To ask if you would pay for GP visits

[justanotherhappyflunkie]

Been talking with various friends who all agree they would rather pay a nominal sum to see a GP rather than the current system.

I have lived in a country that does this (free for children, disabled people, discounts for beneficiaries and long term sickness) and it was great. Same day appointments, good range of doctors, quick referrals.

The UK equivalent of this would be around £20 per visit.

AIBU to suggest it is the system that could help the NHS? prepares for a flaming!

Second actually. The Netherlands was first.

www.commonwealthfund.org/press-release/2010/us-ranks-last-among-seven-countries-health-system-performance-based-measures

Okay second then. No health system is perfect. People always want more and more. But the NHS was objectively strong in 2010, only 13 years ago.

I agree. We’re both on the same side!

@Blossomtoes Apologies

No problem. I just thought I’d post the link before someone else came for us!

How many of the Congregation remember just pitching up at the “Surgery” which was usually the G.P.’s front room of his house, his hall or the room across the hall were the “Waiting Room” during surgery hours ( usually 08.30 ‘till 10.00 and 4.30 or 5.00 until he/she’d seen everyone ). If you went, you’d be seen. If for a valid reason you needed a visit the Doctor would visit you. I could go on, but you get the picture.

PFI payments and big payments to NHS staff under Labour have all caused issues in the years since. It hasn’t been great for decades. Labour brought in PFI to replace dire buildings. But look at the cost! That’s led to a reduction of beds. There was meant to be care in the community until it went missing.

We have an aging population. People need more healthcare. Those who can afford insurance should be incentivized to get it. I believe they do that in France. I heard you pay extra tax or take out insurance. Insurance schemes pay 23% of German health costs. We need a rethink. It’s not just about GP services. My health policy covers gp services. I rarely see a GP but DD has had to use the private one to get something seen to. I’m loath to pay more tax to this NHS behemoth. It’s past it’s sell by date and it needs reform. Every good idea needs to modernise eventuality.

I agree PFI was not a good idea in the long term, got hospitals into huge debt for their shiny new buildings. I liked Tony Blair at the time ( before all the war stuff) but PFI just kicked the problem of NHS underfunding down the road.
I find myself agreeing that those who can afford it should be encouraged to pay or buy health insurance like in other countries. Even my husband is starting to think that way and he has worked in the NHS straight from Uni, he’s 60 now. Didn’t think I would ever say that but neither did I ever think the NHS would be in the state it’s in today. Not enough money for any improvements and unhappy staff.

There's many many thousands more very elderly people now though. With several health morbidities that would have finished them off years earlier.
Our practice has around ten thousand patients for five GP's. What you describe just wouldn't be feasible.

I already pay via my national insurance contributions.

Isn't that what the conservative government do though.... make the NHS so shit that you are practically begging them to make it a fee paying service?

Gets them off the hook for the piss poor management of the NHS and they don't have to lose voters by saying " we are privatising the NHS" because we are already begging them to do it!

You need to have the GPs in enough numbers, whether there is a nominal charge or not.

The running down of the NHS over the past decade, lack of enough emphasis on prevention (for some conditions, though some such as less smoking have helped), and loss of some overseas born staff because of Brexit and the pandemic (people not wanting to be away from family in case they could not visit) have all contributed to the issue.

As a member of the "squeezed middle" with no access to any benefits (even tax-free childcare), no. I cannot pay any more. We are living paycheck to paycheck based on high rents, high student loans, high nursery fees, high gas and electric, and the ever-rising cost of living. I would not be able to see a doctor because I simply don't have a spare £20.

I live overseas. Costs €20 to see a GP here, with a maximum annual charge of €120, after that it's free. Many employers will partly reimburse/subsidise these costs, mine reimburses me 50%.

I think it's a stupid system. The €20 makes it difficult for those on low incomes, while the employer reimbursement schemes mostly favour those on higher incomes/in stable employment, and are an administrative faff.

@TizerorFizz John Major started PFI, admittedly Tony Blair ran with it. The thing is the country was in a dire state after 17 years of Thatcher et al. It was a mechanism to take debt off the government balance sheet to meet the criteria of the Maastricht convergence criteria and for many years was seen as a positive action.

I would, but being honest Id expect an improvement in service and i think it would increase demand as if I could pay I'd go more often, although that might be offset by those who'd go less often due to affordability which seems a bit immoral that i can now go for my minor issue but someone with something bigger might not.

I think the issue is there arent enough doctors and I dont know that paying nominal sums would rapidly increase the number of doctors around to make it function.

I do pay. I live in Ireland, and it’s €60 per visit. I’m happy with it, after nearly 25 years in different parts of England under the NHS, it’s been an (unexpectedly) better experience, even throughout Covid — I can almost always get a same-day appointment at a time I can make, with my specific doctor, whereas at my last GP surgery in the Midlands a next appointment was often two or three weeks away, and the only alternative was to start queueing on the street before eight am for a surgery opening at 8.30, and you could still be waiting till 11 or later to see any doctor. At my surgery, that often meant sitting in a waiting room that contained people who were obviously ill or in pain alongside the regular lonely/time wasters. For whom I felt and feel, obviously, but it wasn’t a helpful situation, and meant I only went to the GP if desperate.

Paying, at least in my experience, has meant a better experience, and better care. Relatedly or unrelatedly, a longterm condition that had a big negative impact on my life and which the NHS was unhelpful about, has been solved here via several minor surgeries and some thinking outside the box — all on public (free) system, during Covid.

I agree on PFI and I’m glad it’s being talked about more as we’re still paying now.

We have a system where low users generally pay more. People ask for change as they see better results elsewhere

I probably wouldn’t overhaul system but take elements from others eg some do tax rebate for private but as much as that’s fine in other countries I think it would be people up in arms here.

I’m ok with a bit more NI for social care but not just massive hikes for everything as it loads more on low users

I don't think it's a bad idea but not £20.
It should be £5.

PFI is appalling - bleeding the NHS for private profit

Someone was telling me about a quote to put in a couple of hooks to hang up a picture in a PFI hospital (would be fined if did themselves) -£45!!

Insurance schemes pay 23% of German health costs

It's a bit more complicated here in Germany. Everyone is entitled (required) to have health insurance via one of the official health insurance companies. Unemployed, students etc are automatically enrolled into the AOK which is the biggest. Once you are on a certain income level (I think around EUR 6,000 per month?) you can use a private health insurance company and are a private patient with the perks that gives (you pay upfront for everything and are reimbursed).

For everyone who doesn't use that system you pay a percentage of your income (around 13%) to the health insurance, which is matched by your employer. The market was deregulated a few (20?) years ago so there are more providers and you have more choice. But the old providers are still there, and certain trades often have/had their own. For healthcare workers, miners etc. They were good (still are) because they offer the benefits, say, that miners might need in particular.

In effect it works like the NHS. It has problems (we have a shortage of beds in many places for eg) and i can always get an appointment when i need one. You go to a specialist for some things, you have to be referred to a specialst by your GP for others. So if you have a baby, you register with a paediatrician. Women choose an OB/GYN and go for all their womanly related health needs directly there. Ditto dentists. When i had shoulder trouble, i found my own orthapedic practice - and there were some treatments not covered by health insurance that i could add on (steroid injections for EUR 35 which pretty much fixed me after one time).

Incientally: my children were covered by my health insurance until they left school at 18 and either earned their own money (apprenticeship) or went to uni. Every visit, everything from birth, through check-ups, vaccinations, accidents everything. And when they had braces? we paid upfront (ouch) and then got 90% for DC1 and 95% for DC2 after treatment was completed. That stops people breaking the treatment off for sure.

"It's a bit more complicated here in Germany. Everyone is entitled (required) to have health insurance via one of the official health insurance companies."

For clarity, the "Bismark" system in place in Germany and much of central Europe is based on insurance Mutual Societies rather than commercial health insurance companies. These Societies exist solely for the benefit of the members (i.e. the people paying in the insurance contributions) rather than being focussed on making a profit for their shareholders. This is a very different form of health insurance to the discriminatory American system.

As @Brefugee explains, insurance contributions are compulsory and are paid by both employees and employers, which is not unlike the UK National Insurance system. One major difference is that these contributions are ringfenced for healthcare. Contributions are a straight percentage of earnings. Those who are not earning (e.g. students, chronically ill, unemployed) have their contributions paid by the State. Pensioners also pay contributions. Just as for employees, pensioners pay a percentage of their "earnings" - so someone only receiving a State pension pays less than someone who has "earnings" from a State pension, a company or private pension, and investment income.

Private health insurance is available, but where I live in Europe, hardly anyone has it. Why would they when they can see a GP just by walking in, see a Consultant within a week or two, have minor surgery within a few weeks, and get a free "MOT" health check every year.

After WW2, when these countries were rebuilding and becoming prosperous again, the governments decided that the standard of healthcare should be the same as that previously only available to those who could afford it. In the UK, the post-war Labour government set up the NHS with similar intentions, and for the last 70 years, the Conservatives (who voted against creating the NHS) have tried their best to dismantle it.

For clarity, the "Bismark" system in place in Germany and much of central Europe is based on insurance Mutual Societies rather than commercial health insurance companies

thanks, i forgot to explain that part. A lot of my American colleagues are surprised by this side of it.

I don’t believe any government here has tried to dismantle it. If they have, they have failed.

There’s a ridiculous misunderstand of NI here. It doesn’t insure you! It doesn’t pay for the NHS. It used to be thought it paid for pensions. It’s not an insurance. It’s tax. If goes into the taxation income pot like every other tax. So how we fund the NHS is not ring fenced. Also retired people do not pay it. Hence their belief “they have paid in and now deserve the benefits”. That’s simply wrong. It needs to be a tax paid by all if they pay income tax. Applied to 18 year olds and 98 year olds. Obviously retired people have no employer contribution, but health care isn’t linked to work is it?

The other alternative is to allow people not to pay NI upon retirement but to use that money for basic health insurance. I respect the posters above regarding other systems but they have more money in their health systems than we do. We also have a lowering tax take due to early retirement and self employed not paying income tax. So we need a bigger overhaul in the medium term. People are not paying what they could. I exclude young families from this by the way or anyone who is generally struggling.

There’s a ridiculous misunderstand of NI here. It doesn’t insure you! It doesn’t pay for the NHS. It used to be thought it paid for pensions. It’s not an insurance. It’s tax. If goes into the taxation income pot like every other tax. So how we fund the NHS is not ring fenced. Also retired people do not pay it. Hence their belief “they have paid in and now deserve the benefits”.

but the basic premise of paying tax and NI all your working life is that you get a pension and healthcare at the end of it. So yes, Tax and NI pays for the NOW, but that is the generational social contract. You can't suddenly now tell pensioners "sorry, mate, it all went in the general pot, now you have to fend for yourself"