To ask for info about the world's best health system please?

[haveyourselfamerry]

I am assuming that somewhere in Europe/Canada/Australasia there is a system that works better than ours.

I have spent time in US -we can rule that one out right here....

Can usually get same day appointment at my GP's surgery.

Completely unlike last place I lived. I've lived in different areas of the UK and wait times have varied hugely - in one city it was a 3 week wait, and that was 20 years ago.

"Compare that to the NHS where all Europeans currently get free treatment."

No, only emergency treatment in theory, just like we can get with our EHIC card in other EU countries. You're supposed to be a resident to get routine treatment, though I can imagine that there are sometimes no checks.

"Yes, of course. I would still assume UK has a similar % of doctors to population though, since more people would want to be doctors."

No, we have a shortage of doctors. Wales in particular has fewer doctors than any other EU country.

"(The UK is not completely free, we pay prescription charges,"

Only England pays for prescriptions I think, and maybe Northern Ireland.
What is expensive is eye and dental care and what I find unfair is if you are on contribution-based JSA you still have to pay for dental care, but if you're on income based you can get free NHS dental care and also the problem of lack of available NHS dentists and the allegedly lower quality.

" If someone has left the UK, pays no taxes here or does not receive a UK state pension they are not entitled to care, even if they have a NHS number and were born/used to live here. "

They just use their old address or their parents' address.

"Would that be any different elsewhere in Europe/Australasia though?"

Yes, you don't have to be as pushy in a system that isn't as cash-strapped. What I find with the NHS is that they spend a lot of time trying to fob you off, not treat you, etc. GPs are treated as gatekeepers with their job being to keep you away from specialists. We're even told we're bad for wanting to see the GP, we should be just going to the pharmacy. There's no treatment for minor ailments and no preventive care at all.

Of course as others have mentioned in a purely private system you can have the opposite problem with doctors referring patients for unnecessary tests or treatments because they can make money out of them. What you want is something in the middle. This can be achieved by a properly funded system, which could be either free at the point of use or paying systems that are affordable like what you have in much of continental Europe.

Sorry for mass posting and cross posting. Was at work all day then saw all of these. Very interesting subject OP.

Singapore is considered 6th best in terms of outcome (uk 18th) and 38th most expensive in terms of cost per head (UK 26th). So cheaper and better than the NHS.

Note USA is 31st in outcome and most expensive, France is best in outcome but 4th most expensive.
Costs include state and private payments.

"France is best in outcome but 4th most expensive."

Yes, but the cost is for the population as a whole (and I think maybe linked to the national debt) and not for the individual patient so is clearly better than the US where people can be ruined by healthcare costs and where many are left with no treatment or buying their own drugs over the Internet.

Spain is free at the point of use and I've known of very quick referrals and treatment when cancer is suspected or found - operations the same week etc.

Nobody is turned down for treatment - other EU citizens might be asked for their EHIC (sp?) card but isn't that how the system works here, too? Or should work if we could keeo on top of the admin and had proper centralised records...

It's not true that hospitals rely on relatives to feed and change patients - it's more that relatives are tolerated by staff because it's commonly assumed that you would want to sit all day by your elderly parent and supervise their meals and care.

Hospitals tend to be newer than in the UK - so designed for purpose, bigger, more efficient and easier to keep clean - and you don't get those hideous, crammed wards (thinking of so many people's and my horrible experiences in UK postnatal wards).

It is true that Wales has fewer GPs per head than the rest of the EU - my local health board in particular is suffering a severe recruitment crisis and I am terrified of getting ill . 2 weeks wait for a GP appointment, all walk-ins and minor injuries closed down, disastrous admin. I have been in the position of needing an ambulance for an emergency (not life-threatening but life-changing) and not being able to get one for love or money. The NHS cannot be the best healthcare system in the world, no matter how often the mantra gets repeated.

Elvira explained the family thing better than me.
I've been in Spain for 16 years and have always been very impressed with the healthcare at all levels.

" other EU citizens might be asked for their EHIC (sp?) card but isn't that how the system works here, too?"

The EHIC card is for emergencies or treatment that you need during a short visit to another country. If you're living in another country and you want to access routine treatment, you'd have to be registered (and paying where applicable) with that country's system.

I think some countries might allow routine treatment with the EHIC and I've heard that British pensioners living in Spain can use it that way, but really you're supposed to be part of the system of your host country.

Re. the family thing in Spain, it might not be a requirement of the hospital, but I've understood that there is a cultural expectation that relatives will look after their loved ones in hospital so from their point of view it's more or less compulsory.

Quite fancy France...

These articles are interesting:

www.theguardian.com/society/2016/feb/09/which-country-has-worlds-best-healthcare-system-this-is-the-nhs

www.who.int/whr/2000/media_centre/press_release/en/

I have found Belgian health care to be absolutely first rate. I can nearly always get an appointment with the GP the same day, or certainly the next day. Doctors still do home visits on a regular basis.

I think Belgian also rates very highly in terms of number of doctors per capita and also in terms of "fairness of contribution". Everyone has to have obligatory state subsidised private health insurance (NOT like the US system at all) and the very poorest are reimbursed/do not have to pay anything.

One "cultural" point; I have spoken to quite a few Belgian acquaintances about this very subject. Many of them have a different attitude to health care to us Brits, ie, they see it very much as their own responsibility to contribute financially to their health; its almost a matter of pride that they do so. "Why would you not?" they say, "the quality of one's health is paramount". One person said "you English are very strange, you happily pay £30 for a ticket to see the football, and yet you are not prepared to contribute £1 to see a doctor!" I've encountered similar attitudes when I lived in France too.

Don't get me wrong, I think the NHS, is in the main, a marvellous institution with noble aspirations. I think most of the staff do a heroic job, day in day out. But I think the elephant in the room is that with an increasing elderly population and increasing expectations/technical abilities, it simply won't be affordable in years to come. No politicians dare say this. A solution must be found.

Other European countries manage to have relatively good health care, state education, public transport, refuse collection. Everything doesn't have to be in a permanent state of crisis. We need to re-examine our priorities and, among other things, our taxations systems.

I think the NHS is brilliant, but there's a secret to how to use it properly; you need to keep phoning up and pushing doctors for appointments and referrals. It takes a bit of effort but once you're with a specialist there's no stopping you contacting them directly with problems and asking for appointments.

We learnt the hard way when my mum passed away with shoddy treatment. But my dad is looked after brilliantly and I couldn't be more thankful for the NHS.

good post sweepingchange

I've understood that there is a cultural expectation that relatives will look after their loved ones in hospital so from their point of view it's more or less compulsory.

No, that's bollocks. I ahve lived here since 99 and had 2 hospital stays and had 2 different family members have hospital stays and I can tell you it's bollocks.

I think if there was an option to pay £30 for a walk in Gp sometimes, nhs would be brilliant system.

I've heard that the UK tends to be very efficient in terms of cost per procedure, however, it does a lot of procedures per capita. I've also heard that the UK is somewhat higher than comparable countries re unhealthy lifestyle choices such as smoking, and I wonder if this is caused in part by people knowing they'll get treatment as of right.

with an increasing elderly population and increasing expectations/technical abilities, it simply won't be affordable in years to come

I'm on a bit of mission to ask people to explain what they mean by this, because it's repeated a lot and I think we need to discuss it transparently.

Eg people might mean:
"I believe a publicly funded, free-at-point-of-use system like the NHS can provide high quality, equal care for all, but not at this level of funding as the population ages. So we should increase funding."

Or they might mean:
"I believe a publicly funded, free-at-point-of-use system like the NHS cannot provide high quality, equal care for all, no matter what the level of funding. But a partially or fully privatised system with an extra tier of admin in the form of insurance companies can provide high quality equal care for all, for the same amount currently spent on the NHS."

Or:
"I think we should withdraw some healthcare from some of the population. There are lots of mechanisms to do this: I think we should use ability to pay."

And there will be lots of other meanings.

I'm particularly interested in exploring what people have in mind when they say "the current NHS system is unsuitable", rather than eg "current funding for healthcare via whatever means is unsuitable."

To tie in to this, here are some examples of mechanisms for filtering who gets access to what healthcare. (All have been suggested in the UK or actually used in other countries.)

• Ability to pay
• Age
• Weight
• Previous medical history
• Participation in specific activities, eg smoking, skiiing
• Occupation/employer
• Sex
• Ethnicity

Obviously some will also be proxy for others, eg ability to pay is likely to be strongly affected by age, sex, occupation, and whether someone is disabled and unable to work.

Interestingly, when this has been discussed on other threads, some people have said they want to both pay more and have a hybrid private-public system.

But didn't elucidate.

I'm interested to know why some people do want to pay more, but don't want that extra funding to go to the NHS.

And also why, if they are happy to pay more, they don't just do that now and use fully private care.

I could guess at some answers, but they'd only be my guesses. I'd much rather hear what other people actually think.

It's not the ageing population which is putting the strain on the NHS. It is the growing numbers of younger obese, sedentary, heavy drinking smokers. I am not proposing to withhold treatment from these groups - except where the underlying condition renders the treatment pointless- but we need a major shift in attitude to teach people that they are responsible for doing their best to keep themselves and their kids fit:
It is not OK to smoke.
It is not Ok to drink a bottle of wine every night
It is not ok to get so drunk you need to be hospitalised
It is not ok to be fat
It is not ok to have fat kids
It is not ok to not excercise...
That way we can keep the NHS for the many unavoidable health problems.