To feel like actually, health care isn't really free at the point of service?

(57 Posts)
RevoltingPeasant Fri 03-May-13 17:05:01

Would honestly appreciate thoughts on whether I am being precious/ demanding here, but..........

Today I went to a physio appointment. Private physio letting out rooms in an NHS GP practice. The GP practice is closed for a couple of hours or something, and he uses their rooms.

Sitting in the waiting room, I noticed these two posters next to each other:

'On a low income and need help with healthcare costs? Eye care, prescriptions (etc, it went on)'

Then an ad for the private physio I was seeing.

I'm seeing a private physio as I have no hope of getting one on the NHS and it helps me keep active (tendon injuries). I pay for private eye care, and obviously even NHS dentists charge. The posters made me think about how much most people can't get on the NHS 'free'.

I wish it weren't this way, but AIBU to think that actually, except for hospital admissions (which are a big thing of course!) much of the time it is really not true to say that healthcare is free at point of service?

Xiaoxiong Fri 03-May-13 17:13:34

Having lived in the US where it really isn't free at the point of care and you have to save up enough cash for the copay to see the doctor to get a prescription for the pill which you then also pay for in full in cash, YABU.

When you say you have no hope of seeing a physio so you have to go private do you mean the wait is very long, or that the GP won't refer you?

I see your point, but the finite pot does mean a line has to be drawn between life saving needs that must be met immediately, such as paediatric intensive care, and life improving treatments such as physio which can wait until mañana hmm

I had to go private a few years ago to get a problem dealt with. The NHS would have stepped in eventually, but it was better to get the tumour removed before it caused life-threatening internal bleeding. Although that annoys me, I know that the diagnostic tests used to work out what was wrong were very expensive (thank goodness for work BUPA) and still might have shown nothing, so I do understand.

More concerning IMHO are the immediate costs such as transport, parking, lost earnings, or prescription charges incurred by patients in order to access healthcare.

SilverOldie Fri 03-May-13 17:16:52

Healthcare is free unless you choose to see someone privately as you are doing. It's your choice to do so.

RevoltingPeasant Fri 03-May-13 17:19:13

Horry oh yeah, don't get me wrong. I pay happily (well, not happily, but you know what I mean!) for my physio. It enables me to cycle and swim and run. I think these things are really worth doing for my health, but yeah, it's not like oncology!

Of course I do not begrudge others lifesaving treatment, that is not my point at all.

My point is, people always say 'but the NHS is free' whenever it's criticised. But it just occurred that especially if you do not have stacks of cash, actually a lot of pretty routine healthcare is not free.

CloudsAndTrees Fri 03-May-13 17:20:18

The NHS is free at the point of service, there's a lot more they could charge for. You can get physio and eye care on the NHS but they understandably have to draw a line with physio somewhere.

In my experience eye care on the NHS is appalling, if they charged for what they provide they may as well mug you in your sleep.

RevoltingPeasant Fri 03-May-13 17:20:52

Silver but e.g., my eye prescriptions are not free. Without glasses/ contacts, I could not drive, work or do anything safely. So it's not much of a choice!

With my physio, last year I had v v bad tendonitis. I limped noticeably when I walked. I paid for a physio privately to sort that out, but I felt that was more a necessity than a luxury, being in pain at every step.

RevoltingPeasant Fri 03-May-13 17:26:20

But Clouds some things like dentistry aren't. IMO that's a pretty basic health need.

I totally understand that govts have slashed NHS spending and that is why. Of course they need to prioritise the most vulnerable/ sickest patients.

I guess I just started to reflect that one cannot necessarily access free healthcare and that is pretty sad

MrsMaryCooper Fri 03-May-13 17:31:37

There are free NHS frames and if you are on a low income or similar you can get you frames free of charge too. Although I think you might have to pay and claim it back.

You have to pay some dentistry costs. I think that the gov hopes that will encourage people to look after their teeth. It doesn;t seem to be working.

Physio lists are often long I grant you.

ChestyNut Fri 03-May-13 17:36:20

I had tendonitis last year too, saw GP who referred me to physio and seen promptly....for free?

I'd hate not too have a NHS.

tomorowisanotherday Fri 03-May-13 17:45:01

I'm sitting here with holes where three of my fillings used to be... I cannot afford to see dentist and cannot afford the standard charges. I don't qualify for any benefits since both me and my husband work. I'm waiting for Dentist to make its way to the top of the necessities list. I'm also waiting for the Spectacles fairy to turn up and grant me an eye test, not to mention the glasses that I know I need.

I have a prepaid prescription that charges me £10.50 per month, and to my shame the direct debit has bounced and they had to take it the following month. However without that I'd have to pay 5 lots of prescription charges per month, and would have to go without medication.

so free on the point of use -NO
accessible to everyone - NO
are there people who cannot afford basic healthcare - YES

I have an impacted wisdom tooth, last time it flared up I couldnt eat for so long I lost 8lb, and I have a low BMI anyway. I cant afford to get it removed privately and I cant get an NHS dentist.

A friend recently asked to borrow some money, she had a prescriptipn for antibiotics but couldnt afford to collect it until payday sad

The NHS is a brilliant service but no, its is not free

ChunkyPickle Fri 03-May-13 17:53:14

I do feel that the NHS might have lost its way occasionally though.

I'm pregnant at the moment, so get free dental etc. for then next 18 months or so - at some point, the NHS did the sums and discovered that it was cheaper overall to do this than to have pregnant women with the problems not being able to afford it would cause - a purely economic reason - yet I doubt that such a policy would get through if it were introduced today (can you imagine the yells from the Daily Mail!)

Physio and some other treatments are similar - by doing something now, you can save a fortune down the line (as well as improve lives), but the NHS, in a mislead fit of thinking its saving money won't actually do anything until the problem is really serious.

I don't know the solution. I do know that somehow the NHS needs to get away from whatever it is now, and try to get back a bit of the spirit it was started in.

abbscrosswoman Fri 03-May-13 17:55:12

NHS healthcare is only 'free' at the point of service (or any other point for that matter) unless you don't pay tax or NI eg you are unemployed.

The NHS is an insurance scheme, one that is very good at keeping the premiums low while still providing a high level of care. I think all other National Health systems are inurance schemes to a greter or lesser degree, some may cot more, some may provide even better care.

abbscrosswoman Fri 03-May-13 17:55:56

* greater, cost

WilsonFrickett Fri 03-May-13 17:58:21

Chuncky though if you're talking about the spirit the NHS was started in, physio basically didn't exist. I think the point is primary health care is free - GP visits, hospital, A&E, childbirth, children's prescriptions, etc.

Although in Scotland all prescriptions are free, as are eye-tests and (I think) more dentist services.

Abra1d Fri 03-May-13 17:58:46

'Healthcare is free unless you choose to see someone privately as you are doing. It's your choice to do so.'

This isn't true, not at our practice. For a number of things they tell you to go privately if they think you can afford it. Especially if you are a middle-aged male. My husband has had to fight for NHS treatment of a huge lump of (as it turned out) fat on his arm that was preventing him from moving the arm. He has also had to fight to have extremely sore joints in his foot investigated.

If you have a bad back they tell you to go to an osteopath or physio. Even my daughter, then 12, with a sore knee joint was told to go to the physio.

ThingummyBob Fri 03-May-13 18:00:41

I think its that 'emergency' healthcare is free at the point of treatment, rather than 'basic' healthcare.

Can you check your area for a dental hospital tommorrowisanother. I've had 'emergency' treatment at the one in my town before when couldn't afford the dentist and was in pain.

ImagineJL Fri 03-May-13 18:06:35

Most things are free on the NHS. You can see a GP, or go to A&E for free, have blood tests, X-rays, out-patient referral, more tests, surgery - all for free. Prescriptions are free for people on very low incomes in England, free for all in Wales I believe, not sure about Scotland. Yes there are waiting lists, but that is due to huge demand.

It was inevitable really, that as science advanced, so the state wouldn't be able to fund everything the medics were capable of doing.

I mean, people can now have surgery costing thousands, to make food they eat bypass their stomach, so they can lose weight that way rather than by eating less. I know that's a simplification, but I think it sums up what is expected of our state health service these days.

trice Fri 03-May-13 18:10:20

I wish I could afford private health care. The Nhs provide a very second class service a lot of the time. Being poor sucks.

I agree, OP, most people have this hazy idea that "the NHS is free to use" which is a massive oversimplification at best.

But the idea of people going without basic medical care - thinking of someone going off ADs cold turkey because the prescription ran out and she couldn't afford to refill it; or someone who put off getting a hospital referral for a year for childcare/transport reasons - because of upfront cost makes me sad

BrittaPie Fri 03-May-13 18:24:27

You can have a relatively high income (about £15000 - higher than I have ever had, anyway) before losing your fee exemption. Could be worth checking out.

You don't pay anything at all upfront for eye tests or cheap glasses, prescriptions or at some dentists (some just charge a lower rate if you have an exemption)

I need some things not on the NHS, more involved physio and therapy, as well as four teeth removing, as the waiting lists are either too long or non existent, and I just have to deal with it. hmm

I do agree that it should be free for all though. I think it is a basic principle that should be holy - glasses and pain free teeth are not a luxury.

somewhereaclockisticking Fri 03-May-13 18:33:13

Worth noting that private and NHS physio are completely different though - I've had both and the private physio was wonderful. They stretched and pulled and used an ultrasound (or something) and after 6 months the pain I had had on and off for years and years - went away. A few years later I was no longer covered by the work private scheme and so had to rely on the NHS physio - I was told you could only receive so many treatments but I actually only went once - basically I was just talked to about what exercises I could do to help. When my DD2 needed physio for her leg we went along every few weeks to the hospital and again she was just given different exercises to do each time. Everyone I have spoken to about NHS physio has said the same thing so the NHS don't even provide a service that I expected physio to be which you do get if you pay privately. Having had the private treatment (at the time it was £28 for half hour) I think if I was ever in need and could afford it - I would choose to go private again.

StinkyElfCheese Fri 03-May-13 18:44:08

my son has had neuro surgery on the nhs ... we could never have afforded this - I am pretty sure i will never pay enough tax to have covered this.

I am gratefull that with live in the UK

tomorowisanotherday Fri 03-May-13 18:47:58

we have no dental hospital, nearest one is on the mainland... then theres the ferry fees to add...sad

tomorowisanotherday Fri 03-May-13 18:49:30

but don't you think that its appaling that I am considering getting my teeth pulled out (£14) cos its cheaper than having them filled (£34)

(or it was last time I looked)

The NHS provides healthcare free at the point of use. It subsidises and standardises drug charges through the prescription charge. If you choose to go outside that system you aren't accessing NHS care. You cannot be charged for NHS care except where specific charges are mandated - such as dental care.
In Ireland you have to pay for every single GP visit. When my dh developed a flare up of cellulitis in South Korea he had to present his credit card before being seen in the emergency room.

RevoltingPeasant Fri 03-May-13 19:29:52

tomorrow thanks You are exactly the sort of patient I was thinking of.

I had a comparable situation last year when an old 'permanent' retainer cracked and came loose in my mouth. I had a bit of wire sticking out into my mouth for weeks. I could not remove it myself. The advice was to go to a private orthodontist - potentially several hundred pounds shock

I do think that is pretty basic healthcare. Thankfully, a wonderful orthodontist at my local NHS hospital agreed to see me and removed it for a minimal charge. Staff like that - and I think most clinical staff are like that - are really working in the NHS spirit and I am so grateful.

But it makes me so sad to think that the NHS is being gradually 'privatised' like this - or effectively, as people are told to go private for certain things.

As someone who is lucky enough to have a comfortable income, I would pay higher tax/ NI in a heartbeat to have a more comprehensive or less overstretched service.

RevoltingPeasant Fri 03-May-13 19:34:05

Northern yeah I know I'm not accessing NHS care, that's my point - I can't, really.

And believe me, I grew up in a country with no state healthcare - I know exactly what that's like and that's precisely why I wish the NHS were much better funded and provided stuff which I see as essential healthcare.

I wonder what people would think of sliding charges according to income? Like, good physio/ dental care is available on the NHS but people on a higher tax band pay more than now and people on benefits etc pay nothing?

Revolting -- we have sliding fees in France, where I live. There's universal health care but it's not free for everyone at point of service -- charges are capped, and everyone has some sort of insurance. If you are poor and on full benefits, you get a state insurance and don't pay for anything. We are low-income so we have private insurance and pay 1 euro to see the GP. Wealthy people pay more (up to 22 euro for a GP visit).

Personally I think it's a good idea, as it gets rid of the main problem with the US system (everyone pays a lot) and the UK system (where treatment can be decided based on quotas rather than patient need). French health care is generally rated the best in Europe and we've been really happy with it.

holidaysarenice Fri 03-May-13 20:04:15

Actually speaking as a physio, if you need physio you will get it.

I don't sit behind my desk looking at referrals going hmmm earns more than me...no sorry won't see them!!

You get a referral, get prioritised and then get seen! Priority by condition not income.

ouryve Fri 03-May-13 20:08:14

In the past 2 years, I've had diagnosis by a rheumatologist, physio, including aquatherapy, OT and enough drugs to make me well and truly rattle, along with regular blood tests to make sure they're not doing me more harm than good. All I've had to pay for is the drugs, which come to around a tenner a month for a pre-payment certificate. I've never had to pay for anything else.

I'd call that free at the point of use.

NUFC69 Fri 03-May-13 20:10:39

Revolting - you do realise, I presume, that the more money you earn the more NI you pay? This means that those with the most money already pay more - you obviously want blood (somebody else's). And, please, do stop peddling this myth that the NHS is free, it most certainly isn't. Someone, somewhere is paying for every little treatment, pill, etc., that we are all taking. I am certainly not saying do away with the NHS, but we need to have a proper discussion about what it should be paying for - when it was set up treatment, and therefore costs, were quite basic compared with the marvellous things we can do now.

Wibblypiglikesbananas Fri 03-May-13 20:12:25

I'm temporarily in the US too and I miss the NHS! Yes, it's not perfect but you're not made to wait in a hospital corridor, bleeding and in pain until you pull out your insurance card!

I do see what people are saying about dental charges etc but the fees that exist now are so far below actual service costs, it's ridiculous. Yes, £50 may seem extortionate for a filling, but here it is a minimum $150 and crowns can be up to $5000. Yes, $5000, so just over £3000 - not the £200 cap or whatever exists in the UK at present.

And this isn't to say I'm not sympathetic to the plight of those who cannot afford to pay NHS charges, but there are thousands of Americans who would give anything for the healthcare opportunities we have in the UK.

ouryve Fri 03-May-13 20:18:45

DS1 takes a drug that costs £60 a packet, btw. For a while, when he was in between doses, he had to take tablets a day, meaning that his treatment was costing £120 a month. It costs us nothing, of course. I know people in the US are having to pay the full cost price for this sort of drug.

littlepeas Fri 03-May-13 20:31:40

I pay for my eyes and my teeth and we have BUPA (which we have used once, but very importantly, to jump a ridiculous wait for a diagnostic echocardiogram when my dd had just nearly died from a common cold - we were seen immediately and would have had to have waited weeks otherwise). But then I think about everything I have had for free and it is buttons compared to what we would have had to pay in a country where there is no equivalent to the NHS. Just having my 3 dc would have cost a serious sum I imagine, plus my dd had heart surgery (for which we didn't use our private healthcare), not to mention every GP appointment, prescription, rush to A&E, we've had over the years. Contraception! Free contraception seems like such a little thing, but it undoubtedly makes a huge difference to people.

WilsonFrickett Fri 03-May-13 20:40:01

I agree peas - by the time I add in my contraception and c-section, I don't think I'll ever be able to pay in more than I've taken out.

I do think there's a debate to be had about what we really expect the NHS to be able to pay for though. As pp have said, when it was set up it was not set up for people to have physio to help them continue to walk or cycle (not getting at you op) more comfortably. What is primary healthcare these days? I suspect we all have different ideas on that...

badtime Fri 03-May-13 20:55:05

tomorrow, I think fillings and extractions cost the same these days (they are both band 2, so about £50 for the full course of treatment).

StealthOfficialCrispTester Fri 03-May-13 20:58:49

Don't forget public health. Immunisations. Management of epidemics. Stop smoking and obesity services.

StealthOfficialCrispTester Fri 03-May-13 21:00:24

That said, that has been split and management if epidemic is now within central gov. Provision of the other services are still NHS though, and public healthcare ( not necessarily nhs) is still carried out

RevoltingPeasant Fri 03-May-13 21:18:08

Wilson yes quite. I think you are right about that debate! Myself, I am a big fan of preventative medicine and public health as I think it leads to a happier, healthier population in the long run. This is probably pedantic but I have always thought that if it really is a primary care service then calling it the National Health Service is a misnomer.

I would love to see it better funded and bigger.

NUFC I'm really not sure what you mean by me being out for someone else's blood. As I said very clearly, I would happily pay higher taxes and NI than I do to fund a more comprehensive NHS. There was a thread on here earlier about a woman denied an epidural because of understaffing. I would happily pay more so that isn't the case. Or so that I don't have to wait 18 months for a kidney operation, as I did the other year.

Yes, thanks, I know people pay more NI the more they earn. DH and I would be amongst the higher earners I am thinking of as we have a household income of c. £65k.

This means I am lucky and can almost always afford health care. Not everyone can. I wish this were different.

RevoltingPeasant Fri 03-May-13 21:21:06

And also yes, I appreciate how lucky we are to have any socialised medicine.

I grew up in the US and when my sister nearly died of cancer, my parents' health insurance paid out. Had they not been able to afford it, they would have been in a horrible mess.

However, I have also lived in France and other countries with different forms of socialised medicine and think it's possible to fund the health service better and make it more comprehensive.

Skinnywhippet Fri 03-May-13 21:23:23

Tis makes me think about getting health insurance. People mention bupa....any other recommendations. Do you just buy online?

We have had ours through work. Personal policies are scarily expensive.

RevoltingPeasant Fri 03-May-13 21:31:05

Horry, not only are they expensive, they don't cover much compared to lots of other programmes in other countries.

We had health insurance arranged through my dad's work when I was a kid but I was able to keep it on at my own expense afterwards (I cancelled it when I returned to study). It was about £90 a month but covered everything-everything and they were not shitty about paying out.

I did at one point investigate BUPA policies and they basically send you through the NHS and just do anything 'extra' faster. So you are not that much better off and still taking up NHS resources (if that is a consideration).

Xenia Fri 03-May-13 21:44:35

I cancelled our private healthcare as no one ever seems to be ill. I have been to our GP myself about once in the last 8 years (I realise I am terribly terribly lucky that this is so) and when we have used the NHS it's been really good. Also if I needed to pay the full cost of anything privately if I wanted it done privately I could probably afford it.

I have paid for the odd thing privately for the children but that has cost nothing like the cost of paying for BUPA and some of that cost would be things private insurers do not cover anyway.

I suspect we are very lucky having good NHS dentists around here and our GP is a large group practice in new building with 7 day a week appointments.

Startail Fri 03-May-13 21:53:31

As another person who cannot function at all without my glasses, that's the one that irritates me most. Because of safety driving and spotting glaucoma etc. I think people ought to get a free annual/biannual eye test like children can. DD still costs me money for glasses because she's a awkward fashion conscious madam.

I choose not to hunt high and low for an NHS dentist as ours is nice and good with DCs (who are still free)

tomorowisanotherday Fri 03-May-13 23:07:21

okay, so £150 for three teeth.... Anyone got a pair of rusty pliers????

valiumredhead Fri 03-May-13 23:20:42

OP why won't your GP refer you for a block of physio sessions? The last to GP's I have had have done so.

WilsonFrickett Fri 03-May-13 23:34:16

That's the other thing of course - private insurance just entitles you to use NHS facilities and staff ahead of the queue and is very expensive. There isn't an affordable, comprehensive 'second stream'. For eg, I'm a freelance copywriter. If I get an RSI I don't think I'd get much help from the NHS, which is kinda fair enough - its hardly life threatening. But if it stops me from working...

But if, again, there was that honest debate that said, 'well the NHS is here for this and that, but if you think this is important you can buy some cheap insurance to help you access it', that would be a good thing IMO.

ouryve Fri 03-May-13 23:45:19

tomorrow - it's a one off cost for all of them. Not one cost for each tooth.

MrsLion Sat 04-May-13 09:01:29

Yanbu to point out that some NHS healthcare isn't 'free'. It's not.

But would be V V U for people to whinge about the costs - healthcare in the uk in general, is amazingly affordable.

Weegiemum Sat 04-May-13 09:55:40

I love the NHS (and not only because they pay our mortgage as dh is a GP).

I've had a tonsillectomy, brace on my teeth for 18 months, serious depression involving hospital care, 3 dc, a prolonged time with kidney stones related to pregnancy (involving 4 visits to theatre!), referral to clinical psychology, and now I have a neurological disability which put me in hospital, and I was "tested" just about to my limits - nerve tests (EMG), CT scan, x-rays, ultrasound, MRI scan, PET scan, lip biopsy by the maxfax surgeon, at my admission they took 17 vials of blood, one of which was packed into a flask of hot sand and sent to Germany for testing! I am looked after at one of the worlds best neurological centres, and my ongoing treatment (an IV infusion of immunoglobulins) costs about £10,000 a month.

We'd thought about emigrating. Guess that won't be happening now!

Maryz Sat 04-May-13 10:01:42

At the moment ds's medication is costing us €144 a month.

Yesterday I had to take him to A&E, it cost €100 plus another tenner for painkillers.

I have to take him to the physio next week - it will be €60 euro per session. He probably needs three or four.

And he has to go back to the skin specialist next month. That will be €100 for the consultant and €120 for the blood tests.

I need new glasses, so does dd. All the kids are overdue a dental checkup, I need a root canal treatment and will probably lose the tooth if I don't get it in the next couple of months, and dh needs to go back to the specialist over a hernia problem he has. But those will have to wait for the moment, as we simply don't have the money.

The NHS is bloody good envy

sparkle9 Sat 04-May-13 10:12:11

I think the NHS is a great idea and works pretty well. I would urge you all to watch Keeping Britain Alive on BBC iPlayer. Really good documentary about the NHS.

I do think there needs to be some debate about what the NHS should fund. There seem to be quite a few ''lifestyle" treatments that are fully funded/free while essential dental work (for example) must be paid for by those who earn over quite a low threshold. IMO that is wrong.

HappyMummyOfOne Sat 04-May-13 10:29:14

Overall I think the NHS is great, it does need tweaking in that it pays for some treatments that are choices but its a system I am thankful for.

I'm quite happy to pay for dental and eye care, far better those than paying when you seriously ill and amounts are in the thousands.

I would imagine 95%+ take out of the NHS far more than they ever contribute so paying for a few things isn't too much to expect of people.

ophelia275 Sat 04-May-13 11:10:46

It's not free, that is a myth. It is paid for from the taxes of those in work and those in work then have to go on to pay even more for things like prescriptions and dentistry. If you need things like a crown or bridge, this will cost hundreds of pounds (as I recently found out) so definitely not free.

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