To think a privatised health service would be an improvement?

[WhiteStars]

At the moment we all have to be grateful for the overstretched and often inefficient service we receive. I had a 9am appointment today with a nurse practitioner. At that time in the morning she was already running 25 mins late on her appointments- how?!

She also couldn't use her computer system so I had to then wait for a doctor to come and issue the standard repeat prescription (I couldn't get this over the phone as needed a blood pressure check). The doctor then issued the wrong medication and only corrected it when I noticed she had done the wrong thing on the screen.

All very minor but not a great service at all really. We all know how over stretched the service is and everyone says it's at breaking point. Why is everyone so against paying for health insurance and getting a better service or going private?

It's not uncommon to hear of people waiting weeks to get an appointment and not being able to book in advance. The government would save an inordinate amount of money that could be ploughed into schools whilst subsidising some health services but with people paying an annual health insurance fee. We already pay for prescriptions in England. I would rather have a better private service than the NHS as it is now- on it's last legs and not really fit for purpose any more. AIBU?

I currently live in Belgium which has a combination of state and insurance via a system of Mutuelles. It seems to work very well. I have to see a Haematologist every six months, and the last bill has just come in for the blood test,seeing the junior doc, and her asking the consultant a question......I was in the hospital for about 90 minutes, and it was €100. We have private health insurance via Dh's employer, and this will be fully covered as they cover my pre existing condition. The bill is less than it costs me for a colour, cut, wash and blow dry. There are evidently ways to keep health costs down.

I think Belgians pay the premiums for the Mutuelles via their social security contributions from their gross salaries, and can choose to top that up. They get back about 75-80% of the cost of the medical treatment, so on my €100 bill, they would get €75 back. There is also provision for those who can't afford this, are on benefits etc.

The system is efficient, you register centrally for out and in patient appointments when you arrive, and hand over your ID card, and show how you will be paying. About six weeks after your appointment, your bill arrives. At one hospital I attend, you present your car parking ticket when you book in, and they validate the ticket, so that you don't pay more than €4 whatever the length of your visit. In the same hospital, you can have a beer in the cafe!

You also pay €25 for a GP appointment, again you get 75% back, and when I saw mine in November, I was able to arrange appointments at an external clinic to see a cardiologist within a week, and a gastroenterologist in one of the local hospitals within a month, who then arranged a CT scan, and I see her for results next week.

You are billed if you miss the appointments.

My GP works in a practice of three. I book my appointments online and get an email reminding me to go for free, or a text,which you pay for. There are no receptionists, practice nurses etc, the docs do everything from blood tests to smears, and I get my blood results in 24 hours, as opposed to 10 days via the NHS.

I know Belgium is a lot smaller than the UK, but I don't think there is any harm in looking at how other countries manage their health care provision, from funding to procurement, and delivery, and cherry picking the best bits and seeing what would work for us, and being able to discuss it, without being accused of attacking the NHS. If there aren't changes, it won't be able to deliver consistently excellent healthcare countrywide.

YANBU

It is not a binary choice between a residence based, non contributory NHS and a private US style system which excludes many.

Many European countries operate a compulsory insurance based system. Everyone is insured. Contributions are means tested and the individual pays half and the employer the other half. Anyone who is not working and is without private means gets their fees paid through the social security system. Rich pensioners continue to pay more than low paid workers. If you do not have insurance - and the card that goes with it - you do not get non emergency treatment.

These insurance based systems deter health tourism and deter those with chronic health problems who despite never having worked in UK immigrate or return in later life in order to take advantage of the free NHS. Think wealthy pensioners who have spent their whole lives working abroad.

The problem with NHS funding is that it was designed for a 1950s society where there was relatively little international mobility. It is no longer fit for purpose. The residence based model means that those who have paid into the system are funding an increasing number of people who have never contributed anything. This means lower standards for those who have funded the system and makes absolutely no sense.

If the Health Service were to privatise there would still only be the same no.of nurses and doctors so the only capacity would be adequate would be pricing people out of the Market.Remove people on lower incomes which would include the elderly and those who can afford healthcare will get a better service.Hope this never happens.

I've never understood why these discussions always become a US healthsystem vs the NHS. Other countries in the European Union operate insurance based systems which combine a mixture of public and private healthcare provision and they have successful health outcomes. I'm not sure whether the current NHS structure will continue to be sustainable given the demographic situation combined with the Government and a large number of the population wanting to reduce the levels of immigration.

Mm.

What's actually happening is that a rapidly increasing number of elderly people - the sector with the highest healthcare needs - is being funded by working age people who are contributing even though they may not themselves be permanent UK residents and may not themselves get the benefit of old age care.

Meanwhile, non-working European immigrants are already required to have private health insurance:
EU regulations require that EU citizens who are non-workers resident in another member state for more than three months must be covered by their own insurance. For workers there are reciprocal arrangements in place.

And although UK citizens who have worked abroad can use the NHS if they come back for permanent settlement, UK citizens who are not normally resident in the UK do actually have to pay at point of use or via some tax arrangement to be entitled to use the NHS (friend living abroad is taxed in UK for this reason).

I don't know what number of wealthy UK citizens who have worked all their lives abroad, not paid tax in the UK, and intend to retire to the UK and use the NHS rather than private health insurance, you are contemplating. But I find it hard to imagine it outweighing the number of UK citizens who retire to spend their non-working years in warmer climes like Spain.

I'm not sure whether the current NHS structure will continue to be sustainable given the demographic situation

How will privatisation solve the demographic situation?

What do you actually MEAN?

So for example, you could mean:

"I think we should withdraw some healthcare from some of the UK population.

"It will politically easier to do this by introducing pay-per-use and then blaming individual patients for not paying. It will also be politically easier if we introduce a new tier of bureaucracy in the form of insurance companies, to act as a cut-out between government and patients, so patients and insurance companies blame each other for lack of care on an individual basis, rather than looking at the big picture and voting out the government which decided to withdraw care.

"The people most likely to have some care withdrawn by this mechanism are the poor, the seriously or chronically ill, and the elderly."

That's just one example of a meaning.

I'd be interested in seeing more meanings from people who repeat the meme of "current NHS structure is unsuitable." Especially when they add, "therefore privatisation (partial or whole) is good."

Want2be - other European countries (and indeed Australasian countries) DO use forceps - not sure where your opinion that they don't comes from?! The highest risks of all come from double instrumentation (e.g. Failed ventouse proceeding to forceps or LSCS) and whilst forceps carry a higher risk of maternal perineal injury, the risks to the baby are actually higher with ventouse (have a look at the meta-analyses referenced in the RCOG instrumental delivery guidance if you're interested). Additionally forceps are sometimes required at section to facilitate delivery of a high head.

UK obstetric care isn't perfect (and more continuity of care within the service would definitely be good), but criticising it's use of a range of delivery techniques without full information is unfair (you and anyone else are of course free to decline any intervention you want - personally I prefer to deliver in a country where a full range of options are available!)

UK citizens who are not normally resident in the UK do have to pay at point-of-use

Perhaps they are supposed to but I've never been asked to pay. I've had to use the NHS several times while on holiday in the UK and they always tell me to just put down my parents' surgery as if its mine. I have to insist on giving my relevant information that my own health service can be billed for my NHS use but whether they actually bother to follow up on that and bill them I am unsure of as they really weren't keen on even getting the information.

I have never known it either.

My sister in law plus family come back twice a year for medical and dental appointments. She has been abroad since 1997. I know a few expats who are retired too and they will come back if they need major treatment.

That's cheeky of them, I only use the NHS if an emergency when over and once when DD's ear infection came back.

." I know a few expats who are retired too and they will come back if they need major treatment."

Me too, of course they aren't allowed to, and this is one of the biggest costs of "health tourism".

White people = expats

Brown people = immigrants

I see what you mean Talking Peace,
but to be pedantic expats are emmigrants, not immingrants,from the point of someone in the UK.
But yes, expats are heath tourists.

Chardonnay
The UK pays out millions and millions of pounds a year to the Spanish government to cover A&E fees for fuckwit UK holiday makers
and then the Daily Fail froths up over a few people coming to the UK for planned ante natal care

All over the world,
White people are expats
Brown people are economic migrants

The Middle East - why are the Europeans there - is to imbibe the culture or to cash in
Hong Kong & China - why are the Europeans there - is to imbibe the culture or to cash in
South America - - why are the Europeans there - is to imbibe the culture or to cash in

and yet when any of them come to Europe they are scavengers ......

Oh, unless they are Medics that its cheaper for the NHS to nick from overseas than train in house

Expats = People who are planning on living somewhere long-term but returning to their country of origin eventually.

Emigrant/ Immigrant= changing country permanently.

Gerda
So transient immigrants are OK?

The ones who make no effort to learn the language
the ones who do not eat the local food
who do not respect local customs
as they might bugger off at a later date
that is OK?

really ?
think it through .................

No, I was just correcting the idea that all expats are white and immigrants are brown.

"The ones who make no effort to learn the language
the ones who do not eat the local food
who do not respect local customs
as they might bugger off at a later date
that is OK?"

Like a huge number of the British immigrants in Spain and France you mean?

do, please,
name me the "expat" community that is not white
source and destination ....

www.theguardian.com/global-development-professionals-network/2015/mar/13/white-people-expats-immigrants-migration

Posted too soon. Correct me if I'm wrong but this is the point Talkin is making.

Formerly - Yup, I've been making it on here and elsewhere for a year or two ... the Grauniad are like the Fail in using this place to pick up stories

amuses me that some people claim the "private sector" is so efficient when I spend far too much of my time trying to sort out private sector inefficiences. I suppose there are some well run private sector concerns but of hand I can only think of ones that are very expensive., including the first few days of this year.

The private sector is supposed to be more efficient because of the belief that the inefficient go out of business - but there are plenty of very inefficient businesses around that survive because the cost of other businesses entering the market is too high. Same thing will happen with health care if it is privatised.

There seemed to be some wierd comparison of health systems posted up thread that was based on nothing worth looking at. International comparisons are very difficult but always need to be considered against the background that we want a rolls royce and pay for a mini www.kingsfund.org.uk/blog/2016/01/how-does-nhs-spending-compare-health-spending-internationally.