Illness, Health Care in Portugal
Tis the season for illnesses. We also talk about our experiences with the Portuguese health system and compare it to the U.S.
Welcome to As the Dinoson's Turn, where we chronicle the adventures of the Dinoson family. A seemingly ordinary family from Iowa who decided, hey, you only live once. So let's move to Portugal. And now your hosts, Jason and Tracy Dinoson.
SPEAKER_01Alright, welcome to another episode of As the Dinason's Turn. We're in separate rooms this time, because uh some people in the house are ill and some people are not, so we're trying to quarantine as best we can, I guess. But uh we said we'd do these weekly, so I was actually prepared to do it myself if I had to.
SPEAKER_02Well, you might have to. We'll see how this goes. I'm trying really hard here.
SPEAKER_01Well, what do we need to talk about this time? I don't even know. We've talked about burnout, we've talked about why we're here. Um I don't know. We we hadn't done one before, you know, April. April 15th or so was our last one before we started a few weeks ago. So I guess there's a lot of ground that we could cover.
SPEAKER_02There are so many things. I'd say that one of the things that we're learning is that with burnout, um, if we continue some of the same patterns that we've had before, that we're going to achieve burnout just as quickly, or we could. And I think that that's one of the things that we need to keep in mind as well. Like we're recovering from all of those and we're feeling inspired and creative. But sometimes some of us do too many things and then we wind up getting sick. So I think that we have to keep that in mind. Um, so we're trying to do some of that with scheduling in particular. Like you don't have webinars every day of the week before you were giving webinars sometimes two, three times a day. So it's nice to have some breaks there and have uh some exclusivity agreements that help with that.
SPEAKER_01Um I think our you know, we're busy, but we we try to keep control of calendars and and I don't know. I know a lot of what we do outside of work is running errands, it seems like, but at least that's not work.
SPEAKER_02Yeah, that's definitely true. And we have time to actually do some of those things throughout the day, and I think that that's helpful. It's not always like 10 o'clock at night or eight o'clock at night, let's go and try and get this stuff done. So that's nice. Um, and we've been pretty conscientious about not having too many things to get done in a day. Um, because we're living in a country, one, where that's impossible. Um, but two, that definitely helps with us overloading or not overloading.
SPEAKER_01Let's see, what else can we talk about? We both you and I both have had various and have for years various medical things that take us to the doctor every now and then. Um you know, and we we knew some wonderful doctors in the United States. The doctors here are very good too, I think. Um there there's um you know the cost of things. I had to have an MRI done on my neck and a series of x-rays on my spine. And we do have so there's it's hard to explain how it works, I think, because it's public uh health care, but there's also private insurance. I don't know, how would you describe private insurance? It's almost it's like it kind of lets you like let you cut the line a little bit in some cases, and and it also lets you do some things that are kind of more voluntary, I guess, as opposed to the public system is more for like you're not gonna go bankrupt if you have to be hospitalized or you you know get cancer or something like that. No insurance is more for the other things.
SPEAKER_02I think you've lost your mind. No. So we are not from this country and we do not pay into social security and all of those things. We can be part of the public health system. We do have public health numbers. There's a problem with the setup there. There just aren't enough public health doctors to go around for everybody all of the time. And so because we are able to pay for private insurance, um, we definitely do pay for private insurance, but it is nothing compared to health insurance in the United States costs, even with paying into Social Security every month to be able to use all the health benefits in the ways that you would want to. Um it's only 60 euro a month to pay in, so it's very different. Um, we pay 275 for private health insurance, but we're since we're in our first full year of private health insurance, there are certain things that aren't covered all of the time. So Jason's MRI was an out-of-pocket expense, and it was like 300 euro.
SPEAKER_01Um the total, yeah. I had an MRI, x-rays of my spine from top to bottom, and blood work, and I think it was all a total of 400 euros, so like 450 without insurance covering any of it. That's just what my out-of-pocket cost was. Whereas in the United States, how many $10,000 probably to do an MRI of your neck, most likely?
SPEAKER_02Well, so the costs of medical care is definitely lower. It's like there's negotiated rates or something. I don't know. Like all of our medications are at a much lower cost. Um, there are two levels. Uh, there's a cat here. There's a camera butting around. He's trying to like rub himself all over the tablet. Um, but there are two levels of medication costs. One is with participation within the public health system, and one is without. Um and so with get you a discount on medications and without you pay the agreed upon price. But we're talking about like my like the medications. Like we got what three months worth of medications for three people for 30 years old. So the agreed-upon price, like even non-participation, is much lower. Um, and I think it's because they've actually enabled you to be able to do all of those types of negotiations. It also is based on what people can actually afford. And I think that that's important to keep in mind as well that the pay in Portugal is much lower than it is in many other countries. Um, and that um health care is definitely seen as a public service and a right. Um, and it's something that everybody is expected to be able to use, just like the bus. So I think that that's one of the things that I truly appreciate. But I also feel like the approach is very different. Like, I mean, most of the doctors speak English on some level. Um, maybe not as fluently as they would want to, because you know, they wanted to learn their medical terminology, they know it in Portuguese, but in saying that in English. So sometimes there's a little bit of a disconnect there, but it's been very easy. But they actually listen to your symptoms, I think, in a deeper way than what we experienced in the United States with some doctors. Um, I had a wonderful rheumatologist in the US, so he listened to everything, but that was, I felt like the first time somebody really listened to me and had a conversation with me. Whereas here, every single doctor really wants to get to know you, and they're like, So you have the symptoms, and then they're putting things together in their mind. They're like, oh, well, let me guess. You also have this, and you also have that, you also have this, and you're like, Yes. Like, well, that makes perfect sense. So I don't know.
SPEAKER_01I think it's also interesting. Maybe it's this way in other countries, it's not this way in Portugal, where it's like, oh, it takes nine months to see a doctor. Um like I so I've had to see an ear, nose, and throat doctor several times uh through in my life, including in the U.S. because uh I uh I'm strange and I have uh salivary gland stones occasionally. And I had one back in December, actually, first time in Portugal. And we could get in to see an ENT the very next day. Now, maybe it's not that way everywhere throughout the country, but uh it was here, whereas in the United States I'd you'd go to your primary care doctor to get immediate treatment, I suppose, and then wait six weeks or eight weeks to get in with the ENT.
SPEAKER_02Well, and to be clear, that's also paying out of pocket at a private hospital. Um, but paying out of pocket at a private hospital is not something we would consider expensive either. I love when they actually apologize that you might have to pay out of pocket for something and then get reimbursement from your private health insurance. Paying out of pocket at a private hospital is between 60 and 80 euro for the visit, depending on what it is. Um, with your insurance, it's like 19. I love. It's always 19 is your kind of co-pay. Um, but at the same time, I think that you're right, you have the availability, whereas I expected even in the price private system to not be able to get into anything for months and months and months, and that's definitely not the case. Like, yeah.
SPEAKER_01I guess we should say six sixty to eighty dollars out of pocket, if we're talking to an American audience, that's probably a pretty good deal. Um to a Portuguese person, sixty to eighty dollars is a big deal, though, for a lot of people.
SPEAKER_02It can be very expensive. And I think that that's the reason why you know people like you can get up really early and wait in line outside of the health center to get an appointment for urgent need. You definitely can do that. Um, the hospital here in town also starting at 8 p.m. sees um health, like the S they call them S, so the public health clients, and then there's no you don't have to pay, or you pay like four euro instead of 30. So it also depends on your hospital um on how much you're going to pay. So, but yeah, out-of-pocket costs is very different. But I also feel like the philosophy is very different here as far as medications and taking medications, but also um really concerned about you as individual holistically, um, and not a problem to be like, oh, well, we have to go through this whole big long series of tests before you could actually access that MRI. It's like, nope, we're gonna do it all at once. So you literally went in and were there from like eight o'clock in the morning until like what, like noon or something, had all of those tests done all at once, all in a row. Um, and it was like they scheduled it and it was fine. So I think that there's also there's not all as many hoops to jump through to get your insurance to pay for things either. If the doctor says you need it, then you need it. Um, and then there are some things that you know, I went and had I had to have some precancerous treatments, nitrogen things burned off my face, and I thought, oh, you pay for your consultation and then you have to go back and pay for your exams. And I was like, good lord, how many hundreds of dollars is this gonna be from a dermatologist? And it was three euros. So um, I think that you mean you're paying for all of these little pieces of things, but each one of those pieces is definitely cheaper. I don't know. Some of the mystery things, though, that even you have dealt with or had questions about, and they're like, oh, well, let me guess what about X, Y, and Z? And do you have this and do you have that? And you're like, Yes, I do. They're like, Well, it's no wonder. You know, like they've really kind of listened. And I know, at least in the States, every time Jason would talk about these rare things that he has, especially with these stones, he gets this big gland infection, his whole face pops up. And, you know, he had a tear duct that just like his tears were constantly running and had to have surgery. Every time he has this conversation, he was like, I'm sorry, I know this sounds crazy. I know this sounds crazy. Um, and in the US, they'd say, Yeah, it does sound crazy. Um, he's never once heard that from a doctor here ever. He was like, Oh no, absolutely, that makes perfect sense. Yes, this is definitely a real thing. Like, and so I think that's the other piece of it. There's like some element sometimes in the medical system in the United States that if you have a symptom, oh, you must be looking online and thinking you've got all these crazy things and you're a hypochondriac, and that can't be a real thing. Whereas here we're saying, yeah, no, they're like, oh, I know about this symptom. And then what about this? Do you have that too? Do you have this? And like, um, there's also an idea of treating things. And then there's also the idea of like when you should consider surgery and when you shouldn't, based on your own quality of life and length of life, you would have to be dealing with something. Like, it's better for you to have a surgery in order to not have to be on medication for the entirety of your life, um, instead of just taking your medication. Like, we're learning all kinds of interesting things. Like, I didn't know some of these procedures existed at all. So we go down the health rabbit hole, and um, we have not had a bad experience with a doctor yet. It's just been completely positive. And I love our pharmacy. I do, I love our pharmacists.
SPEAKER_01So yeah, we have a far our favorite pharmacy, and uh well, all of them are are good. I like all of them in in that uh particular pharmacy, and uh they get to practice their English on us, and we can practice our Portuguese on them. I had to go in there by myself one time, and I got the other guy, he is friendly too, but he doesn't really know who I am, and I don't think he recognized me either. And all I heard was and I looked at it. He repeated himself, because when people talk fast, that's how it sounds to me. It's just like he was asking if I wanted generic or name brand, is turns out what he was asking, but that's you know, I must have looked like a total idiot. And so then he put his finger on my name on the the piece of paper and he said, English. I said, Yes, please.
SPEAKER_02No, but I really enjoy like the number of people that we've gotten to know and that they're like, oh, I just want to practice. Just even, you know, um, one of the best pharmacists, his name is Nelson. He's got quite the sense of humor and is very nice. Um, but even having conversations like with the medical doctors who are like, oh, I need to practice my English more and I need to listen to more English and and have higher level conversations than just hi, how are you? Because I go to a conference and my field is all in English. And here in practice, I use Portuguese almost all of the time, and so it's so nice to have English-speaking clients. It's it's been entertaining. But the We're working on that. Yeah, and we've had I have an idea on that. So you have tons of ideas. You're never gonna like he's never gonna run out of things to do. But I would say that also, um, even the doctors who have spoken Portuguese have spoken very slowly to make sure that you understand and you understand what's going on, no problem. You don't have to worry about that. So that's a good thing. No, but it's appropriate since I've got the crud and the boys have the crud. But I think it's just the time of year, it's also been very wet and cold. Well, cold for us. It's a cold spell for us. It's not really that cold in comparison to some of the things we see in the US. So um, but rainy and damp. It's been reality. Yeah. So we all have got like this sinus cred, where you get you might have a fever and then you have to go to sleep and all of that. It's going around everywhere. Um, knock on wood, we haven't gotten the bad flu yet. Um, that's a good thing. We know that we've already had some version of COVID at some point in time. They're like, oh yeah, just accept that you've had it. You're good now. Like, let's not worry. That's the other thing. Thinking about COVID. There are very different philosophies here. I mean, Nestle, um the booster shots and all of those things are completely available, but they are available to people over 60. Um, and that is kind of the threshold, and starting in like September. And then the younger populations can't get those until November, at least in our town, if you're lucky, December. And then by then we'd already had it. So it was like, well, here you go. I guess we don't need it now. Because we went to the hospital because the the um symptoms just wouldn't go away. Jackson just couldn't get his symptoms to go away. Like, oh yeah, you've had COVID. That's just what's going around right now. It's fine.
SPEAKER_01So well, we wanted to get our weekly podcast up. So as usual, we had no real agenda and somehow we filled nearly 20 minutes.
SPEAKER_02So I think we're good at that, apparently.
SPEAKER_01Apparently. Well, maybe next week we'll all be healthy. I haven't caught it yet, knock on wood.
SPEAKER_02I was gonna say you better knock on something because Tyler's got a little bit of cough, and then I've been like this for a little while, and poor Jackson's just down for the couch. So it's coming your way. Be prepared.
SPEAKER_01I'll just stay locked in my office and we'll see what happens. All right, join us again next time on As the Dinason's Turn.
SPEAKER_00You've been listening to As the Dinason's Turn, a podcast presented by Dinason Media Ventures. Don't forget to like and subscribe, and catch us again next time for another episode.