NHS should be a co-pay system.

This is just bollocks, if there were easy efficiency wins they would have been taken - the NHS has been under 'efficiency' reform literally my whole adult life.

The people running it are not stupid or ill-intentioned, there are no easy 'common sense' solutions to large and complex problems

The reason why systems like the French are so much better is because they spend about 2% more GDP on them every single year.

It's money pure and simple

most of all we need to stop persistent hospital visitors, who go to the GP and A&E all the flipping time
this!! Especially like on here… with
the advice to lie to 111, 999 etc to get seen quickly

We don’t need more money. We need better efficiency, we need to cut wastage, generous sick pay for staff who are off sick all the time, we need to cut all those management jobs and let medical staff run the hospitals, and most of all we need to stop persistent hospital visitors, who go to the GP and A&E all the flipping time.

Yes that is exactly what I am saying. It’s no better in many other countries.

You paint a gloomy picture which isn't the case. The NHS is a beacon of how good healthcare can be, it's affordable and it needs to be funded correctly.

NHS Dentistry was designed around co pay and it's been a utter disaster. Most people are now private paying the highest fees in Western Europe....

Could anyone really contribute to heart surgery or cancer treatment considering the costs involved. I'm France most people are exempt because they don't earn enough.

So let me put it this way, the wealthiest people paying the majority of tax....so we are saying these people who already pay huge amounts into the system should part fund their healthcare.

Free Healthcare is a civil liberty and should be enshrined in law

Trouble is, you can be accused of missing appointments that you didn't miss.
A few years ago I was booked in for a scan on Saturday morning. On the day I woke up with D&V. No one was going to be doing an internal scan! I phoned the clinic, the office isn't open on a Saturday so no way to cancel.

More recently i needed to see the GP for MH reasons. Booked an appointment for 2 weeks later. Managed to get an emergency on the day appointment a couple of days later so asked to cancel the later one. They told me they had. Then I got a snotty text berating me for the fall of the NHS. OK thats hyperbole, but being told off for missing an appointment I'd cancelled, along with stats about how much that costs the NHS was a little unfair.

I previously lived in a country that had a co-pay system. It seemed to work really well and the standard of care that I experienced was brilliant. I was young and healthy, and the costs that I needed to contribute didn't seem excessive at all.

But then I got talking to a colleague who told me that she had decided to have only one child because her first baby had needed to be in the neonatal unit and she just couldn't afford the risk of another bill like that.

And then I spoke to another friend whose family had ended up bankrupt because of her mother's cancer treatment.

And I concluded that it wasn't such a great system after all.

The way it works in my country is that you pay a co-pay per doctor visit or per night of hospital stay but the amount you pay is capped (around 600 and something euros a year), once you reach the cap you no longer pay and get the services for free. Certain things are entirely free like maternity clinic (but if you need appointments in the hospital you have to pay, and you pay for the birth depending how many nights you stay - no one gets sent home the same day as giving birth), child health clinic and school health services. People poor enough to be on the last resort benefit (income support) get their health bills and prescriptions paid. Working people usually get occupational health care which at the minimum provides regular check ups for free as well as treatment for accidents and illness at workand good employers have healthcare plans that include specialists, surgery and whatnot. Mine is basic but does include physiotherapy (which i am currently making use of). This takes some of the pressure off the public system.

How will OAPs pay out of their 1K a month. Given that, health insurance for a 70-year-old with health conditions would probably be 1K a month.

Agree
It’s badly managed with no accountability from those at the top management and in charge of budgets.
Huge wastage and then claim they can’t afford proper staffing.

I don't necessarily disagree in principle with contributing to healthcare or going over to some kind of health insurance system. My worry around it though is how "frequent flyers" like myself with chronic conditions will be accommodated. As things stand, I would be very likely to get insurance, or if I did it would be prohibitively expensive and most of what happens to me would likely be linked back to "underlying conditions" and would therefore not be covered. There would have to be some kind of government-backed system to take care of people like me, otherwise treatment would be missed and, as others have said, problems would get harder and more expensive to treat.

It all needs long-term and cross-party consensus and planning, but I despair of that ever happening. Until then I support the NHS all the way and am incredibly grateful to have it, imperfect though it may be.

This. The NHS isn't struggling because of a lack of funding. It is struggling because of a massive increase in demand for healthcare. Demand it is struggling to deliver because of lack of investment over the past 20 years or so.

You could throw billions at the NHS tomorrow but you won't solve the problem because you cannot instantly recruit the thousands of trained people needeed to deliver the healthcare.

Making people pay for treatment will only solve the problem if it means less people get treated because they cannot afford it.

If they introduce a paying system it needs to be applicable to everyone no exclusions. If everyone contributes the cost can at least be kept down.

so absent PPs description of "co-pay in Germany" i am going to call bullshit.

We do have prescription charges, and unfortunately dentistry has gone the same way as the UK. But aside of the EUR 10 per night hospital stay, there is no co-pay.

We have a system of health insurance, which is mandatory but you can choose which one to join. Employee and Employer pay the contributions to that (around 14% gross salary). You can have private insurance if you earn enough, where you either pay up front and are reimbursed, or you agree the fees in advance.

Several years ago they introduced a system of payment of EUR 10 per quarter, the first time you went to a doctor (and then got a receipt so you didn't have to pay again if you went to a different one) - exceptions were OB/GYN IIRC - and that was too costly and onerous in the admin, and lead to people not going to the doctor for some things which they should have gone for. So it was scrapped pretty quickly.

The Australian system is good I am told. A certain level for poor people but people who are well off are expected to go private. The Government controls the insurance companies and makes sure the health policies are affordable.
Anyone able to describe how it all works there?

Absolutely yes. To raise money but also to reduce pressure on the system due to time wasters and no shows.

we should also be able to pay the nhs for different standards of care - premium appointment slots, private rooms, enhanced physio, longer appointments, etc. we effectively have a two tier system in place already and private healthcare is booming as the nhs declines. I would much rather pay my local gp for some of this (with funds going back into the local practice) rather than having to drive 45 minutes to the nearest city with a private gp

You could presumably achieve this without taking us all along with you @PeonyPatch ? Just put some money aside each month for private healthcare and use it for anything you don’t want to use the nhs for. Call it “co pay” and live happily ever after.

https://www.chroniclelive.co.uk/news/north-east-news/four-women-share-horror-stories-32973828

define co-pay.
And tell me how it works in Germany?

The thing is, the NHS now is focused on running more cheaper to save costs etc. if much of it becomes privatised it becomes about making a profit, not about balancing the books.
a big problem is all the IT infrastructure and how shite it is, shortage of staff. More money isn’t going to be invested in those things unless it makes a colossal amount of money in profits, which it won’t do under a co pay system, so I’m not sure what the answer is!

It would hurt people like me, my prepayment certificate is over £10 a month as it is, the dentist and optician I have to save up for, I earn £1400 which is too much for any help, I have savings (from divorce settlement) which means I’ll never get help which is fine but I can’t afford £20 for the dr - I’ve been 3 times already this year because I’ve got some health issues. My friends in France say their system is terrible btw as does my Australian relative

Yes, everything is a mess.

I think we definitely need to start paying for our healthcare. The current system is unsustainable.

I work in the NHS and there are so many people who take the piss by not turning up for their appointments and either don’t let us know or let us know like 5 minutes before their appointment was due to take place so we can’t book anyone else in for that slot. The waiting list is so long for the service I work in so it’s really annoying when people waste our time. I doubt they’d do that if they had to pay for the appointments.

However, I don’t think it is achievable due to high housing costs. I earn above national average salary but because half of my take home pay goes on rent, there’s no way I would be able to pay for healthcare costs. I can’t even afford a check up at the private dentist (no NHS dentist), never mind any dental treatment!

There are a lot of us working in professional jobs who are struggling financially - this would have been unheard of in the not too distant past. Someone in my job would have had a pretty good standard of living, own their own modest home with enough disposable income to afford a holiday each year and other luxuries.

Fine to co-pay, end final salary pensions, cooperatives boards for repair and maintenance to ensure that expenses are being waved through.

I can see some possibility that a small charge for GP appointments might stop some time wasters. But I think the additional cost of administrating a co pay system and chasing up non payers etc would off set some of the revenue