Would you pay to see the doctor?

[justasking111]

The IMF has said that the government will need to raise taxes. One way is NHS charges. This will be means tested I should add. It's being covered in the financial times, telegraph and others but hidden behind a pay wall. I don't know how to archive, if anyone else does please do.

I don't know which one I would choose, it's a thorny problem.

https://www.telegraph.co.uk/business/2025/07/25/raise-taxes-working-people-charge-for-nhs-imf/

I live in France, so I do pay to see the doctor. In reality when I pay to see the GP, about 70% is later refunded by social security and the remaining 30% is refunded by my health insurance, which I pay 60€ per month for.

I don't usually get everything refunded if I see a specialist for something non critical, such as a private dermatologist for a minor skin complaint.

I found it weird at first but I can't deny that the healthcare system is much better here.

Yes some jobs pay for private healthcare - but on the scale of the amount of jobs (very little), lots of jobs (retail, cleaning, driving, hospital porter,shop workers, construction) will never offer that, and even jobs like social work, speech therapist, teachers, prison officers, probabtion officers. Deprived groups are more likely to work jobs which don't offer that because they have worse education outcomes, more likely to be in care and more. They're aren't actually that many jobs that do that (so if yours does it's likely in a corporate field) which on average earns better. So many deprived families who are houseless and forced to share 1 room for the whole family. They could never even think about having the ability to save for private treatment. To have the ability to make a CHOICE (even begrudgingly) means you are more privileged than those who have NO MEANS to even think about making that choice.

Except we don't pay for clean water - water bills are this year have risen by 26% and sewage dumping is up. Lots of peoplr actually can't afford to pay their water bill and have bailiffs turn up. Some people aren't doing regular washing, or washing their clothes because of the price, more and more teachers are washing children's clothes for them (some schools have bought washing machines). Then there's housing, landlords have continue to do no fault evictions (soon to be banned finally in the Renters Rights Bill), more and more people are unable to pay rent and going to shelters or becoming homeless than ever before. 131,140 households lived in temporary accommodation in England - a 12% increase from the year earlier - which is a new record high. Those households included 169,050 children - also up by 12% from the year earlier. Rough sleeping I'm England rose to 4,,667 people on a single night- a 20% increase from 2023 and 91% higher than in 2021. As for food - use of food banks is also higher than ever before. 15% of UK adults (8 million adults and 3 million children) experienced food insecurity on 2024, which look to rise in 2025.4.45 million children were living in relative poverty after housing costs - an increase of 100,000 children (31% of all children). Absolute low income households rose by 300,000, reaching 25% of children which is largest increase since 1981. Working families with children in poverty have increased by 44% (900,000) between 2010 and 2023, now accounting for about 3 million children in poverty in working households alone. So yes some of the essential things people need to live, food and housing and water aren't free and yet it doesn't mean there aren't devastating effects of that.

As many other posters have said, it’s not a case of the NHS or a US style system. I can access a lot of healthcare for free in Australia if I want to. There are GP’s who don’t charge the patient anything, if I’m referred to a specialist I can generally ask for one in the public system, blood tests are free, A&E is free, many scans and tests can be free if you meet the criteria.

I was referred to a neurologist earlier this year, opted for private and was seen within a couple of weeks, I was out of pocket around $300. My ongoing treatment costs $550 a month but as I meet the criteria, I pay $30, the rest is funded. I could have waited for a public appointment and saved the $300, the wait was around 6 to 9 months.

Oh silly me, I forgot that there are only two countries in the world - the UK and the US.

Incidentally, I have friends who live in the US, they all seem to manage to get healthcare without having to work three jobs, and the healthcare they get seems pretty good.

Um, I live in one of those countries, I think I know a bit more about it than you do. Horrendous levels of preventable deaths????

Are you sure you're not posting from the grave right now?

I mean overall if you count the amount of preventable deaths across many countries because of the lack of acess to healthcare then yes it's horrendous. The OCED's Health at Glance Report for 2023 found that there were nearly 3 million premature deaths among people under 75 in in 26 OCED countries which could have been avoided. This is about 1 in 3 deaths split roughly into 2.1 million preventable (public health failures) and 1 million treatable (healthcare acess failures).

In the U.S preventable (public health failures) is 336 per 100,000 and 98 per treatable illnesses (healthcare access failures). In the U.S, lack of health insurance has been associated with about 45,000 avoidable deaths per year one of the highest. The average preventable mortality across OECD countries was 158 per 100,000. It is 144 per 100,000 in Australia, in Canada its 171 per 100,000. South Korea avoidable mortality is 142 per 100k below OCED average and tratable mortality is 62 per 100k. The EU average is 122 per 100k of preventable deaths. The UK had an estimated 83 per 100,000k treatable deaths.

The lowest income quintile across OECD countries report worse self-rated health and access fewer preventive services (e.g cervical cancer screening 17 percentage points lower than richer peers), and have higher unmet medical needs due to cost which is around 26% report unmet need vs 8% among top-income groups. OCED countries: Europe (27 members inc Belgium, France, Germany), Americas (4 members inc Canada and America), Asia–Pacific (6 members inc Australia, Japan, South Korea, NZ.

Who’s we? People making appointments to see, was going to say their own GP, but when in reality if someone makes an appointment they will see a locum doctor they don’t actually have their own GP.
I don’t have a GP, it’s just whoever’s there on the day, of that appointment, where they don’t know anything about you, there’s no continuity, so it’s hardly a place to just go in for a chat.
Your comment is laughable, many can’t get appointments, let alone, have regular appointments because it’s 'free’ for no real reason.

The UK has a higher avoidable mortality rate than many countries that have a health care system with co payments, and is only just below the oecd average so looks like free at point of use isn't helping much.

The Paramedics, assess the patient, it’s their call who they take to hospital, if it’s essential.They don’t just take people in an ambulance for no good reason.

I mean it's actually pretty low overall in comparison. Obviously you have to account for other deprivation, if more people lack acess to housing, more drug use etc then likely to have more deaths generalising but yes. Also I don't necessarily think we shouldn't reform the NHS but I think we need to be very careful about how we do so. Countries like Australia particularly in rural areas and children do struggle with acess to healthcare. However I still think a majority state system would be much better (which yes some EU countries do have) - 95% of France are covered by the public scheme and refunds for payment is not a completely bad idea as long as its administred well - I'd have a minimum income to enact it. Though it doesn't mean it couldn't be adapted to 'free at the point of use' - I wouldn't have it linked to employment. Instead I'd have a' dedicated contribution' not from employers and employees but from progressive tax. Germany still heavily regulates insurance companies because they have to accept people and caps the amount of procedures which I'd think we must also do. I'd also like to point out that Germany and France spend more per capita on healthcare infrastructure, staffing (doctors are paid more), and beds. And for all the talk on admin fees and managers in the NHS we spend less on admin/managers than Germany. The NHS spends around 2-3% of its budget while Germant spend 5-6% because it has to regulate insurance, and the competition between them and billing. However I don't think the idea of just a basic £20 would a. Be enough anyways (considering GP's get £110 per appointment) so the state would still pay around £90 and then have to administer the £20 charge and b. Would make that much of a difference to the wait lists etc. I also wouldn't charge for emergency care and hospital fees would be majority the dedicated state fund (you could incentive companies to add to it, conditions of infrastructure and energy building in the UK).

Also you can't completely compare to the EU because 1. The bloc has cross‑border healthcare directives exist (e.g. the EU Cross‑Border Healthcare Directive lets citizens seek planned treatment in another EU country and be reimbursed) and 2. EU mutual support mechanisms (like the European Health Insurance Card supports joint procurement of vaccines, and shared research initiatives) reduce costs for member states and 3. They have more state protection for other things which reduced deprivation and thus preventable deaths:

France: 1. Universal payments for all families with at least two children under 20. Higher rates for larger families and low‑income household - OECD estimates show child poverty rates would be around 25% without transfers, but fall to about 13% after them. Housing Support Means‑tested support with rent or mortgage costs for over 6 million households receive this. It covers students, low‑income workers + the unemployed. Roughly 17–18% of housing stock is social housing, and 20-25% of towns have to have social housing. A guaranteed minimum income for adults with low or no income, including a top‑up for single parents which reduces extreme deprivation.

Germany: Child Benefit - paid to all parents regardless of income (€250 per child per month). Reformed welfare system guaranteeing a basic income for unemployed or very low‑income households. It now includes housing allowances, integration support). A means‑tested housing allowance subsidy for low income tenants which around 1.5 million-2 million get. Rent caps in some cities. France’s child poverty rate after transfers is 13-14%. Germany’s is 11-12%. The UK’s is around 18-20% (post‑benefits)

My friend, Lorna set up a free clinic in Phoenixville PA because of the sheer numbers of people with no insurance, despite working. You are in the fortunate position of not needing that. There are people in the UK who would be similarly disadvantaged. People on zero hours contracts, those on low wages. We don't remember pre-NHS days when doctors were only consulted as a last resort. That's why the Labour government of 1945 established the NHS.

In France anyone who is employed has to have mandatory health insurance through their employer. Anyone who is too poor to pay for their own health insurance gets top up insurance paid for by the government.

I suppose it depends on the country. The problem is that no-one trusts that the government wouldn't just go straight for the American style scheme to line their pockets really fast at the expense of the UK population, especially as they haven't done anything long term for the benefit of the UK or that doesn't make them richer.

My point being that we can always manipulate stats to say what we want. We could chbage our healthcare system to France and Germany but we cannot do that in isolation. If we want to model France and Germany's healthcare system let's also implement the reforms they have in housing and child benefit, and minimum income I listed below on (because those measures obviously have a major impact on deprivation - which impacts health outcomes and on poverty etc. If we simply just copy the healthcare system without the other measures which reduce poverty, give reliable housing access we won't get the same result because we'll likely increase preventable deaths because we aren't providing a widespread safety net.

France: 1. Universal payments for all families with at least two children under 20. Higher rates for larger families and low‑income household - OECD estimates show child poverty rates would be around 25% without transfers, but fall to about 13% after them. Housing Support Means‑tested support with rent or mortgage costs for over 6 million households receive this. It covers students, low‑income workers + the unemployed. Roughly 17–18% of housing stock is social housing, and 20-25% of towns have to have social housing. A guaranteed minimum income for adults with low or no income, including a top‑up for single parents which reduces extreme deprivation.

Germany: Child Benefit - paid to all parents regardless of income (€250 per child per month). Reformed welfare system guaranteeing a basic income for unemployed or very low‑income households. It now includes housing allowances, integration support). A means‑tested housing allowance subsidy for low income tenants which around 1.5 million-2 million get. Rent caps in some cities. France’s child poverty rate after transfers is 13-14%. Germany’s is 11-12%. The UK’s is around 18-20% (post‑benefits)

The reason I disagree with a simple charge is because France and Germant have a much more complex welfare system. I also highly doubt that those in politics (generalising) we spread the idea of a transition to a system like France and Germany are actually simply suggesting that we should privatise and will actually have a system like the U.S but want to pretend that they'd never let that happen, when they're so backed by business and would want insurance companies to do the same in the U.S which is deny so many procedures for no reason (I'd look at Dr Potter's content on Instagram and Tiktok to see how bad it is). I think this because if were to say let's move to a France/Germany system but with the other reforms they also have that I've listed above, they'd shy away and say it was rewarding laziness, and economically impossible, despite also wanting people to have more children. I highly doubt they'd implement the same level of regulation on insurance and ensuring they accept everyone that Germany has, instead I think they'd slowly but surely make healthcare a lottery.

The UK ought to improve its welfare system too, that's for sure, and I agree that things like preventable deaths aren't down to healthcare alone. Basically the UK needs to up its game in a lot of areas! (As do other countries, nowhere has it just right)

But the point is that adding co pays doesn't mean increasing preventable deaths.

Lots of people can't pay the dentists fees so just have a tooth pulled. With vets it's normal now to pay upfront then claim back the cost after excess from insurance so people are giving up their pets....so what shall we do if we can't afford treatment? Be like in America and go without.

I'm saying if we did it without reforms it's likely (not 100%) you'd have to do proper mapping but that I think it would be foolish to simply change the healthcare system and nothing else. I mean Germany's child benefit is €250 per child per month, so for 2 kids that's around €6000 per year. That likely helps people take their children to the dentist and afford primary care for their children. France and Germany have a minimum income - which if you don't reach, they help you reach. That likely helps with homeless and getting better food, playing more sports. So I'm saying if we just implemented their healthxare system with little else, it's likely that we may see an increase in preventable deaths. I mean we aren't even willing to get rid of the two child benefit cap - let alone in France where you get more for having a larger family. So these measures also stop deaths, and improve healthy living.

Let's look at the impact of charging for densitry. Wes Streeting said a couple weeks ago that the number 1 reason for kids admissions now to Alder Hay Hospital is tooth infections and tooth issues because these kids aren't seeing dentists as their parents cannot afford it - rather than spending time on complex care. So there we see the impact of charging for densitry because now it's likely costing us much more to pay for those children who go to hospital for tooth issues rather than the regular check ups at the dentist. 49,112 hospital admissions for tooth extractions in children - 62% are for tooth decay. Making it the number 1 reason for hospital admissions among children aged 5-9 . Decay related tooth extractions have risen on average by 17%. Decay-related extraction rates for children in the most deprived areas were nearly 3.5x higher than those in the least deprifed areas (381 per 100k v 109 per 100k). NHS cost for all tooth extractions in children aged 0–19 was estimated at £74.8 million.

We already pay the NHS costs the public £188 BILLION in 2023-2024. It’s not free. That is all the people who are tax payers - pay it.

Yes I would pay to see GP or secondary care, ambulances etc. I suppose it;s an easy yes because I use them so rarely, though. A cap on the annual costs is one way to help people who have chronic illness.

with dentists and vets is you tend to visit and get a diagnosis, treatment plan at the first visit.

That is SOOOooo not my only experience... often the vet or dentist (stopped having NHS dentist 20 yrs ago) try a few things or never get to a great resolution. Lots of money paid for no improvement or treatment gets very delayed because the dentist who devised the treatment plan literally leaves the practice... I've had those experiences a few times for my teeth or the cats.

in Ireland unless you have the medical card or GPS card (both have to meet certain criteria in order to get) you have to pay at least 50e to see a doctor. if have health insurance you can claim it back and you can claim 20 percent of it on your tax at end of year. only in recent years that children under age of 6 or 7 are now free aswell. before you had ti pay. we have gp issues too. appointment takes at least 6 to 8 weeks where I am. if you have to pay you don't go as often to the doctors

When my son worked for an international company that the French bought a slice of everything changed. Salaries, private health care, working hours, shift lengths. Was great at first, sadly it broke the company financially.

The whole point is that there are NO NHS appointments. I had a serious chest infection and over the space of three weeks just couldn’t get an appointment at my local clinic. My chest got so bad I couldn’t breathe properly and it was painful to move. I had to resort to paying to see a private GP.
The NHS is broken which is sad, but when you need to see someone quickly sometimes you have to pay