to be gobsmacked by the efficiency of private healthcare?

[grovel]

I have never used private healthcare before and we have no insurance. Over New Year my left knee "went". I could not straighten it. Very painful. DH called a GP friend (not in our area) who told him that real diagnosis could be weeks after initial visit to our GP (referral to consultant, probable referral to MRI unit, back to consultant etc). If surgery was required I might have to wait weeks after diagnosis. In the meantime I would be on crutches and painkillers. I was prepared to suck this up.
DH wanted immediate diagnosis. He called the local private Orthopaedic practice. Appointment next day. Scan immediately after consultation. Diagnosis immediately after scan. Offer of surgery within 6 days. Price for all of this - £4,100 (initial consultation, scan, surgery, anaesthetist, 5 physio sessions, follow-up consultation etc). We have decided to go ahead. We are lucky that we can afford to (just about - Butlins, not Greece this year, I suppose, and no car upgrade).
Now I love the principles of the NHS and will defend them until Kingdom comes but this experience has got me thinking about how it is organised. Why do I have to see my GP to get anything started? Why do consultants have to correspond with GPs? Does it really cost the NHS less than £4,000 (fully-loaded) to treat my condition (cartilege-related)? Could Landsley even be right about a physician-led service?
I may be spouting nonsense because I am so relieved to be getting resolution to my discomfort.

bemy, measures like life expectancy aren't perfect, but they tell you more than personal anecdote. Is your claim that the Dutch system is "vastly superior" to the NHS based on anything more than anecdotes from your relatives?

If the UK spent the same proportion of its GDP on healthcare as the Netherlands, we would be spending an extra £26 billion a year. That would pay for a lot of niceities like better premises but it wouldn't necessarily deliver better health outcomes.

Ormiriam, I'm sure you are right. The NHS is too big and too much of a political football to be joined-up and rational in its processes.

First - I haven't read the thread as I know it will make me frothy.

I was very grateful for my private health cover when I first got sick. After two years, though, it stopped paying out. Most health insurances have a ton of weaselly clauses to limit their liability. My supposedly special insurance for long-term conditions that stop you working paid nothing at all. They have a strictly-defined set of conditions you must meet before becoming elgible and, although I had a long-term illness that stopped me working, I didn't meet all their criteria. BUPA did offer me continued treatment, but at such an extortionate premium I may as well have paid the clinic direct.

While enjoying BUPA-funded treatment, I had a couple of surgical procedures done. One of them - a keyhole oophorectomy - wasn't available on the NHS. I have no complaints at all about any of it, and it was certainly a nicer experience than being in an NHS ward.

The doctors and nurses, however, were quick to point out that all the training and research to enable this level of excellence was provided by the NHS. That's what people forget about. Training & research are the two most expensive aspects of medicine. If we hamstring the service which provides it, medical standards will go down across all sectors. That may not matter much if you're in for a humdrum reason, but it bloody well will if you need surgery to a major organ.

I'd far rather see more funds - and professional management - go into the NHS than still more chopping and poking. I'd like everyone, rich and poor, to get fantastic treatment and reasonable comforts and service from our health service. I was shocked to learn how little private health companies were expected to contribute to the NHS. I imagine it's even less now.

anyone unfortunately I talk from anecdote only as this subject is rather complex and I am not familiar with data, however,
my dh (5x valve replacement patient) had an undiagnosed under the NHS aortic pseudo-aneurysm (fatal condition if not treated in time and that one could have rupted at any point). we were given 3 weeks to wait for an MRI scan "because even cancer patients have to wait". We paid for the one to do privately, he was in surgery several days later (could have been operated immediately, but doctors decided to consult due to high complexity of the condition). Three weeks later he was out of the hospital (private) recovering, when his original appointment was due. Incidentally, our private consultant was also one we could have used through the NHS (in theory).

Had he died waiting for the scan, it would not come up as a NHS system failure because no guidelines were breached. By going privately paying tens of thousands we not only saved dh life, but also saved some money to NHS that pushes the GDP % down for NHS use so cannot be accounted as NHS efficiency.

My dd died at 3 weeks being born 24+1 prem due to undiagnosed incompetent cervix and subsequent strepB infection. Also "one of those things". In Holland I would have been tested and treated appropriately. Now I am a private patient, because even having lost dd, I am not "high risk" for the NHS as I have to loose 2 babies before they start treating me as one. (I had Cervical Suture put in that I paid for privately, so again, paid where NHS should have).

I know that plural of anecdote is not data, but these are my experiences that shape my way of looking at things and do my best for the family.

In the UK private insurers are not regulated to the extend they should. Again, bringing example of Holland (sorry), where insurers are not allowed to discriminate on the basis of sex, age, prev med history and pre-existing conditions are all covered.
The rules that private health providers are playing under should be changed methinks.

bemy I am so sorry to hear about your DD. But, if she had been born in the Netherlands at 24 weeks, she would not have been resuscitated as they have a policy of not resuscitating before 27 weeks' gestation. I'm not meaning to get into a tit-and-tat about your DD - that would be totally inappropriate after such a devastating loss for you. But I'm just making the point that it is very difficult to make generalisations about care based on personal experience.

that is true and there is a good reason for that anyone (I wonder if you also watched the programme on BBC last year)
not that I agree or disagree with that
but my condition was brought in by the lack of appropriate antenatal care that would not happen in holland.

anyway, i appreciate that we cannot make decisions based on anecdote, but i was just pointing out that rather than bringing a failing US system as a comparison to efficiency of the NHS one can look into other systems, which have a reputation for being efficient, whilst still being accessible to all and free at the point of need

YABU to be gobsmacked.

...... qui mal y pense.

You're doomed.

But your experiences of one system doesn't mean that is a great system either. My recent experiences of the nhs are outstanding and couldn't be any better how much I paid, however that doesn't mean I am naive enough to think it is faultless or could stop things happening which happen elsewhere with a decent health system

Grovel I hope they downsized the final bill!

Garlic : re training and research, the new health bill while devolving most of the NHS services out to private companies strategically fails to explain who should train and educate the up and coming staff nor yet maintain the training of those still in post. I'm all a-froth just thinking about that.

bemybe
if private insurers cannot discriminate then how do you prevent moral hazard whereby healthy people avoid insurance knowing that they can get covered if they get ill?

dutch system functions differently to the british though elaine. it is a national system, so everyone gets insured (so the system is compulsory and there is no issue of moral hazard), but the individual premium contribution is based on the income tax bracket afaik, so the lowest earners pay nothing. i have to pay very high premium because i am (well, my dh is) an expat and we do not contribute anything into dutch tax pot, but i am allowed to buy a policy. i have never claimed up until two years ago due to IVF and the pregnancy, which are both covered under the insurance policy as are all medicines; i also started claiming for dental care (up to 500Euro for "routine" and any amount emergency work) because i did not realize that it was covered and i can claim only 3 years back.

Mostlymum - exactly!!! Things just keep getting more and more hare-brained ...

bemybebe - So what you're describing is a more expensive NHS. Which supports my thesis.

only under the nhs ivf is not covered, test and treatment into my pg complications are not covered, prescriptions are not covered and dental and optician work is not covered. ah, and not waiting lists. otherwise it is just like the nhs - universal and free at the point for care.

Does anyone find it hard to believe that any efficient service has NO waiting lists anywhere? Surely a service like that has a hell of a lot of waste?

i do not know sirzy you are right to question it and i am not an expert.
when i am saying "waiting lists" i mean 3 weeks for "urgent" MRIs or 18 weeks for an op to sort out not life-threatening but painful condition.

all i was saying is that not all insurance-based systems are evil or bad for patients and there are examples we can STUDY. not that NHS should be abolished and something else should be built on top of it.

OK I see your point bemybe. I completely agree that you CAN have a good insurance based system or an HMO system or some other system of coverage, I've lived in other countries apart from UK and US which have various systems.
But it's not really a free-market private system in Holland as everyone has to be covered and the insurers HAVE to take everyone. I wonder how they prevent the insurance companies cherry picking and targeting the healthiest people.

I still think the NHS is a pretty good system even though it's a public one, especially when it comes to cost effectiveness and value for money, and the Dutch system isn't successful BECAUSE it's got a private component. You can have a public/private mix or even fully private but it can't really work as a true free market, the only reason they can get away with it in the UK is that you have the NHS there as the back up - they clearly can't behave in the same way in Holland.

"I wonder how they prevent the insurance companies cherry picking and targeting the healthiest people." Elaine I just know that companies cannot refuse cover or discriminate with higher premia. Also, hospitals (and insurers) are not-for-profit run. I never said that free-market is the answer, this is exactly the area where market participants have to be highly regulated, but is the absence of any market is necessarily a good thing?

No, I think a free market can have its place with a lot of regulation so it's not genuinely a free market.

But one of the problems is that the insurance companies in countries with that kind of universal system, because they can't turn people down or charge higher premiums, focus on trying to recruit the healthiest segments of the population and focus services on those groups. In one country I lived in, they had a capitation system so the insurance companies got considerably more money for elderly, chronically ill, recruiting in poor areas etc - but it still wasn't worth their while!

Private healthcare has its faults. Look at the breast implants story. Or my godmother, who paid £10kish for a double knee replacement, which technically went OK, but crap nursing left her with an infection that means she is now permanently disabled. Nuffield couldn't give a toss, and made her pay the full whack - and refused to see her to treat the infection unless she made her own way to the hospital. Which is miles away from her home, the far side of a big city, and she'd had a double knee replacement so couldn't drive... and she's 90, hence needing the knee replacement.

That's the sort of thing I expect to see more often now, Edam :( If you can pay for the private ambulance, full hospital charges and after-care costs, then you'll get your knees, hips and cataracts done as needed. If not, you'll be waiting until the NHS beds aren't all taken by emergencies ... and you might be hobbling around, half blind, for a very long time. Possibly until you're no longer a 'burden' on the economy.

Grim.

Oops, I'm supposed to be de-frothing tonight!

I would just like to say that I think the exchange between ElaineBanes and Bemybebe has been very helpful and probably illuminated the crux of the issue to a great extent.

Essential what is being proposed is for FREE market health care provision to be introduced to run parts of the NHS. This is a far cry from the Dutch system and the notion of an insurance based provision regulated in the way the Dutch do is absolutely not what is on the cards here.