Health care is a big debate in the United States these days. There’s no denying that care in America is among the best in the world. But it’s not without its flaws. I could go on a rant about how, as a freelancer not attached to a large corporation, the price tag for insurance as a single person is beyond exorbitant. Instead, I am going to tell you about my limited experience with Brazil’s public health care system.
Now that I live in Brazil and no longer carry insurance in the U.S, it was time to start utilizing the system for certain annual procedures and maintenance checkups. Many Americans have no clue how much their care costs. As a freelancer paying out-of-pocket, I had some exposure to those costs before I moved to Brazil full-time. To give some context, a regular doctor visit for a check-up runs about $250 in New York City. That is only for the visit and doesn’t include tests or anything else. An EKG in NYC runs US$2,500. A mammogram without insurance – just out of pocket – costs almost $6,000. Of course, there are many resources that allow for free or reduced scans. But in general, healthcare in the U.S. is prohibitively expensive if you don’t have insurance.
Breast Cancer Awareness has global reach, even here in Uberaba. So when “pink month,” as it’s called here, rolled around this October, I decided to get a mammogram through the public health care system. I was told by many Brazilians that even though the scans are run through the public hospital system, the scans themselves use state-of-the-art machines and top oncologists review the scans. Of course, they don’t have anything to compare their scans to, but as it’s free and not an emergency situation, I was willing to give it a go.
In mid October, I went to the woman’s public hospital in Uberaba to make an appointment… for the first week of December, which was the first available opening. In the U.S., we always hear horror stories about public health care systems and the waits involved. But with no history of breast cancer in my family, my scan is merely routine and preventative, so I wasn’t too upset by the wait.
When I arrived on time for my appointment at the woman’s public hospital, there were 19 women ahead of me. Despite my scheduled appointment, I was given #20 and waited for an hour and 15 minutes… just to register. The wait was uneventful; while the woman’s hospital is simple and perhaps slightly run-down, it was calm and organized, and mostly clean. I say mostly because a dog did walk through the waiting room, with nobody blinking an eye about it, which made me wonder about hygiene in a place woman come to specifically to give birth. I pet the dog, registered for my scan, and then waited another 65 minutes to be called to the scan area, which actually takes place in a pink truck parked directly outside the hospital. The inside was indeed state-of-the-art: clean, modern and with a mammogram machine equal to ones I have seen in the e U.S. The technicians were polite, professional and fast, which is not a common quality in public workers here in Brazil. Overall, my experience was a good one.
Granted, the success of something like this really depends on the level of training from the doctor who will read the scan for anything suspicious. The results of my scan will not be available for another month. Long by U.S. standards, but not worrisome to someone at low risk. They did ask about my family history, and it’s my impression that if I was at risk, my scan might be reviewed more quickly. I am basing this solely on secondhand information regarding my husband’s cousin, who has a history of breast cancer, and through regular scans detected her cancer in the early stages. Again, I don’t have any evidence to support this, as it’s only my assumption.
I should also point out that this was not my first public hospital experience in Brazil. Earlier this year I had a medical emergency involving my kidney. I was in a lot of sudden pain, and my husband took me to the a public hospital because it was a Sunday, it was close to our house and, having never actually had an emergency of his own that required hospital attention, didn’t know where else to go. This public hospital was run-down and crowded, and when they took blood, the technician didn’t wear gloves, which freaked me out a bit. However, they were quick to treat me and I left feeling better. Our total time there was only three hours, which for anyone that has waited in a U.S. hospital emergency room knows, isn’t too bad.
But when I had to return the next day, it was jammed with people. It was loud and a bit unruly, with people coughing and hacking under a general cloud of despair and impoverishment, leading me to have a bit of a panic attack. This probably had to do with a combination of feeling unwell and my Americanism, which isn’t used to such conditions. Also, hospitals in general make me nervous. Still, my husband and I decided to go to a private doctor that I paid for out-of-pocket. Interestingly enough, while the facilities were much better at the private office, the wait was actually longer, at about five hours (no joke.)
Truthfully, I have no proof that the private doctor was giving me a higher quality of care than a doctor at the public hospital might have. And I am fully aware that my behavior is completely elitist. But there are just some things — heart, kidney — that you don’t mess around with. I’m glad that I am in a position to know that there are alternative care options, and that I can afford to pay for them if I so choose. In the end, I spent approximately R$2.500 (US$1,000) for three private doctor visits, three Tomography scans with contrast, and medication. While that’s still a lot on an English teacher salary, it’s ridiculously cheap compared to what I would have paid out-of-pocket in the U.S. without insurance. Each tomography scan would have run almost $5000 each in the U.S. I don’t regret my decision and would pay out of pocket again, rather than wait in that particular public hospital, if I had another medical emergency. (Health insurance is available in Brazil, but that’s for another post)
But my experience at the public women’s hospital for my routine mammogram was a pleasant experience. And it makes me wonder if a public health care system has a place in the U.S. for routine, non-life threatening procedures? Realistically, my minuscule exposure to the public health care system here in Uberaba, Brazil is hardly a comprehensive study. But if you have no history of cancer in your family, and you have nothing suspicious going on, and you are literally just doing your annual check — and you separate your American need for immediate results from the equation — is three months from start to finish really too long to wait? I wonder.