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United States of America (USA) - Health Service

If you are involved in a life threatening emergency situation and need help, call 911. This will allow access to police, fire and ambulance services. Calls can always be answered in English and often in Spanish.

The use of an ambulance via 911 will incur a large fee being levied.

The US has a high standard of healthcare, but it is very expensive. According to the World Health Organisation (WHO) the US spends more on healthcare each year per capita (over $8,000) and more on health care as a percentage of its GDP (about 17%) than any other nation. It is a healthcare system based on free markets and insurances, and therefore involves substantial administration and financial processes throughout, with a significant portion of the population unable to access all but the most essential treatment. Infant mortality is at one of the highest rates of the developed world and average life expectancy is shorter than in thirty other nations globally, reflecting the lack of comprehensive medical care available to those in social and economic need, despite almost 65% of health spending being provided by the government.

If you are moving to the US, medical insurance for your and any accompanying family will be expensive but critical. If your prospective employer offers insurance as part of your package, make sure you understand what level of cover will be provided and the extent to which existing or unexpected conditions will be limited for cover.

Primary care is delivered through

• Family physician/associated professionals in a group practice
• Family physician in a solo practice
• Public primary healthcare centres
• Non-profit community healthcare centres for the low-income/uninsured
• Public service clinics for the military, prisons etc.
• Sometimes vis secondary care centres, such as walk-in services at ER

Some primary care practices are incorporated into preferred networks for health insurance providers.

It will not be difficult to locate local doctors across any state. When you find one which you like and has vacancies for new patients, you will be asked to complete forms about your details and medical history.

A doctor’s prescription is required to access scheduled medication from a pharmacy, all of which are run as private businesses. The extent to which the cost will be covered by your medical insurer depends on the plan you have; you will have to pay for the medicine and will not be reimbursed for anything not covered.

When you make an appointment to see the doctor, you will generate negotiate an appointment time convenient to yourself and the practice. Many patients experience a waiting time on arrival for their appointment.

Secondary care is delivered through:

• Local community not-for-profit hospitals
• Local government owned hospitals
• Local for-profit hospitals
• Ambulatory surgical centres
• Long terms and residential care for the elderly

If you have had an accident and are going to hospital, you are advised to call ahead to say you are arriving. In England the NHS Accident and Emergency departments have a target of 4 hours to assess, treat and discharge, or to transfer the patient to another hospital or facility; with a rapidly increasing and aged population leading to higher levels of presentation and a triaging system which identifies severe cases for priority, they achieve this target in 91% of cases. In the US 95% of patients are seen by a doctor within three hours, but treatment, discharge or transfer times may be longer than this.

You will need to bring proof of your insurance and show it at the front desk on arrival, before treatment can take place. Payment for a portion of the medical treatment must be made before you leave; the rest of the hospital bills will be sent to you through the post for you to pay or discuss with your insurance company. Check bills and reimbursements very carefully, as errors can be difficult and time consuming to amend.

Tertiary care centres, offering highly specialised care, include:

• Public facilities owned by the state or city municipality
• Private or semi-private facilities
• Charitable and/or religious founded facilities

Obesity and diabetes, which contribute to a range of disabling and life threatening conditions including the biggest killers heart disease and cancer, are a serious problem in the US. It also contributes to the high infant mortality rate, although in 2013 this was 73% higher for the children born to unmarried mothers than to married mothers and suggests a close link between social, economic and health problems . Suicide, alcohol abuse and chronic liver diseases have also been rising, especially for women.

Attitudes to smoking have changed dramatically over the past 50 years, although the number of smokers in the US today is estimated to be just over 42 million. The extent to which you will be lawfully permitted to smoke in a public place or use an electronic cigarette will depend on the state this activity occurs in. By 2012 thirty states in the US had adopted laws banning smoking in workplaces, restaurants and bars, and South Dakota is an example of a state which has gone further by also prohibiting smoking in places of gambling. Some states may ban outdoor smoking in public places. 16 states in the US, including Pennsylvania, Nevada, Tennessee, Oklahoma and Virginia, still permit smoking statewide in both bars and restaurants. Idaho, Louisiana, Florida and Indiana have laws prohibiting smoking in restaurants but not in bars. To add to the confusion for visitors and new residents, county or municipal laws may have imposed a ban on public smoking even though their state law has not done so, although Oklahoma has a pre-emption law that makes local authorities unable to introduce a ban not imposed by state law. Polls of US residents confirm that the majority welcome laws which enhance a smoke free environment.

If you are unsure about whether and where smoking is permitted in a new location, you are advised to ask the waiting staff or a nearby customer for advice. Do not presume it is acceptable to ignore laws you are unaware of, as you are likely to receive both a fine and a hostile reaction from those around you.

Most of the large tobacco companies have recently invested in electronic cigarettes, either by buying existing makers of vaping supplies or developing their own. The market now generates sales of over a billion dollars a year in the US alone. The extent to which it is lawful and acceptable to vape again depends on state and county laws, so clarification from reliable locals should be sought before use.

The US had been more open to offering and receiving mental health services for the wider public than many other societies. Most of the non-acute services must be paid for, but insurance plans will often help. For anyone considering help or treatment, organisations such as the not-for-profit Mental Health America would be a good starting place for finding information.

In the US the Samaritans run volunteer-staffed hotlines, professional and volunteer run public education programs, ‘suicide survivor’ support groups, and many other crisis outreach and advocacy activities throughout the country. The youngest volunteers work on the Teen Lines.

Suicide is the tenth leading cause of death each year in the US, with almost 43,000 people in 2015 ending their life. There are an estimated 25 suicide attempts for every death. If you are in crisis or know someone who is, please contact the Samaritans urgently; ring 1(800) 273-TALK or contact one of the local branches which each have a dedicated hotline with trained volunteers ready to listen to you in confidence.

Samaritans (Boston)
Hotlines - (617) 247-0220, (800) 252-TEEN (Teenline), (877) 870-HOPE (State-wide)
Roberta Hurtig, Executive Director
141 Tremont Ave.
7th Floor
Boston, MA 02111
Business phone - (617) 536-2460

The Samaritans on Cape Code and the Islands (Cape Cod)
Hotlines - (508) 548-8900, (800) 893-9900, (877) 870-HOPE (State-wide)
Maura Wilson, Executive Director
P.O. Box 65
Falmouth, MA 02541
Business phone - (508) 548-7999

The Samaritans of Fall River/New Bedford (Fall River)
Hotlines - (508) 673-3777, (508) 673-5160, (866) 508-HELP (MA toll-free)
Del Ferus, Executive Director
627 State Rd.
West Port, MA 02790
Business phone - (508) 679-9777

Samaritans (Framingham)
Hotlines - (508) 875-4500, (877) 870-HOPE (State-wide)
Eileen Davis, Branch Director
235 Walnut St.
Framingham, MA 01702
Business phone - (508) 872-1780

The Samaritans (Keene)
Hotlines - (603) 357-5505, (877) 583-TEEN (Teenline)
Christine Brehm, Executive Director
103 Roxbury St.
Suite 304
Keene, NH 03431
Business phone - (603) 357-5510

The Samaritans of Merrimack Valley (Merrimack)
Hotlines - (978) 327-6607, (866) 912-HOPE, (978) 688-TEEN (Teenline), (877) 870-HOPE (State-wide)
Debbie Helms, Executive Director
430 North Canal St.
Lawrence, MA 01840
Business phone - (978) 688-0030

The Samaritans of New York (New York City)
Hotline - (212) 673-3000
Alan Ross, Executive Director
P.O. Box 1259
Madison Square Station
New York, NY 10159
Business phone - (212) 673-3661

The Samaritans (Providence)
Hotlines - (401) 272-4044, (800) 365-4044
Denise Panichas, Executive Director
P.O. Box 9086
Providence, RI 02940

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