In wondering why UK can't adopt the Australian Healthcare system?

[chopc]

I was talking to some friends abroad and in Australia about frustrations with our wonderful
NHS for both patient and doctor. One of them wondered why we can't adopt the Australian Healthcare system. I thought the same and checked with those using it in Australia, and I can't see any downsides to it ........

What is stopping the UK adopting the same system?

Having worked lived and expereinced - UK, OZ and NZ - all much of a muchness.

What I would not want is the NZ situation of not being able to sue for mistakes or both of countries blatant rationing.

NHS def not the only way to deliver healthcare and there are manythings that could improve as there are in OZ and NZ. For those with long term chronic conditions as I do - I know where my loyalties and wallet lie.

My parents are in another european country. Used to have an NHS-type system, but privatised it a couple of decades ago.

By most accounts the quality of healthcare is better now. However, the mandatory insurance costs about €100/month (but low income households receive a discount), has a minimum excess of about €400, and does not include things like dental checkups.

I do wonder if a public system could have achieved similar outcomes if the government had simply increased the tax rate and funneled the money into health care.

I remember my cousin needing to see a doctor while I was over in Australia. She had to ask her dad to borrow $50.
I wondered how many of my friends back in the UK would have been able to see the doctor if they had to pay for an appointment like that. I’m from a very poor area in the UK and I can’t imagine many people have spare cash to see the doctor with.

I wouldn't want the Australian system here.

My uncle developed skin cancer after working outdoors on the railway building programme for years with no protection from the sun (he was a pure redhead). He was only covered for the removal of the cancer, not for making him look 'normal', as it doesn't cover 'cosmetic surgery'. As he'd been a contracting worker, he didn't have a reliable income to pay for insurance (and there's always at least an element of 'I'm strong, fit, why would I need insurance?' - by the time skin cancer was being realised to be a major issue, it was around 25 years too late for him). As it was a slow growing cancer, he waited what he termed 'a few years' because he wouldn't be able to afford the medication recommended until he qualified for the extra help. But that decision to wait meant the cancers still progressed. He was traumatised by what he saw after his surgery.

The NHS recognises that at times, cosmetic surgeries are medically necessary and provides them free, such as with cancer.

Medicare does not provide benefits for the following:

most dental examinations and treatment;
most physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry or psychology services;
acupuncture (unless part of a doctor's consultation);
glasses and contact lenses;
hearing aids and other appliances; and
home nursing.

Whilst not all of those are provided by the NHS, some are - ones I personally rely upon and could never afford privately, by the way - and some are at least provided at a significantly lower cost.

Even emergency ambulances aren't covered unless under specific circumstances and in particular areas. Can you imagine needing an ambulance but knowing you can't afford it - or waking up in hospital and realising you're going to get a massive bill for being taken there?

If somebody has a severe mental illness, Medicare only allows them to be ill and in hospital for 190 days in their lifetime. They still have to copay for each admission. Mental health screening is only covered once a year - so if you're depressed, you'd better tell the doctor first time, as if they need to ask you twice, it's going to cost you, as it will if you've got an alcohol problem, including when you're pregnant. Can't afford a second screening? Oh well, Fetal Alcohol Syndrome awaits. And if you don't need to be admitted, it's going to cost you.

Looking at all the things that are covered and not covered and what is part covered and what needs to be claimed back and that the cover varies from one place to another, it looks to be considerably more complicated and bureaucratic than the NHS is. But insurers and private hospitals/doctors/etc make a fuckton from it, so I suppose they're happy with it, as will be the people who can afford insurance that actually covers them for their conditions.

I'd far rather have the NHS than that. I can get hit by a bus and not charged to be scraped off the road and taken to hospital. I won't have a bill for being admitted. I won't have a bill for developing PTSD. I won't have a bill for physio or surgery with the intention of improving the appearance of injuries. I won't have a bill if my injuries mean I need speech therapy. I won't need to get a credit card out to cover doctor's bills in the hope that I'll be able to claim it back later. And I won't be given distressing news and decisions to make that include an estimate of how much each option costs and have to decide on that basis.

All I have to do now is buy a pre payment certificate for any prescriptions and the most expensive medication, physio, podiatry and other services I need are provided absolutely free through the hospital. It costs me nothing for the GP to check in on my mental health whilst I'm there for something else. They can quite sensibly doublecheck what I eat/drink/etc just in passing without it having to be charged.

The people who think the Australian system is great are the ones who can afford insurance and all the extras. Ask the people who can't afford it and you'll get a completely different story.

most physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry or psychology services

There are public services for children, I don’t know about adults. Those who are eligible for and have been approved for NDIS will receive community care from therapists but parents won’t need to pay anything. It is a lot easier to access therapists for children under 6 though.

I don’t think vision therapy and chiropractors are NDIS approved though

To clarify - children can access these therapists in the public system. If they have Funding from the National Disability Insurance Scheme they will have their services from private providers, in the community, but the NDIS will pay.

I think the key is to look at the system you have, improve the areas that need improving, keep the areas that are working well, and change the parts that are not working.

NeverDropYourMooncup

Your post suggests you don’t understand that Australia has two arms of healthcare, its public system which is akin to the NHS and the private system which you’re describing. In Australia everyone is entitled to free public healthcare, just like the NHS.

Your uncle could have had his skin cancer treated in the public system in Australia and it would have been no different to the NHS, although likely better in terms of wait times etc. The fact he chose to persist in the private system was his choice, not a choice inflicted upon him.

Allied health services are provided in the public system in the same way as they are in the NHS. For example if you have a stroke, there will be a physio, OT and speech therapist as part of your rehab. Not chiropractic obviously because that’s bollocks.

Ambulance fees vary state to state and no one is ever neglected medically due to an ambulance fee.

No one ever wakes up in hospital wondering if they will get a massive fee . Are you confusing Australia with America? If you get taken unconscious to your local public hospital it’s free.

Public mental health services in Australia are under just as much strain as the rest of the world, but it has nothing to do with Medicare funding. States fund public health services (with some political provisos) and no one has only one chance to tell people about their mental health issues, or a 190 cap in their lifetime.

I could go on, the rest of your post is the same nonsense.

You do realise Australia has a public health system where people are treated exactly the same - better than in the NHS? If you get hit by a bus, you get taken to your local public hospital. No bill.

I live in Australia and I think there are pros and cons. I think it’s better for the “normal” “average” person in terms of easier to see a gp and much shorter waits in emergency departments. I’m not sure it is necessarily better for people with serious health conditions that require long term care. The private sector provides excellent care, especially with cancer, etc. but it very expensive and a bit complex in terms of exclusions, extras, etc in the policies.

I have lived under a lot of different healthcare systems including the NHS and Australia (and the US).

From my perspective, the Australian system wins hands down.

First, it is easy to see a GP. I can choose to go to any GP I want. Choice is important to me. I can choose a GP that ‘bulk bills’ (i.e. is free to me at point of service) or I can choose a private doctor. As it happens, I go to a private GP who is closer. That means I pay approximately $30 for an appointment. I’ve just checked the exchange rates and that is £16 today. I can choose my appointment time and which doctor I want to see at the practice. I don’t have to take time off work. And - shock, horror! - I can even ask for - and get! - a double appointment! If I need blood tests, they are done as a walk-in patient at the pathology lab next door. Depending on what is ordered, I may need to pay for that. In reality, I have rarely needed anything beyond standard tests and therefore only had to pay for an IVF related karyotyping. 3/4 of that was covered by Medicare so I received a bill for about $100.

I really appreciate that my GP is easy to access at my convenience and the emphasis the healthcare system puts on preventative healthcare. I remember seeing a GP in the UK and basically being scoffed at for asking a question about preventative healthcare.

My GP will also refer me to the specialist of my choice and, if I ammot well informed about that when I see my GP, will write three referral letters so I can take my pick after doing my research.

Again, choice is important to me.

I’ve wound up in the emergency room of a public hospital. There was a wait of about 90 minutes. I expect the same would have happened in the UK. Again, I liked being given choice about my treatment options there but I have to say it was a traumatic experience for me and, post surgery, I met a really shitty doctor, a negligent nurse, and a trainee doctor who needed to be trained in compassion (I say this to show that the Australian system is not flawless). It was free and the medical treatment was actually good and I had a choice of dates for my surgery. Other than choice of dates, I believe the NHS would have been exactly the same.

I also have private health insurance. Because DH’s salary is over the required amount, we either have private health insurance or pay more tax. Private health insurance is cost effective for me and my husband. It has paid for several operations, chiropractic, remedial massage and contact lenses. I never knew private health insurance would pay for contacts and massages! It also paid for a small portion of an expensive prescription.

What is confusing about the Australian system is actually one of its major benefits. That is the Medicare safety net. When you see a doctor, Medicare will pay 85-100% of the schedule cost. The percentage varies depending on the reason for seeing the doctor. Also, your chosen doctor may charge more than the Medicare schedule cost. So without careful checking in advance, you don’t always know how much treatment will cost you. Also, one you reach the Medicare safety net threshold (an amount set in January of each year) you get a larger percentage of the Medicare schedule cost back.

Note that I have said you get it back. That isn’t entirely accurate. Some doctors are set up to claim directly from Medicare on your behalf so you don’t get it back because you never pay it in the first place. Likewise with private health insurance.

That is my other minor gripe about the system - sometimes I don’t pay because it goes straight through Medicare or private health insurance, sometimes I pay and claim back part of the cost from Medicare, sometimes I pay and claim back part or all of the cost from my insurance company, sometimes I pay and I’m not covered (IVF, for example).

I live in Australia and work in the public health system.
In City
Emergency care? Great. Get your leg chopped off and you will be sorted as soon as is physically possible by good people
Urgent care? Turn up to ED and you might wait 12 hours to be seen in my department (yes people who do actually need to be there) or 2 days for a bed on the ward.
Outpatient care? 2 year wait for outpatient clinics in any number of specialities
Private care is variable- I am suspicious they over treat and you have to pick your hospital carefully if you are having major surgery or you might be left with a very junior doctor being your only medical cover overnight. If you want a standard appointment and treatment it is excellent but you will be paying a LOT of money for that even with insurance.
Live rurally? Good luck. There will be weeks at a time even in fair size towns with no doctor and your quickest getting to one might be 90 minutes. Have a big car accident in huge areas of Australia and you might wait an hour for a volunteer crew and then 4 hours from the time of accident to get a senior doctor to you

Follow up of things is shit. Drugs are a huge problem and no one is looking after people so they just bounce around uncared for. Unless you need to be admitted for mental health you might wait months to be seen by a community team. If you have no one to advocate for you it’s all a complex system and VERY politically driven
and after 10 years working in it I still don’t really understand it! Everything is about politicians making big statements, people work in silos and no one is actually trying to make anything better outside their small areas

I won't have a bill for being admitted. I won't have a bill for developing PTSD. I won't have a bill for physio or surgery with the intention of improving the appearance of injuries. I won't have a bill if my injuries mean I need speech therapy

Yeah, this is all bullshit. All of this is free in Australia. Neverdropyourmooncip, you are just making all this up.

While the Australian system is far from perfect, think there must be enormous health benefits in being able to access a GP on the day you need to see one and to get a quick referral to a specialist.

While the Australian system is far from perfect, think there must be enormous health benefits in being able to access a GP on the day you need to see one and to get a quick referral to a specialist

Only if you can afford it.

@echt

While the Australian system is far from perfect, think there must be enormous health benefits in being able to access a GP on the day you need to see one and to get a quick referral to a specialist

Only if you can afford it.

Bulk billing.

You do not have to pay to see a GP.

You can find a bulk billing GP at least in capital cities. Surely this is better than ringing a NHS clinic and having to fight through a gatekeeper who tells you to wait for 3 weeks.

GP access in most parts of Australia is significantly superior to the UK. If you’re willing to see anyone you can, on any given day and not pay. Only barrier generally across the country is access in rural and remote areas, which is a reflection on Australia’s geography, not the type of health system.

In a city as well as multiple bulk billing medical centres there are BB after hours doctors.

My own GP doesn’t BB and is busy and popular - for a smear I have to book an appt in advance but she also leaves gaps in her day for emergency consultations for people who are unwell.

It is true that for those seeing a private specialist the referral needs to be renewed yearly by the GP (well, unless you’re wealthy enough not to need the Medicare rebate) but a) not every GP charges for this and b) it’s presumably supposed to be a chance for patient and GP to review general progress. And yes, there are indefinite referrals.

Ambulance fees vary state to state and no one is ever neglected medically due to an ambulance fee

No, but they get bill if not insured:

Victoria: $1265.00 in urban areas, $1866.00 in the regions.

@NotBadConsidering

NeverDropYourMooncup

Your post suggests you don’t understand that Australia has two arms of healthcare, its public system which is akin to the NHS and the private system which you’re describing. In Australia everyone is entitled to free public healthcare, just like the NHS.

Your uncle could have had his skin cancer treated in the public system in Australia and it would have been no different to the NHS, although likely better in terms of wait times etc. The fact he chose to persist in the private system was his choice, not a choice inflicted upon him.

Allied health services are provided in the public system in the same way as they are in the NHS. For example if you have a stroke, there will be a physio, OT and speech therapist as part of your rehab. Not chiropractic obviously because that’s bollocks.

Ambulance fees vary state to state and no one is ever neglected medically due to an ambulance fee.

No one ever wakes up in hospital wondering if they will get a massive fee . Are you confusing Australia with America? If you get taken unconscious to your local public hospital it’s free.

Public mental health services in Australia are under just as much strain as the rest of the world, but it has nothing to do with Medicare funding. States fund public health services (with some political provisos) and no one has only one chance to tell people about their mental health issues, or a 190 cap in their lifetime.

I could go on, the rest of your post is the same nonsense.

You do realise Australia has a public health system where people are treated exactly the same - better than in the NHS? If you get hit by a bus, you get taken to your local public hospital. No bill.

Except for the fact he was treated by the public system because he didn't have insurance to go private?

neverdrop, you have misinterpreted your uncle. Do don’t live in Australia yourself, do you?

I would be happy to pay to see a GP if that meant I could choose who I see & at a time convenient to me, maybe we could have a prepayment system for people who need to see a doctor regularly, almost like the prepayment certificate you can buy for prescriptions. Even if the charge was only £20 it would help fund the NHS better, or a sliding scale where the more you earn, the more you pay & people on benefits don't pay, after all we pay to see a dentist or to get our eyes tested. It may make GP surgeries improve the service they give patients because if patients are paying they can demand a better service.

Except for the fact he was treated by the public system because he didn't have insurance to go private?

You wrote that he was “only covered for” which suggested insurance cover. Public health in Australia doesn’t “cover” you, decisions are made on rationalisation of services the same as anywhere else. It’s not true that cosmetic procedures following cancer isn’t “covered” by the public health system in Australia. It is likely true that there is a rationalisation of services depending on where you live or a medical decision specific to your uncle. I know for a fact it can be done and is done regularly. If your uncle couldn’t get it done then it is probably akin to the postcode lottery of all public health systems, not least the NHS.

Bulk billing. You do not have to pay to see a GP

I was responding to the poster who saw a virtue in being able to see a GP on the day. Bulk billing practices entail a wait for most, though not as bad as in the UK.

Also while anyone can go to bulk billing, anyone earning $90, 000 gets stung with a tax hit if they ^don't* have private provision.

I have lived in Australia my whole life, I am incredibly grateful for the health care system we have, especially when you look at other developed countries & compare (USA). I have benefited from our free health care so much and continue to do so. Knowing I can go to the doctor as and when I need is reassuring.