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?

No, I didn’t think you were and the Australian system isn’t perfect. Insurers are just as unscrupulous as insurers for home, car, etc.

I grew up with and worked in the NHS. I know that people do their best. I also know that people have weird expectations - low expectations of it. Reading Covid threads over the last 12 months I’ve been shocked at what people have put up with in terms of treatments for other conditions. There was a thread about a baby who had hip dysplasia and needs a harness and just couldn’t get one. It was shocking how the baby couldn’t get such simple treatment and that people were defending it because of the need to “protect the NHS”. Even in Sydney with its peak Covid outbreak at the moment, such occurrences just wouldn’t happen. Too many British people are conditioned to put up with unacceptable standards because it’s the NHS and everyone should be grateful.

But any insurance-based system is a political nightmare for the UK. If the Tories introduce it they’re just looking after their fat cat mates, and if Labour introduces it, they’re betraying all that Bevan stood for and deserve to die of shame.

What other countries do it well? I assume Nordic systems are good but come with tolerance for high taxes.

I can only talk about my experience. I have no idea about the NHS except a few threads where some of the issues raised have horrified me.

I came from Spain where we have a good health care system and I prefer Australia. We pay the top tax bracket for Medicare and have private health insurance but frankly, we've never used it.

Our GP bulk bills, which means they get paid the Medicare rate and don't charge extra. Most of the GPs I know in Sydney just bulk bills. My doctor is excellent but I can always change to any other doctor of my choice, There are no constrictions. Tests are free, from blood work, MRI, ultrasounds, x-rays etc, they take no longer than a week to be done and as I say, free of charge.

Specialists are private ones, referred by the GP. Most of them charge a fee and then you get the Medicare reimbursement. As an example my youngest son has an immune condition and sees his specialist a couple of times a year. With private health insurance the specialist is free but without it, we would be $70 out of pocket per visit, which is very reasonable. As Sydney is now in lockdown and my son needed some blood tests, instead of going to the Pathology service, it came to us. Arranged a date and time, arrived with a mask, took bloods and the specialist gave me a call a week later with the results. This on Medicare, not private health insurance.

Same son broke his arm last May. We debated going to the private hospital or the public and because the public was closer and my son was in pain, off we went. We arrived at Emergency (your A&E) at 10.00am and by 12.00 we were home again. He had been seen by bone specialist, x-rayed and cast made. Again, public hospital.

Ambulances are not free but if you are a pensioner or disabled, they are.

I find the system really good. It's a mixture of public and private that works really well.

I can see that you're very experienced because you write very passionately and eloquently. To be honest I think covid has brought to a head the problems have been going on for years and people have talked about it and bemoaned it before, but now you're actually hearing people say it needs to be reformed. It's just that it's political suicide for any party do anything other than tinker with it. It really needs to be taken out of political hands. I think surplus money over the core money that the govt pays, needs to be taken from tax and ring fenced for NHS and social care. I have a quite fully formed plan actually, haha, but no ones going to listen to me. I'm glad you're happy with how your system works over there.

Obviously there are pros and cons to the Australian system. Equally obviously some posters don’t actually know it or have heavily biased viewpoints. Eg:
Much of the population is blackmailed into having insurance through taxation penalties, even if they don't earn enough to use it (there are huge gaps on cover) and still rely on the public health system.
No one is blackmailed. Healthcare is expensive. If you earn above a threshold and choose to ask the govt to provide your healthcare free/low cost rather than get private insurance then you bloody well should pay some extra tax to cover it. It’s very entitled to think this is an outrageous demand.
Costs are rising. People can access gps for free (bulk billing) but you’d have to look around and probably longer wait lists. The ability to jump online one evening and book a gp appt for the next day at your local practice or another one is amazing. I don’t shop around for bulk billed so pay 38 a visit I think. Specialist costs are expensive. That said, treatment is often Medicare covered. I have psoriasis and in the uk had private health through work. I did one round of UV treatment and they told me that was my lifetime limit so I could wait a few years to get more on the nhs. Here I get a referral, pay specialist fees of 1-200 for the periodic review appts but the 3 x week treatment sessions are completely free and I can come back next year no problems.
I decided to move back to oz to have another baby as I didn’t want to have a baby through the nhs again. It’s just too exhausting to be so vulnerable and treated like a number not a person and you’re the only advocate in the room for you despite having just been stitched up. Im loving having a baby privately here (which I couldn’t afford in the uk as it costs a shit ton) and the birth arrangements sound like a spa day compared to my london experiences. Parking near hospitals is tricky or expensive though, we need to investigate that before baby arrives! Others who work in them/ have had babies in them say lots of the public hospitals here are great for giving birth although you’d go home sooner afterwards than in private. Like the uk there is a difference of access in rural areas, private healthcare costs are climbing (family works in it), because healthcare costs are climbing but also because numbers are declining so that could be a problem for the system. Specialist wait times can be long on but so can the uk.

@DifficultBloodyWoman 'invested'?? You write that like you don't think I'm entitled to an opinion on the matter.

I don't like being forced to buy expensive health insurance I don't use in order to avoid being charged extra tax.

I don't give a shiny shit what you think about that.

I'm guessing you weren't around or paying attention in the 90s when the goverment introduced a 30% rebate on health insurance premiums in an attempt to tackle skyrocketing costs, and the insurers immediately bumped their premiums by 30%. Millions and millions of taxpayer dollars going into propping up the industry every year. Most people are rightly cynical.

I haven’t lived in the uk for over 10 years and only had experience with the gp and maternity services while there, so not much experience to be honest. But I found it all good and had no problems. Large city.

When you talk about Australia there are vast differences across the country. Rural services in australia are expensive, no bulk-billing and even kids have to pay to see the gp. Also because of distances even if you have free healthcare at a public hospital you will need to pay for travel and accommodation.

Also dental services are expensive, free for children in big cities though.

I have used the Australian health services in cities extensively (maternity, surgery, emergency) and we are not high earners so don’t have private health insurance. But to be honest I’m always confused as to why people bother with it as we have never had a problem with public system. Wait times were fairly short for non-urgent procedures and standard of care excellent. So health care in big cities is great!

Only thing my children missed out on is speech therapy (private therapy was completely out of out budget) and they would have received that from the nhs from what I’ve read on here. This hasn’t affected their learning though and they are doing well at school.

We do pay for ambulance insurance which is less than $100 a year. This cost can blow out to $1000+ for a call out.

I feel incredibly lucky to be in Australia and have the health care system we have. Just last week, I felt an infection coming on. I could get in to my GP the same day, at no cost. Got my script, picked up my antibiotics, and was starting to feel better by that night. I was thanking my lucky stars I was able to do all that.

It’s not perfect, but I’ve never had a bad experience with it. My father died of cancer in March, and the palliative care he received in his own home (including fitting it out with disability access items) and in hospital was first rate, and free. I earn enough to either have to pay extra tax, or take out insurance. I don’t mind doing either.

@Millicentsparty

So if the NHS was going to be overhauled, would you say the Australian Health system was the best one to model itself on? Or are there better? Because that's really what the thread is about.

My back operation took me 20 months from gp to operation, with treatments in between. That's a long time. Australians I communicated with on the forum I was using, said the wait for them could be longer than that (in that it was impossible to predict) so they took out private payment. They hoped that might get some of their out of pocket expenses back but they had to pay before they made a claim so couldn't be sure. It was stressful because they were not only in pain and then recovering but they had financial worries too. But, they did get it quicker than my 20 months. In the uk I couldn't get health insurance because it was a pre-existing condition, and I couldn't afford to fund it all. So I really had no choice but to wait. But I didn't have financial concerns. So two systems, but neither ideal.

Actually, as per the opening post, it is about the Aussie system.

But if you want to talk about changes in general, I wouldn’t advocate shipping a system in from another country in its entirety. If a healthcare system is to be changed, the needs of the population should be taken into account and something designed and funded accordingly. It would be far better to design something new or cherry pick from other systems instead of saying this one is flawed but ok, let’s try it out.

@DifficultBloodyWoman
It would be far better to design something new or cherry pick from other systems instead of saying this one is flawed but ok, let’s try it out.

Well yeah, I already said this.

The op wants to improve the NHS so talks about about adopting the Australian system because there are no downsides. Ergo, they are looking at the best system for improving the NHS. Which, as it happens, is not the Australian system.

In all countries the deliverers of a health system will see the system differently from the receivers. 30 yr olds will see the system differently to 70 yr olds. Parents looking after children will see the system differently from children looking after parents. Inevitably so much opinion is based on an individuals experience.

The NHS and free healthcare is great in principle but my experience of NHS care at hospitals hasn't been that good on the whole. My GP surgery used to be good but since covid, it takes 45 minutes plus to get through on the phone then another 3 weeks to wait for a routine phone appointment.

Appreciate that corporate schemes are far cheaper than personal healthcare but we pay £250 per year per person for our AXA PPP healthcare plus one £100 excess through our employer. Having recently decided it was time for a hip replacement, I was able to see the specialist within 10 days and book the surgery for a month after that. It wasn't a hospital my plan covered but they've made an exception. Appreciate that many consultants work in the NHS and private sector but I've been able to pick the particular specialist (my surgery isn't that straightforward) and a nice hospital in London with en suite single rooms (and back up emergency facilities). AXA have just started offering a free GP service under our plan, with online appointments available within 24 hours. I'd rather pay £20 per month for private healthcare than Sky tv or a new phone.

As an aside, my son had grommets fitted at 2 years (also privately) and it made a big difference to his health and speech.

This isn’t really confusing, conflicted thread.
Some people saying they have to pay upfront for services, others stating that is absolutely not true.
Is it this confusing for Australian citizens to access?

@AllTheUsernamesAreAlreadyTaken it’s not so confusing in practice. Clinics / gps that ‘bulk bill’ don't charge patients a ‘gap fee’ ie extra to the govt payment for the appt, so they just charge the govt directly. Many don’t bulk bill so they charge more than the govt pays them and then patients have to pay - here I pay the full appt amount and tap my Medicare (govt healthcare) card on the card reader and get half (for gp appts it’s roughly half) back immediately or in 24-48 hours so my out of pocket is only the gap fee but I do need the full amount in my account for this method. There are probably also medical centres that don’t have systems upgraded to do the immediate repay so you’d take the reciept and claim it back online, which would be longer delay. Govt COVID Vaccine clinics all bulk bill. For my 20 week ultrasound I’m just booked in at the place at the private hospital I’m at so it won’t bulk bill, but my obstetrician checked if I wanted to find a bulk billing place instead and get referred there.

It can be confusing and payment methods vary depending on the provider.

Let’s say I go to the bulk billing GP. I book my appointment, see her for 15 mins, and then walk out. They will bulk bill Medicare. I don’t
At anything to them or anyone else.

Let’s say I go to my private GP. I book my appointment see her for 15 minutes, and then go to reception. They tell me that it will cost say $110 for today’s visit and Medicare will reimburse me for $80. I pay $100 by debit card and by the end of the day, $75 has been credited to my account from Medicare.

The same happens with some/most specialists.

But some providers (usually specialists) will say we don’t do Medicare rebates. In that case, after your appointment, you go to reception and they say that will $250 please. I pay. I get a receipt. I then submit the receipt to Medicare and am reimbursed within a week or two. The reimbursement will be for the ‘schedule fee’. Most doctors charge more than that so, as with my dermatologist, I think I get about $130 dollars reimbursement and have paid $120 out of pocket.

Does that help, *Alltheusernamesaretaken’?

I’m sorry! I didn’t proofread, changed numbers and completely screwed that up.

Let’s try again.

Let’s say I go to the bulk billing GP. I book my appointment, see her for 15 mins, and then walk out. They will bulk bill Medicare. I don’t pay anything to them or anyone else.

Let’s say I go to my private GP. I book my appointment see her for 15 minutes, and then go to reception. They tell me that it will cost say $110 for today’s visit and Medicare will reimburse me for $80. I pay $110 by debit card and by the end of the day, $80 has been credited to my account from Medicare.

The same happens with some/most specialists.

But some providers (usually specialists) will say we don’t do Medicare rebates. In that case, after your appointment, you go to reception and they say that will $250 please. I pay. I get a receipt. I then submit the receipt to Medicare myself and am reimbursed within a week or two. The reimbursement will be for the ‘schedule fee’. Most doctors charge more than that so, as with my dermatologist, I think I get about $130 dollars reimbursement and have paid $120 out of pocket.

I hope that provides more clarity than my earlier post!

I think it needs to be explained even more from the start.

There are three different aspects of healthcare in Australia.

1. state funding. Each state funds its public hospitals (ignoring higher details of that funding for pedants). This is just like the NHS. People walk in to a public hospital and absolutely do not have to pay. Anyone can be referred to your local public hospital for anything: knee replacement, cancer, whatever. You’ll wait as long as it takes. Just like the NHS, subject to the same foibles, but overall better.

2. Medicare. This is the Federal government’s funding. Everyone pays a levy, like National Insurance and if you earn over a certain amount, a surcharge. The government sets a fee for every single type of consultation or procedure and will pay the doctor that amount. This is the basis of GP practice. A GP decides whether they will charge the patient the exam same as the government decided, in which case there is no extra to the patient (called “bulk billing”), or above that set fee, in which case the patient is out of pocket. This also applies to seeing specialists in their private rooms outside of a public hospital, for example a physician. The government will pay the doctor 134 dollars, anything extra can be charged by the doctor.

Medicare also determines how much of inpatient procedures the government will cover. For example (I don’t know actual fee) for a cataract procedure the government will pay 1000 dollars.

3. private insurance. This is to cover other aspects of inpatient private hospital cover. It will pay for the charge from the hospital to actually stay on the hospital. It will cover charges above the government-paid fees for the procedure you’re there, to a certain point. Anything above or outside of what someone pays for their private insurance is down to whether a doctor in the hospital charges above that fee. For example a spinal surgeon may deign that their services are worth several thousand more than the government and health fund will pay combined, so the patient has to meet the difference. This is also known as being a twat.

So while it may seem confusing, in reality it is this;

Anyone can go to a public hospital for free. Anyone can see a GP and if you’re not fussy won’t have to pay. And anyone can pick and choose what they want to do if you have the ways and means to do so.

Anyone can go to a public hospital for free. Anyone can see a GP and if you’re not fussy won’t have to pay. And anyone can pick and choose what they want to do if you have the ways and means to do so.

And this is what I like best about the Aussie system - the choice. I can choose my doctor and my doctor can choose their fees. Their choice may impact my choice.

@NotBadConsidering

I think it needs to be explained even more from the start.

There are three different aspects of healthcare in Australia.

1. state funding. Each state funds its public hospitals (ignoring higher details of that funding for pedants). This is just like the NHS. People walk in to a public hospital and absolutely do not have to pay. Anyone can be referred to your local public hospital for anything: knee replacement, cancer, whatever. You’ll wait as long as it takes. Just like the NHS, subject to the same foibles, but overall better.

2. Medicare. This is the Federal government’s funding. Everyone pays a levy, like National Insurance and if you earn over a certain amount, a surcharge. The government sets a fee for every single type of consultation or procedure and will pay the doctor that amount. This is the basis of GP practice. A GP decides whether they will charge the patient the exam same as the government decided, in which case there is no extra to the patient (called “bulk billing”), or above that set fee, in which case the patient is out of pocket. This also applies to seeing specialists in their private rooms outside of a public hospital, for example a physician. The government will pay the doctor 134 dollars, anything extra can be charged by the doctor.

Medicare also determines how much of inpatient procedures the government will cover. For example (I don’t know actual fee) for a cataract procedure the government will pay 1000 dollars.

3. private insurance. This is to cover other aspects of inpatient private hospital cover. It will pay for the charge from the hospital to actually stay on the hospital. It will cover charges above the government-paid fees for the procedure you’re there, to a certain point. Anything above or outside of what someone pays for their private insurance is down to whether a doctor in the hospital charges above that fee. For example a spinal surgeon may deign that their services are worth several thousand more than the government and health fund will pay combined, so the patient has to meet the difference. This is also known as being a twat.

So while it may seem confusing, in reality it is this;

Anyone can go to a public hospital for free. Anyone can see a GP and if you’re not fussy won’t have to pay. And anyone can pick and choose what they want to do if you have the ways and means to do so.

So it’s like first, second and third class care as opposed to first class and economy like we have in the uk?

I’d rather everyone pay higher taxes so that the poorest still get quality care.

@nolongersurprised

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

Just used to authorise insurance payments for visitors to Australia who became ill and needed to claim for the things that were chargeable. Which is an entirely separate matter to residents and citizens, but as I was potentially going to cost insurers millions of pounds, they made damn sure I was trained to know the nuances of the system.

Perhaps I should have gone into detail about where I quoted the Medicare doesn't cover bit? From the Australian government site. I'm on the MN app, which isn't as functional as the desktop version, so I can't do links.

(BTW, when you've worked in insurance, you tend to use the word 'cover' in both terms of insurance covering and the State covering. It's just normal words. Like when you move into education and cover becomes the word for 'stand in' or 'help out' - 'I'll cover breaktime but can't do lunch')

I’d argue it is all quality care. But paying more means you are seen on your timetable not the doctors, in an office that is convenient for you, at a time convenient for you. And if you are in hospital, it means a private room rather than sharing. Incidentally, even in a public hospital, you can elect to pay extra for a private room if one is available.

And to explain more about the caveats and complications:

1. there are discrepancies between accessibility to services particularly in rural and remote areas the same as any other country.

2. you can travel as far as you want to see a GP, you’re not hamstrung by geography like in the UK, same for treatment in a private hospital, but treatment in a public hospital is determined by your address.

3. there is no regulation of fees by specialists. A specialist can charge what they want for a consultation and market forces will determine if it is sustainable. That’s fine. But a surgeon can set their fees for surgery well over and above the national average of others and people in vulnerable positions might think they need to mortgage their house for their spinal surgery because it must be good if it’s so expensive. (You might be able to tell I don’t like spinal surgeons).

4. costs are blowing out. Medicare hasn’t been properly revised for decades. I mentioned cataracts; the fee the government pays - say for example, $1000 - is based on what the government in the 70s determined it would cost, based on cataract surgery at that time being considered a tricky reasonably lengthy procedure. Now, they knock of 20 patients in a morning list with each procedure taking about 10 minutes and the government want to change how much they will pay, but surgeons and doctors’ organisations like the AMA resist this, because they’re twats. Surgeons make millions out of the government being too scared to change things. Like with spinal surgery again - there have been calls for the government to stop funding their arm of the fee altogether because of evidence it doesn’t help at all, but spinal surgeons kick off the second it’s tabled. As a result, the government is paying millions it doesn’t need to.

But this is the same as anywhere else really. Inefficiency is a problem. The only reason the NHS is deemed value for money is because it is so underfunded.

Perhaps I should have gone into detail about where I quoted the Medicare doesn't cover bit?

Yes, but what you’d realise if you lived here is that, for many people with chronic illnesses, NDIS picks up the pill. And that therapists can also be accessed through the hospital

So it’s like first, second and third class care as opposed to first class and economy like we have in the uk? I’d rather everyone pay higher taxes so that the poorest still get quality care.

No, not at all. I have private cover. But for somethings the public hospital is best for. For example with trauma, you go to a public hospital. For Covid, you go to a public hospital. For certain specialised treatments, you go to a public hospital.

Everyone gets good care, money just brings you care sooner for elective procedures. The poor still get excellent care at their local public hospital, give or take. They may not be able to bypass waiting times like someone with money. But if the rich and middle income people weren’t taking up the option of treatment in the private system, the poor person would wait longer - not as a wealth-stratified waiting list, just out of pure numbers on the list.

Any poor person who sees a GP with suspected cancer tomorrow will be seen and treated very quickly.

So it’s like first, second and third class care as opposed to first class and economy like we have in the uk?

No, not at all. It’s more that your specific needs can be spread over a hybrid private/public system. A child might see paediatrics publicly, a neurologist privately and speech/OT privately but funded through the national disability scheme.

A teenage girl with an anxiety disorder may see the community mental health team but a private psychologist they’ve chosen.

Bad parts of the Australian system.

Rural people are disadvantaged. No bulk billing for gps in my experience, not even for kids. Add to that having to travel for specialists and surgery means health costs were why we moved to a large city.

Also all therapies are expensive. I’m not even sure that private health would cover them in full, you would still have to pay a gap. The only time I saw a physio was when I was still under the care of the public hospital after giving birth. They discharge you at around 6 weeks and then you’d have to find your own and pay yourself. Things like speech therapy and occupational therapy and psychology and dieticians are out of the budget of most people.

If you have a diagnosed disabled child (or you are disabled) you get a funding plan to cover therapies and support workers etc

Medicines are also expensive. People of welfare pay the same price per item regardless of the item. However everyone else pays what it costs - items my family buy range from $15- $60 per month. In total our family pays a minimum of $200 a month on medicine. And we are not high income.