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Differences in health care systems and diagnosis for SA.
I am from Denmark, a small country who is a member of the EU. (And no we are not the capital of Sweden). I have read some posts here about health care, insurance, and how SA is diagnosed and treated.
I was thinking that with your new president and his promises to improve health care, it would be interesting to hear how it works in most of the EU countries.
There are big differences in our health care system. First and foremost, in Denmark and most of Europe, we have a Public Health Care System, where the government pays for all services and equipment. Few people have a private insurance (in Denmark about 5% of the population). Even our insurance system is different because our insurance covers the same as the public system. The only difference is that with insurance you can use one of the few private clinics. However, this advantage is very small, because our public system has a maximum treatment guaranty to 1 month (especially for Denmark and some other EU countries). If the public system cannot meet it, you can free choose a private clinic.
Although our public system works very well, we've had trouble with the recognition of SA as a disorder requiring treatment.
The U.S. began diagnosis and treatment of SA, much earlier than here in Denmark and the most of other EU countries. Apart from a few pioneers the sleep medicine first started really in earnest in 2002. So we are in some ways behind the U.S. when we talk SA.
A few years ago, in-lab sleep studies (PSG) were also the gold standard here. But then our public system realized, how many potential SA sufferers there exist, and because of new technology allows it, they changed the guidelines for studies and treatment of SA (together with a lot of other countries). This means that today we can find and treat at least 10 times as many for SA, for the same resources.
Our system is built in 2 levels:
Level 1:
All who are referred to a sleep apnea study starts here. Typically, it will be your own doctor having regard. Within a month, you will receive a call for a sleep apnea study. Do you have a private insurance you can have an appointment within one week.
This study is a "partial Polygraphy" in-home test, where you sleep in your own bed one night. These devices measures primarily on respiratory problems and desaturations.
The day after the test you will meet up at the sleep lab, and have a conversation with a sleep physician. If it is found that you have sleep apnea he will transfer you directly to a specialist nurse in the sleep center, where you are supplied with an AUTO CPAP (We don’t have DME’s), are testing various masks and will be instructed in the use of equipment.
So already on day 2, you are in treatment. Then you will have a date for a new sleep test (with CPAP) 3 months later. This 3 month is our “titration study”.
If this proves that you are well treated you will have a yearly control, and they will read your data card. Masks and equipment can be replaced regularly as needed.
If during this test is evidence of other sleep disorders or that reading has not provided the expected impact they will send you to the 2nd Level
Level 2:
This is very specialized departments.
There you will undergo a full PSG sleep study - still as an "in-home" study. This test involves an additional set of measurements - including ECG, possibly the pressure of esophageal, PLMD, and many others depending on the assessment.
Subsequently, a sleep specialist will take a position on the way forward.
In many ways I think this system is good because we get a huge number in treatment. The downside is that there probably are some who "pass through" between Level 1 and Level 2 - specifically, I am afraid that some part with UARS may fall through.
I think this system will spread to more and more countries, including the US. Some US sleep centers already use this system.
Henning
I was thinking that with your new president and his promises to improve health care, it would be interesting to hear how it works in most of the EU countries.
There are big differences in our health care system. First and foremost, in Denmark and most of Europe, we have a Public Health Care System, where the government pays for all services and equipment. Few people have a private insurance (in Denmark about 5% of the population). Even our insurance system is different because our insurance covers the same as the public system. The only difference is that with insurance you can use one of the few private clinics. However, this advantage is very small, because our public system has a maximum treatment guaranty to 1 month (especially for Denmark and some other EU countries). If the public system cannot meet it, you can free choose a private clinic.
Although our public system works very well, we've had trouble with the recognition of SA as a disorder requiring treatment.
The U.S. began diagnosis and treatment of SA, much earlier than here in Denmark and the most of other EU countries. Apart from a few pioneers the sleep medicine first started really in earnest in 2002. So we are in some ways behind the U.S. when we talk SA.
A few years ago, in-lab sleep studies (PSG) were also the gold standard here. But then our public system realized, how many potential SA sufferers there exist, and because of new technology allows it, they changed the guidelines for studies and treatment of SA (together with a lot of other countries). This means that today we can find and treat at least 10 times as many for SA, for the same resources.
Our system is built in 2 levels:
Level 1:
All who are referred to a sleep apnea study starts here. Typically, it will be your own doctor having regard. Within a month, you will receive a call for a sleep apnea study. Do you have a private insurance you can have an appointment within one week.
This study is a "partial Polygraphy" in-home test, where you sleep in your own bed one night. These devices measures primarily on respiratory problems and desaturations.
The day after the test you will meet up at the sleep lab, and have a conversation with a sleep physician. If it is found that you have sleep apnea he will transfer you directly to a specialist nurse in the sleep center, where you are supplied with an AUTO CPAP (We don’t have DME’s), are testing various masks and will be instructed in the use of equipment.
So already on day 2, you are in treatment. Then you will have a date for a new sleep test (with CPAP) 3 months later. This 3 month is our “titration study”.
If this proves that you are well treated you will have a yearly control, and they will read your data card. Masks and equipment can be replaced regularly as needed.
If during this test is evidence of other sleep disorders or that reading has not provided the expected impact they will send you to the 2nd Level
Level 2:
This is very specialized departments.
There you will undergo a full PSG sleep study - still as an "in-home" study. This test involves an additional set of measurements - including ECG, possibly the pressure of esophageal, PLMD, and many others depending on the assessment.
Subsequently, a sleep specialist will take a position on the way forward.
In many ways I think this system is good because we get a huge number in treatment. The downside is that there probably are some who "pass through" between Level 1 and Level 2 - specifically, I am afraid that some part with UARS may fall through.
I think this system will spread to more and more countries, including the US. Some US sleep centers already use this system.
Henning
Views: 59
Replies to This Discussion
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Permalink Reply by Melodie on
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Henning,
Thanks for sharing this vital information! Your country is far above the USA in that you get treatment quite a bit quicker than we do. Hopefully our newly elected President will take Health Care Reformation as seriously as it needs to be taken, and put into place a better system so that everyone can have access to the same kind of treatments as those with private insurance now have. Currently if you do not have private insurace, many here in the USA cannot afford medical attention - much less the expensive testing required for diagnosis of Sleep Apnea and other sleep disorders.
This is part of why this site is set up - to make a better awareness of Sleep Apnea and other sleep disorders, and to help get the attention of the medical associations so that we CAN get better care.
Thank you again for sharing and please keep posting on the discussions board anything and everything that you think may be of use to anyone reading on the site. We are all here to help each other and to learn things that we are not always told.
Kindest regards,
Melodie (Mel)
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Permalink Reply by sleepycarol on
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Unfortunately no health care system is perfect. Certainly not the USA (where I am) and most industrialized countries have NOT perfected the system.
I know I have always thought I would like to see our government turn to a more socialized system with treatment being provided regardless of coverage (government or private) that was more equitable than it is now. I have done some research on some of the European countries and and Canada and the more I read and hear about their health care systems the more I am leaning on keeping our system the way it is.
European countries and Canada have their own nightmare stories about their health care systems. I am still doing some researching and I have been known to change my mind -- but for now -- socialized medicine is not in our best interest I don't believe.
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Permalink Reply by Henning on
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I think that most people in Denmark (and most of the European countries) love their public health care system, and I don't say it's allways perfect.
But of course our system has some consequences.
We are the country in the world with the highest taxes (Not only because of our health care system). But on the other hand, we are the last 3 years elected as the country with the most satisfied citizens.
Of course you can't transfer our system immediately to the U.S. It took us maybe hundred years to establish here.
Henning
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Our system isn't perfect and certainly needs fixed -- but there is freedom of choice here -- where many times in countries with government health care there is very little choice for the consumer.
Even in Denmark you have to make a choice of a doctor within so many kilometers of where you live (reports indicate 10 kilometers) -- this limits your choices if you are to use the government sponsored healthcare. The number of patients per physician is approximately 1,600. According to a 2000 report there are only 71 hospitals in Denmark with an average of 3.7 beds for every 1000 people. According to this same report specialists can only practice outside the government sponsored medical system with the associated costs paid for by the insurer or patient.
According to this same report Denmark has fallen behind other European countries in life expectancy.
In speaking with my doctor recently we started discussing socialized medicine and she said that in many instances the government can and does dictate which patients receive treatment -- example she used was that they may deny dialysis for someone over 50 -- opting instead to spend their health care dollars on the younger populations.
Many times in the countries with this type of health care systems there are long waiting periods for diagnosis and then for treatment.
In the above cited cases of sleep apnea diagnosis in Denmark -- what is the initial wait time for an appointment to a doctor to determine if you need the sleep study? Your system to diagnosis sleep apnea seems faster -- but what about the patients that have other sleep disorders that may be overlooked due to this type of system? From what I read from your post it could possibly take another year before you see the doctor for a follow up to determine if a full blown sleep study is warranted.
Probably many Europeans love their system as they know no other system of health care. I know in Canada they are familiar with our health care system and will seek treatment in the US when their system lets them down.
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Hi Sleepycarol,
I wasn't trying to “sell” our system to the US, but only inform you about the differences in our systems, especially when we talk SA.
Every system has their pros and cons. For example I would have preferred a full PSG at my first appointment.
You are probably right when you write that many Europeans love their system, because they are born to it.
And for your other information’s. A lot has happen within the last 10 years. I don’t know the number of hospitals here, but today I think there is fewer but larger hospitals with more specialties. But we are a small country with only 5 million citizens.
We must choose a primary physician within the municipality, but when we talk therapy (Hospitals, clinics, etc.) we can choose freely throughout the country. Normally we can have an appointment with our primary physician within a day or two (if it is not acute).
Our treatment guaranty of one month is relative new (about 8 years). Before that we had some waiting lists. As mentioned, if the public system cannot meet it, you can free choose a private clinic, also in other countries.
By law our public system are not allowed to discriminate patients (sex, age etc.).
But there are big differences between the European countries. For example I know that in Spain they have a waiting list for SA around two years.
Henning
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Permalink Reply by Judy on
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Thank you, Henning and SleepyCarol, for your comments regarding OSA Dx'ing and health care in your countries. I would hope that those from still other countries will jump in and share their country's health care and OSA Dx'ing and treatment! This could a wonderfully informative and interesting discussion!
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Henning --
Not trying to really knock your health care system -- it is just that I don't believe any country has perfected their system yet. Hope you are not offended - as I really wasn't trying to make you mad -- just trying to point out that every system seems to have its downfalls.
I hope that other forum members from other countries will chime in as well about their countries health care system and how it is in dealing with getting a diagnosis of sleep apnea and then the equipment.
Even here in the states there are so many different options that it makes it hard for the average person to know which type of coverage best suits their needs -- and then there are those that have insurance through our employers and don't have much of a say about what type of coverage we can obtain.
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Hi Sleepycarol,
You insulted me certainly not. A good debate is always good, and to give a better understanding of each other's views, it is good to know the differences in our treatment options.
Henning
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Henning,
Thanks for starting this discussion as it is by comparing pros and cons of each system that eventually, or should I say hopefully, they can evolve towards better care.
FYI in Europe to my knowledge things are moving fast in terms of social security coverage for slep apnea treatment:
France - for the 1st time an oral appliance received reimbursement status and there is a lot of pressure on CPAP service providers as it costs a fortune to the State Health System
Netherlands - I heard that there are plans to reimburse oral applainces along the CPAPs
Sweden - the place where custom made oral appliances got their initial legitimity. There are more Slep Apnea patients being prescribed oral appliances than CPAPs. Pretty amazing when we know that everywhere else in the world it is a ratio of 10 or more CPAPs to 1 oral device. The Swedes have a pretty clever system: whatever your treatment you have a co-pay of 80 euros per year if you suffer from Sleep Apnea and then your doctor prescribes what seems most appropriate for you.
Anyone else knows about this in other countries?
Cheers Fabpaub
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Hi Fab,
I think you are right that it is going very fast in Europe with regard to the diagnosis and treatment of SA. But we came much later in the process of treatment than in the US. so we have some catching up.
The guidelines about the diagnosis I described in my first post, was produced in cooperation with Norway and Sweden, and later spread out to other countries.
But when we talk therapy, I believe that the differences are greater.
In Sweden and some few parts of Denmark first line treatment is oral appliances for mild SA. Sweden was also first with public subsidies for oral appliances. Here in Denmark, we have unfortunately not this possibility (yet).
But if more and more countries recognize this treatment, it will probably change.
Henning
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Permalink Reply by Banyon on
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I agree with SleepyCarol that a nationalized health care system is not what is needed for the U.S. The culture is very different here. 30% of students entering ninth grade this year will never graduate from high school. 14% of our population is functionally illiterate (cannot even read a simple child's book). There is a high rate of violent crime. The diet is horrible and obesity is a major problem. A significant segment of the population lives a sedentary lifestye. There is a large illegal immigrant population. The majority of the population does not want to pay to treat the preventable health problems of people who have been very irresponsible with their own lives and health.
Henning, this comment of yours is what interests me:
"A few years ago, in-lab sleep studies (PSG) were also the gold standard here. But then our public system realized, how many potential SA sufferers there exist, and because of new technology allows it, they changed the guidelines for studies and treatment of SA (together with a lot of other countries). This means that today we can find and treat at least 10 times as many for SA, for the same resources."
We need to move forward with this in the U.S., but not with a government plan. The problem here is our Federal Drug Administration (FDA) issues too many restrictive regulations. Companies that are wanting to invest and move forward with novel health treatments have their hands tied by the FDA and our Congress. Unfortunately we have just elected a President who intends to make the central government bigger and more powerful. This will put further restrictions on companies delivering health care and further restrictions on individuals seeking new, more effective, more efficient treatments.
We will fight this move toward socialism. It is not too late. The current Congress and President have a big advantage at the present time. But it might be amazing how quickly they fall out of favor. When the educated, responsible working people begin to see the horrible results things will change. I personally predict the honeymoon will be over two years from now. Unfortunately, in the next two years, the current Congress (Democrats and Republicans) and President will probably get a lot of damaging laws passed. We will see in time.
BTW, you have some major problems in Denmark which are politically incorrect to discuss on a public forum. And despite all the problems in the U.S., no one wants to leave and millions around the world have dreams of joining us here.
I traveled often to Europe on business for 30 years but never made it to Denmark. I hope to visit your lovely country on vacation in the next five years.
Thanks for your post and will look forward to hearing from you again as time goes by.
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I will not go into a political discussion with you.
We have here in Denmark and most of other European countries, a more social behavior. I think that most agree with this.
It is true that we are a very socialist society. It is something which has arisen over many many years. This is something virtually everyone in this country agree in.
When you talk about big problems politically in Denmark, I think you are talking about our freedom of expression. If so, I must say it is one of our most important values. And here we all stand together, and I'm sure I talk for everyone in Europe.
Henning
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