the U.S. system. AS I’m writing, I can’t help but think of the health care reform currently in question in the U.S. Whatever legislation happens to pass, or not, don’t expect it to be easy; even countries with national plans have layers upon layers of history built in around them. There is no Holy Grail. But on average, those I’ve spoken with – both expats and the British – have been happy with their healthcare options in the U.K.