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 love the NHS but I agree there are better systems (European, Canadian, for example). And much worse ones (US). But they will cost us a lot more and they are socialist. We have a government and right wing press who promote the US alternative while running the NHS into the ground as they are anti socialist and politicians personally benefit from sucking up to the profit makers.

YAB ridiculous to base the decision that the NHS is rubbish on a basic GP appointment. Also you could pay for a private GP service if you want to. HTH.

One of the things that comes up regularly on these threads is people don't quite understand the word "efficient".

They think it means "quick for the customer". It doesn't.

An efficient system is one which maximises output per input.

From a health service's point of view, having patients sitting round waiting for a doctor, whose time is 100% utilised, is efficient. Having the doctor sitting round twiddling their thumbs in case a patient wanders in is highly inefficient for the health service - though quick for the patient.

So it's a blunt choice as to where to set the bar.

Resource a health service so it's usually working at (say) 80% capacity and can absorb spikes in demand or staff stuck in traffic without patients noticing very much.

Or give it fewer resources, so it's working at closer to 100% capacity and therefore every bump and wrinkle immediately causes delays and cancellations for patients.

Or you know, give it so many resources that usual demand only reaches 50% of capacity, and then we can wander in off the street and see someone who's just sitting around. (My optician does this - and sets his prices to cover all that non-earning time.)

Yes re the consultant being on the ward. Also the nurse in the OP may have been called to a home visit or may have had a complicated patient or any manner of things.

I shudder at the thought of where the NHS might end up (quite possibly in some corner of history, sadly) because this government are insidiously weaving a script of brokenness in order to sign it all over to their buddies in Atos and Captia and other such companies so well known for their humanity and compassion.

I fear that it'll end up more like the US system than the more equitable (but still expensive) system in somewhere like Germany.

I watched a friend in the US with the same chronic lung condition as I have die because her insurance wouldn't cover life saving antibiotics for a chest infection. The system there is evil.

Still, it'd mean that the weaker members of the society got bumped off sooner, I guess. Brave new world, people?

it would be a huge amount of money, if people on 200,000 say they are struggling ( or jams or whatever the short version is) how could people on NMW also then have to pay for health care too? Insurance would be happy to take on a healthy working 20 year old with no issues, but an older person with lots of problems and medication? forget it.
I can see it coming in, but in stages ( we pay for our teeth and meds) so we would then be charged , say a tenner for any A and E visit, then pay to see the doctor ( as they did pre NHS) and it would just happen gradually like this. Lessons the pain and becomes totally private 30 years down the line when the new generation don't know any different.

As someone else with experience of the UK and US systems, YABVU. DH had surgery when we lived in the US - he never saw any doctor at the given appointment time as they were always running late, we paid silly amounts of money on top of our premiums and they still managed to cock some of it up so he had to spend an extra week in hospital. The US private system is one of the most expensive in the world yet is one of the least efficient with poorer outcomes compared to other countries in the developed world. And if you need to see a specialist in an 'unprofitable' area, you still have to wait months for an appointment - my friend waited over a year to see an autism specialist and still had to pay a fortune for the privilege as their insurance didn't cover it.

The basic business model of an insurance company is to take in more in premiums than it has to pay out for claims.
I have lived in a couple of different countries with privatised health care and it was a nightmare. As a healthy person, you can basically expect your coverage to have been used up by June/July. If you need any actual medical treatment or your kid needs a hospital admission, your coverage is probably used up by March or April. That means you pay out hefty premiums for the rest of the year and pay for all your medical treatment. And the premiums go up loads every year, way abive the cost of inflation.
This, by the way, is the scenario for those who can afford health insurance. If you can't afford it, you are absolutely shafted and an accident or illness can ruin you.
Why would you even think that a private system wouldn't run late as well?
Sure, the NHS isn't perfect, but you are living in a dream world if you think a privatised system would benefit anyone other than shareholders.

Myfavouritecolourisputple Yes, we spend hours waiting in outpatients clinic for consultants appointments, but when DC is an inpatient that same consultant starts ward rounds at 7.30am, dealing with people recovering from surgery, needing to work alongside consultants from other specialisms, accommodating emergency admissions etc.
So when our consultant 'rolls in' for clinic, we understand. That same consultant has also been in the phone to us at 9.30 at night, having come out of emergency surgery and seen a note we had sent to the specialist nurse.

Emergencies mean that skilled doctors simply cannot guarantee that routine appointments are kept on time.

Discussions of private healthcare always remind me of the little comic I saw "If breaking bad had been set anywhere but the US"
www.buzzfeed.com/lukelewis/if-breaking-bad-had-been-set-in-the-uk

Under a privatised system:

• still have to pay additional amounts (thru tax or additional insurance premiums) to fund people who are not able to get insurance or can't afford it. So you still subsidise people anyway.
• introduce additional layers of business that need to make a profit
• additional administration increasing cost
• change the decision making process around treatment towards more expensive/better marketed routes or just to be seen that you are doing something for the 'customer'
• real people have their lives destroyed all because they have a child who is born with a long term illness or disability.

I'll defend the NHS till I die. Whilst paying £40 for a private GP appointment underneath my office when I want a convenient appointment.

If you have anything big, the NHS is amazing.

If you have something chronic that makes your life difficult or painful but you're not going to die, it's less good.

One of the things that comes up regularly on these threads is people don't quite understand the word "efficient"

This is a good point.

Also note users want three things.
Good.
Cheap.
Quick.

You can generally only ever get 2 of the three. The NHS has gone for good and cheap. Comparatively.

Otherpeoplesteens, as you've pointed out, private providers ARE currently involved in a small way in the NHS.

So we know how they behave.

The private companies have quite naturally been very reluctant to take on risk. They have IIUC mostly only been interested in set, predictable amounts of business, bought in advance.

So the NHS may contract them for 2000 hernia operations but only need to refer 1500 patients: private company walks away with the money. If 2100 operations are required that year, the NHS is left having to do them anyway - but now without the specialist experienced staff, because after all it outsources its hernia work, doesn't it?

So no, outsourcing isn't a synonym for efficiency. Often it's the opposite.

I think the NHS at the moment can only manage to treat people if they are going to die soon without treatment. It is so terribly overstretched and I think there could be a market for private clinics for non life threatening stuff.

I saw an old lady begging for her ears to be syringed as she couldn't hear. The GP receptionist simply told her there were no appointments and the old lady had to just go away. Thats the sort of thing I think clinics could be used for. Also there could be clinics for people to take primary aged children to for ailments like cough/chest infection/temperature/ear infection/worms sort of basic stuff. Most worried parents would gratefully pay £10 for such an appointment on the same day and the poorest 10% of people could be subsidised (not pay anything) by the remaining 90%.

I am against privatisation of emergency and serious illness care but think privatisation of minor stuff would be good because in many areas, you just can't get treatment.

Yoarchie there are private clinics for non-threatening stuff! and for threatening if you have the money.

Like a few PPs, I'm a bit perplexed as to why the horrifying US private system is being referenced almost exclusively, like it's the NHS or live in penury if something untoward happens in a private system.

Australia actually has a thriving two-tier health system: free at point-of-access public health system available to those who need it and a full A&E-to-grave private system, the insurance for which is highly affordable - nothing like the US. The government gives tax incentives to people who take out private health as a 'thank you' for taking the burden off the public health system.

HOWEVER

The infrastructure is there to support it. Multiple fully established private hospitals with A&Es and ITUs. No BUPA hospital has that as they're only there for hips, knees and hernias, so they needs must fall back on the NHS if something doesn't go to plan. The cost to set up an effective private alternative to the NHS goes so far beyond just paying for the insurance as to boggle the mind.

Also...is a two tier health system such a desirable thing? Rich people get better quality health care than poor people? That's shit. As an NHS clinician myself, and as a patient with a long term condition, I am continuously impressed by its effectiveness. There are staggering inefficiencies, and breakdowns in communication regarding patient care are rife, but it's a huge system staffed by, well, humans. These things happen. The reasons deaths caused by these inefficiencies in the system make the news is because they are rare, not because they're the daily occurrence the toilet paper tabloids would have you believe.

OP, you've cited some significant first-world issues in your post (and your absence from the thread is becoming conspicuous ) and I can guarantee that those would happen in a private system just as much as a public one.

Pausing, the "minimum takes" you refer to were a necessary part of creating the market in the first place, to mitigate the high entry barriers in healthcare coupled with the ridiculously short contracts that were on offer. The 2003 wave one ISTC procurement appeared to be in search of new hospitals designed to fall down after five years!

Local commissioning decision-makers (be that PCT, CCG or GPs) then decided that they would not refer patients to these services "to protect the NHS family" (King's Fund words, not mine).

All across Europe state-funded services are delivered by private providers. It really does work if we could just bring ourselves to let it.

luckily there are lots of private services so you don't have to use the NHS. I don't think the NHS is that great and if they actually investigated illnesses rather than come back in 2 weeks for everything there would be more GP appointments.

I always go private. £40 for an appointment and I get noone else in the waiting room, a bored GP who is delighted to see me and spends ages and gives me lots of empathy which seems to be included in the price. Its bliss.

At least part of the problems the NHS faces come from the fact that people do not appreciate it as much as if they were paying for it.

This is so true. Imagine how much more compliant patients would be if their medicine label said something like "Cost to the NHS of this bottle of drugs: £4,000. Cost to you: £0. Please use as directed."

There's also the issue of personal responsibility when all NHS funding is risk-pooled nationally. There's little incentive to lead a healthy lifestyle if there are no direct, quantifiable financial implications to smoking, being morbidly obese or whatever.

OP hundred pounds when your DC needs a short course of antibiotics? That's after the £60 for the appointment with the GP. Double that if you happen to have two DC ill at the same time.

That was what I was paying in Latin America, where it's so much cheaper.

If you can afford to pay for your medicine and treatment then go ahead. But don't knock the service you are currently using just because it's over stretched.

Watch Michael Moore's 'Sicko'. Should answer all your concerns...

What happens if you don't have 15% of your take home pay to spare too much ?

It's actually 7.5% as the other 7.5% is from your employer. But if you don't pay it (and don't have private insurance with the same basic cover) I think you get into trouble with the authorities, same as if you don't pay your taxes.

As blu said it is a lot to pay. The NHS is very cheap when you consider what it all does, the Swiss and German systems are a lot more expensive. If British people are happy with the NHS level of service for NHS levels of funding that's fine. I just get tired of people suggesting that the only alternative to the NHS is US style fully private insurance with no socialisation of costs.

yanbu
there is a big difference between other insurance based health system in europe vs us.

surely there would be one that could work well in the uk?

YABU (and glad to see everyone else saying the same), a fully privatised system would be hell - you do not want a system like the US with people needlessly suffering and dying because insurance companies have to make a profit, there's no win-win with an insurance company, they don't make money by paying for everything that's needed.

The NHS is a wonderful model but underfunded. I do think some reforms would help but they would be unpopular e.g. charging for missed appointments.

I live in Finland which has a three-tier system, the public system, occupational health care that employers pay for (I believe any company over a minimum size must provide some form of occupational health care) which provides things like yearly well-checks and non-emergency treatment, and then there is the private system which can be paid for via insurance or pay as you use (usually around 60 or 70 euros for a GP visit and 100-200 euros for a specialist, depending on how long the visit is (20 mins, 30 mins, an hour, and procedures and operations can be up to a few thousand euros but not more than that). The State pays for a percentage of private costs (you pay first then claim back). Its not bad, if I don't want to wait for a GP I'll pay for the private one but most of the time I just go to the public one. The public service often outsources to private ones but the service has been the same (in my personal experience), just not as long to wait (this especially happens with the dental service). You have to pay fees in the public service too (14ish euros for GP visit or 40 euros to cover all visits for the year, about 30 for A&E visit, around 30 euros a night for hospital stays. Lots of clinics have no fees as well for instance child health clinics and maternity) but anyone on a low enough income can get income support which will pay for all health care fees including prescriptions (you take a note to your local pharmacy and get your prescriptions free for that month, renewed each month your income is low enough)