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....

MerylStreep17 - while I agree with your list of things that people should not be doing, I fear that it is not so much an issue of individual so much as of collective responsibility. I despair of the fat, unhealthy-looking people waddling round Tesco (when I go there, which is rare) but I despair even more of the total rubbish on offer as "food". No it's not! How have we managed to let the food industry take hold like this? That is an issue of collective responsibility.

Gwenhwyfar really shocked to see Ireland right behind UK on that list. I am Irish lived in the UK for a decade and would rank it way higher then Ireland. We get decent healthcare here but you need private health insurance to get past the long waiting lists and in the main have to pay in excess of €50 for every gp visit.

@Bobo - very much agree that the food industry needs tackling as well.
We need to get back to cooking for ourselves from scratch instead of relying on ready meals and take aways. Schools need to address this too and return to teaching cooking as a core skill.

Some interesting views on the Eat Well thread.

Even when cooking from scratch, which I very much agree we need to do as a rule, many raw ingredients are not as nourishing as they should be because they have been factory-farmed, sprayed with chemicals, picked before ripening, transported long distances, heat-treated etc etc.

We urgently need to return to a farmers' market food distribution system.

I've noticed that treatment in the NHS is excellent if you can be both incredibly compliant and also sharp elbowed when needed. So jolly and prepared to wait at GP drop in or A&E, you get seen on the day; gently but persistently push for a referral and follow up it'll happen within 2 weeks. Those who don't make a fuss, or make too much fuss don't get as good care. So the elderly, those who don't speak the language or are inarticulate or have MH problems have poor outcomes.

I live in France and in my experience the health system is extremely well funded but limited in other ways. If your doctor judges that you should have a test or treatment you get it fairly quickly with no sense that anyone is considering the cost. However, many doctors are very paternalistic and there is limited patient choice. In addition the medical profession seems behind the times in terms of cutting edge research and staying abreast of developments.

There is cutting edge research in France. Indeed, this summer I was talking to a British surgeon who had completed his training, post PhD, with a world-standard surgeon in the South of France. The British surgeon was very gloomy about the prospects for British medicine post-Brexit as he believed that British doctors, who were already sidelined from European networks due to poor language skills and the strange inner workings of the NHS, would be further penalized by no longer participating in EU supported programmes for knowledge exchange.

PausingFlatly

In answer to your previous questions/alternatives - I am not sure that the answer can be reduced to your three options but fwiw ...

All the indications are that the NHS cannot provide the universal, high quality service for everyone under the current arrangements. With an increasingly ageing population, it looks difficult to foresee a return to budgetary contributions increasing at 10% per annum, as opposed to the current 3%. It also seems that the NHS is being punished operationally for failures in other policy areas. So logically, if these other policy areas could be reformed (more money required for elderly/social care/mental health) it might be possible for the NHS to continue as is.

However, having lived with very high quality health care in Belgium for over many years, with very modest financial contributions, it becomes difficult for me to understand why a means based contribution would not be the best way forward. Why should someone who earns over £400,000 per annum receive free health care?

I'm not trying to reduce the answer to three options. That's the point - I'm asking people to give their own meanings.

For which thank you.

And can I ask for clarification: what do you mean by "under current arrangements"? Do you maybe mean, under current levels of funding? Or something else, eg something structural about the way funding for the health service is collected or allocated? Or something else again?

(I'm not trying to put words in your mouth, just giving egs to help elicit a more detailed answer.)

Regarding means-based contribution to healthcare, surely we already have this through progressive taxation? The person earning £400K isn't receiving free health care; they're being charged in a predictable way spread over many years, rather than suddenly at point of use.

Would it perhaps be a good idea to have it ring-fenced and appearing separately on tax statements, as someone on another thread explained the French system does?

BTW, thank you for giving some detail about interplay between medical care and social care.

Merly,

I think any system such as yours will become extreme and dubious. how about:

"it is not ok to study at a desk all day causing unnecessary musculoskeletal problems"
"it is not ok to drive a car increasing the risk of dementia to those living near the road"
"it is not ok to have more than two children"

"Best for individuals?
Best for populations as a whole?"

I don't know but we need a more honest discussion about it. most people don't realise this conflict exists every time you go to the gp.

@haveyorself

We know there is a direct causal link between smoking, consuming too much alcohol, obesity and inactivity on the one hand and major health problems costing the NHS vast amounts of money on the other. These health problems can be avoided if we shift attitudes. We are already on the way there with smoking - 30 years ago it was socially acceptable to smoke. Now it is not. We need the same shift with regards to over drinking, inactivity and obesity - instead of laughing when teens are hospitalised following a night out, indulging ourselves at wine o'clock and living off junk food and takeaways. Because no amount of extra funding is going to cater for 50%+ of the population with type 2 diabetes - and the amputations, blindness etc that follow.
Tbh I don't think your examples hold up in the same way. The link between having more than two children and ill health is tenuous, as is the link between dementia and proximity to a main road identified recently in one Canadian study. And sitting all day does aggravate back problems - so we have a raft of health and safety legislation in place to address and this is usually welcomed. We need a similar approach to being fat, not moving and drinking too much - instead of pretending these things are OK.

It's not the ageing population which is putting the strain on the NHS

I disagree, I think it definitely is. This is a very unpalatable truth because we all hope to be old some day (ie not to die young). It is also a major vote loser.

Elderly people often have several complex, serious conditions and they aren't exempt from lifestyle-related conditions (and don't smokers pay way more in taxes than they cost the NHS?). I live in a retirement area (50% of patients at our GP surgery are over 65) - our population pyramid is very top-heavy, the health service cannot cope. When elderly people are admitted to hospital they often need to be seen by several doctors. They are likely to need care afterwards which delays discharge (ie bed-blocking). And social services budgets have been cut to the bone.

This is the most serious issue facing he NHS imo, and unless it's acknowledged and tackled the NHS will come crashing down. No idea what the answer is though!

Bohochic I never said there is no cutting edge research in France, just that overall they are behind. My feeling is that they are behind for two reasons: they do not engage with the English speaking research community and they follow central protocols regardless without much individual professional development efforts in the general medical population. So for example, in 2014 my gynea didn't know what the Harmony test was and wouldn't even accept to write a prescription for a blood test for me when I found a private company that would do it even though I was arranging the test. Similarly a specialist refused the existence of an osteogenesis imperfecta genetic test - he didn't question it, or accept it was not available in France, he refused to accept it exists at all despite irrefutable evidence to the contrary.

It cuts both ways - there are medical procedures available in France that are not available in England, or elsewhere. There is also, almost everywhere in Europe, significant discrepancy in access to cutting edge treatment between capital/major cities and the provinces.

I asked for something that is very well known internationally and my GP had never heard of it so there are things they don't know here as well. She was able to give me something similar.

"my gynea [in France] didn't know"

At least you had access to a gynae like many of the world's women, but not British unless they have very serious issues and the GP has exhausted all his/her knowledge.
You could probably also have your own gynae deliver your baby if she was an obstetrician as well instead of being under different midwives.

"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."

According to your massive sample of 4 hospital stays? It's just what I've been told by Spanish people and your individual experience doesn't really disprove it.

Depends on what your criteria for "the world's best". Do you include countries that provide free access or countries that have the best for those who pay?

"I've also heard that the UK is somewhat higher than comparable countries re unhealthy lifestyle choices such as smoking"

Any stats. The European countries I've been to seem to have higher smoking rates. Binge drinking is a problem here, as it is in Ireland and some Nordic countries, but alcoholism is an even bigger problem elsewhere. Where we are really bad is obesity, second only to Malta in Europe I think.

"We need to get back to cooking for ourselves from scratch instead of relying on ready meals and take aways. "

Not going to happen for the majority of the population. Healthier quick meals also need to be part of the solution as well as a combination of subsidy for healthy food and tax on unhealthy food.

That families sit there the whole time their relative is in hospital? Yes.
That this is so common that patients don't receive proper care if their relatives aren't there? No, that is bollocks. If you are in hospital with no relatives to visit your care is exactly the same. Relatives are not expected to bring food, change bedding, or monitor the doctors. They might hang around a lot but it just isn't true that your care is of a lower standard or that the health system depends on willing relatives, it just isn't.

"Regarding means-based contribution to healthcare, surely we already have this through progressive taxation? The person earning £400K isn't receiving free health care; they're being charged in a predictable way spread over many years, rather than suddenly at point of use."

Exactly. I don't understand all this "we should be paying for our healthcare". We are, unless we're under the tax threshold. Maybe we should be paying more, but that's another matter.