Aaaaaah - Lithuanian Hospitals!

I can't really compare hospital care between Germany (34 years ago), the UK (29 years ago, during the winter of discontent with the porter and auxiliary strike and petrol shortages) and Lithuania (this week), when the last one was a private hospital, too, but it might be nice to take the frighteners off medicine in Eastern Europe.

Needs to be said, though, that I'm also insured through the state health system in Lithuania. Not sure how the cooperation between state sector and private sector works in Germany, except that private patients go to the normal state hospitals. In the UK people go to the private sector and pay for everything, or sometimes, when the state sector is in Big Trouble trying to meet its multifarious targets, the state pays for them to go private (or abroad, though usually like a state patient of the foreign country).

In Lithuania, for about the last year or so, the state health insurance had drawn up agreements with certain private health care providers whereby the state pays a share of the costs (maybe what it would normally pay in its own system for the treatments that the state system provides?). This is kind of cool, and keeps the private costs quite low for those of us who pay the state, too. It's a bit bizarre, too. In Lithuania people are still quite happy to pay the doctor, nurses etc a considerable 'bonus' 'under the table' for their treatment, the so-called 'informal payments'. Apparently you ask the doctor how much you should pay, and some tell you the sum, others let you guess. I remember a friend paying 200 informal Euros to a doctor in for a nose operation in the state sector (how complex can that be) - this week I paid less than this, formally, for a small abdominal operation, including hospital stay of one night. The Health Ministry, or at least the last Minister before he disgraced himself over a car, was firmly against the system of informal payments, but in a discussion after his speech, the potential payments thought that the doctors deserved these payments. If you are a Lithuanian needing fairly predictable and plannable hospital treatment, I would want to compare the costs of private treatment (in a hospital with an agreement with the state) with the costs of state treatment plus under-the-table bonuses. Probably if you live in the deep countryside you don't have that choice.

One of the problems of private treatment, though, is the fact that many of the highly specialist doctors have 'day-jobs' in the state hospitals. It's kind of high-prestige-low(?)-income in the state hospitals, and almost the other way around in the private hospitals. As a doctor, you probably get the more interesting cases in the state hospital. Their day jobs have to be completed first, so they come round to the private hospitals in the afternoon/early evening. I wonder if they have an 80/20 arrangement like doctors used to have in the UK NHS? If you have to wait for your specialist for assessment prior to discharge then it'll be early evening. I wonder what would happen if you had a sudden catastrophe in the morning? There are permanent staff grade doctors around, but what would they do? Perhaps the most complex cases which need most supervision by the specialist might not be done in a private hospital?

In the case of the clinic I used everything was included in the price; it was not xx lt for a blood test, or yy lt for a pill for something unexpected. That was really great. The quality of care was wonderful with the nurses doing everything they possibly could for me, extremely kindly. The one thing that surprised me a little, having worked in a British hospital over 30 years ago, When They Were Still Clean, was that while I was not allowed out of bed for 24 hours no-one came to wash me or change my bed (I know how to change a bed with the patient in it). By the time I realised I had missed this I was almost able to get up again. Maybe that is what people say of Lithuanian state hospitals - that the relatives have to provide the care. But overall, the care was fine for me, and I especially like the plates of fruit that appeared mid-morning and mid-afternoon. No cups of tea, though.

If you are a foreigner and thinking of getting private treatment (with or without state support) in Lithuania, though, get a Lithuanian-speaking friend to look at the Lithuanian version of the clinic's website. Often this has very different information from the English website - the Lithuanian version often includes a price list, too. That's really useful to have. Also useful is a list of the doctors which you can then check out in the internet for publications, research interests, their day jobs etc.