A 'foriegner' with some thoughts on Health and Education ....

[ghosty]

Hello,
I have been reading with interest the Education and Health threads in the last few days. Due to the terribly tragic death of a Mumsnetter's baby there has been much debate about the NHS and how it is underfunded and overstretched. And thanks to Jamie Oliver's mission to improve the standard of school dinners there is now a debate on Education and how to improve the overall standard of EVERYTHING ...
So, I have been thinking and I hope you forgive me for what I write is just the observations that I have now that I live in another country.
We have been living in New Zealand for 3 years now. My son goes to a fantastic state primary school that is incredibly well resourced (there are very few that are 'bad'). We have a very good health system ... yes, it has its problems but IME it is very good.
The main difference here, to the UK, is that everyone who can, PAYS! We pay taxes, my husband is on the highest tax bracket here ... we pay rates, council taxes, all sorts ... The government subsidises schools and health authorities. BUT no one PRETENDS that the government can foot the whole bill ....
So, all parents are asked to pay a 'fee' to their child's school (the socio economic circumstances of an area determine how much govt subsidy a school gets, the parents have to cough up the rest). We have to buy all the stationery for our children. We have to provide packed lunches for our children (most schools have a lunch scheme but it is usually a PTA fundraiser thing and parents run it on a voluntary basis).
No one complains much about all of this, it is the way it is here. At first I had a problem with this fee paying state school system but actually now I see my son thriving I would gladly give the school more!
The health service also cannot run without patients paying .... I pay $50 to see my GP. Everyone in my area does unless they have a community service card and so they get a discount. My son (5 years old) has one more year before we have to pay $15 every time he goes to the doctor. Because people have to pay to go to the doctor people don't go unless they have to (I have been to the doctor once in 3 years) ... and so the doctor is not so stretched that I cannot make an appointment for my baby until a week on Tuesday .... I have never once been made to wait a day to get an appointment for either of my children and I have never been asked that incredibly annoying question, "Is it an emergency?"
When my baby was taken to hospital by ambulance in the middle of the night when she was 2 months old I was a bit shocked to get a bill of $67 a couple of weeks later. But in hindsight I see how so very important the contribution from the patient is.

I know this is a long ramble and you (if you have got this far) are probably thinking "What is the point of this??" Well, it is this .... is it not time that people began to 'pay' for their health care and education in the UK like in other countries? Yes, I know that you already 'pay' in National Insurance etc, but the government just can not handle it can it?

Sorry, at first it looks like I am saying that we pay tax and you don't .... obviously I don't mean that ... what I mean is that we pay EXTRA, ON TOP OF ....

HI Ghosty, as I'm sure you know, the school system is the same over here. I was astounded at being asked to pay 2 lots of contributions (less than £50) for the whole year for ds1's kindergarten plus about £30 for pencils and stationery and all that. However I don't begrudge a penny as the school is FANTASTIC and I cannot imagine a better one with even comparable outdoor facilities in London, fee paying or private. I love it.

You are right that down here there is the ethos that if you can pay for health and contribute as parents and citizens to your child's education then that's what you do. And like you I would gladly contribute whenenver I am am asked.

When we first arrived here we received very generous child benefit and income support and that generosity makes me determined to put back in to the service within the community that I use.

I know it's not perfect here, god knows the Aboriginals in the north of WA are treated shamefully all things considered, but as for the affluent MC in the suburbs, it all seems to be about give and take and contribution and works out pretty well.

Interesting points, my fellow Antipodean

Thanks Suzy
DS has had swimming 3 days a week at school all this term .... which is a damn sight better than he would be getting in the UK.
We don't have any child benefit though ...
The only totally free health care we get in NZ is Maternity care but many people choose to go private ... even friends of mine who don't earn a huge amount of money put money aside to pay for a Specialist for all their maternity care.
The point of it is that if those who can pay do then there is more money in the pot for those who can't.

As another 'foreigner' living in the UK - one who has seen benefits in paying for school and med care on top of taxes, I agree with all that has been said before. I remember getting dirty looks when I would say in the staff room that paying on top of taxes can have loads of benefits. so I started to keep my mouth shut.

I am aghast that children seem to think that they are entitled to a pencil or pen if they did not bring one themselves. I charge 'em 20p as I have to go to the stationery shop and buy them before I can hand them out. Since I stop lending pens which was a nuisance to get back, a lot less pupils need pens from me.

That is really interesting Ghosty and sounds (to me)like an excellent system. Is the amount that you pay for school and health care standard for all or is it based on income? Will you pay more (ie double) when your daughter goes to school?Does this mean that there is no private education and health care or are they still available if people so desire? I agree that the government just can not handle the costs of everything for everybody especially as in the UK there is also the 'bill' for benefits etc (something that is practically non-existant for example in Greece) Do you have a benefits system too in NZ?

I agree Ghosty I was living in NZ before the paying for health care came in
It started with paying for after hours care, very high prompt standard of care, with immediate referral to hosp, avoiding A+E, in order to take minor cases out of A+E
Children were not charged when I left 7 yrs ago though nor over 65's or unemployed people. Which is where I guess CSC card comes in
I remember my mum buying stationery and paying for us to have a "bought" lunch which the local dairy produced as a once weekly treat.
I (we) would happily pay, but there is a lot more taxation in the UK so people already pay more, which is why the debate gets overwrought, IMHO there needs to be an opt out of taxation by a certain percentage when choosing to pay for your own services like health and education
And as the mum of a dd with a genetic condition and a list of doctors as ong as some hospital staff lists, it seems like a double edged sword at times
But something needs to change for sure.

Nope, disagree. We also pay a phenomenal amount of income tax. We also pay "extra" taxes called NI, fuel duty, VAT etc... For this, I expect healthcare and an educational system otherwise why are we paying it? It infuriates me when I can't get a GP to see my sick son and then to read on the news about millions of pounds being handed to all and sundry for ridiculous committees and jollies. My point is that the government has our money and it can and should be handling it. I also hate the thought of a two-tier system like you are describing where if you can afford a doctor, you get one and if you can't, well then tough you'll have to suffer. We are happy to subsidise others to make a fair system.

'everyone who can pays' is also the point of the tax system though.
I see the other side of it. I have great health insurance and can get all the medical treatment I need but people I know can't afford a damn thing and that's exactly what they get - not a damn thing. So they don't get their life saving heart ops, kidney dialysis, they don't go to the doctors at all unless they really have to and the situation is much much worse than if they had gone earlier.
I look at people in the UK and think how lucky they all are.

Sorry, but I am horrified at the charging for children's medical care. I don't know the ins and outs of NZ tax regime, social security etc compared with UK, but I can really see children suffering if their parent's can't afford to take them to docs. and what happens if a child has a chronic condition?

I think many people would be happy to pay 'top-ups' if they felt that the money we already pay was being used effectively. IMO too much is wasted on the administration of targets and the like which serve no useful purpose.

There are a lot of issues with regards to the 'postcode lottery' in the NHS, in that standard treatment in one area isn't standard treatment in another - where you live can mean the difference between obtaining a life-saving drug or not. The same for education; statistically the area I live in is pretty deprived yet historically children in this area receive less per child for education from central government, than children in more 'affluent' areas. There's certainly a long way to go towards making both systems fair to all before people in the UK would consider making further contributions.

From a personal point of view I'd be horrified to have to pay extra for my child's medical treatment. Dd probably cost the NHs upwards of £150K in her first year and I've friends in the US who suffer dreadfully financially because of their childs chronic medical problems.

In Oz you don't pay for children's medical care under 12 years old, practises can bulk bill the govt and you are out of the loop or if you are billed by the practise it is reimbursed

Even if we paid more taxes IMO the health service and education would still be in a mess. The taxes would just get eaten up on bureaucracy.

I would find it worrying to have to pay to take a child to see a doctor. I've had too many close calls where I've thought "Should I take ds1 to see a doctor about this or am I just being overanxious?" and have discovered when I got there that he needs hospital treatment asap. If I'd had to pay directly for this then that might have been just enough to tip the balance in the other direction.

Ds1 and ds2 will, in all likelihood, need help from our NHS for years to come. There's no way that I could pay for all of that. Our income is pretty low but not always low enough to entitle us to extra financial help. I can still remember putting off getting more asthma inhalers because I couldn't afford to pay the charge for the prescription.

I should add that the inhalers were for me and not ds1.

GRMUM ... in answer to your questions:
The amount we pay to school is decided upon the average income of the people that live around the school ... When they have a census each area is given a rating (called a decile) according to income. Decile 10 areas are basically where the higher earners live and Decile 1 where the lowest earners live ... and then there are Deciles 2 - 9 inbetween. Schools in the Decile 10 areas get the least amount of funding from the govt and parents are asked for more money. In Decile 1 areas they get the most funding from the govt and the parents are asked for least. DS school gets around $400,000 LESS than a Decile 1 area school(that is about 130,000 pounds)a year ... the parents pay for the shortfall.
I will have to pay double when DD goes to school ... and then more when they go to high school.
There is definitely Private Schooling here ... but it tends to be a 'posh' thing rather than a 'better education' thing IYSWIM. We looked into private schools for our children but I don't see the point ... some/many of the state schools are as good if not better with the added bonus of 'normal' kids going there!!!
There is private healthcare and many people, if they can afford it have it. Some companies offer it as part of the salary packages, like in the UK.
Yes, there is a benefits system in NZ ... there is unemployment too (but only 3.5%).

Logic, we also pay fuel taxes and VAT (it is called GST here) and 40% income tax ....

I also find it odd that I will have to pay for DS' healthcare from the age of 6 .... but we can afford it so that is ok with us ... but there are systems in place for children whose parents can't pay. No one is left to die because they can't pay ... believe me!
Don't get me wrong, people on lower incomes ARE looked after here, very much so, but the reason they are looked after is because there is more money in the pot because the people who can pay do ... DYSWIM????

Your school system does sound very fair in theory but we already pay tax in percentages so that higher earners DO pay more than lower earners in the first place. It's a fair system too.

The point I'm trying to make is that there is enough money in the taxation system to provide a good level of service for everyone but the money is not reaching the places that it should. For example, last year our NI contributions went up by about £40 a month - and in return our out-of-hours GP service was cancelled. That is why everyone is furious and so resistant to paying more. The government forcibly takes our money and promises us a health and educational service in return and then doesn't deliver it. Bailing them out again isn't going to solve the underlying problem, IMO.

I also think the danger with that system is that sometimes, you can have something quite serious the matter with you which looks quite minor. If you're not aware that something which feels like a bad attack of indigestion may be gallstones, which if untreated may end in pancreatitis (extremely serious and lifethreatening) or that constant diarrheoa may be a symptom of bowel cancer, then you are less likely to go to the doctor and get it checked out if you have to pay. So for example, cancers may spread unnecessarily because people don't get round to going to the doctor because they put it off till next month.

When opticians' charges were introduced in the UK, loads of people simply stopped going for their regular check-ups. There was a prediction then that glaucoma and diabetes (both of which can be spotted in an eye check) would rise - I don't know whether they did or not. But it's the same principle.

I also don't like the two tier system idea - it makes it uneconomical for people in the bottom to find work, and it's usually people on lowish to middle incomes (but not judged "poor") who get hit hardest.

Thanks for explaining that ghosty.I actually think that it sounds a good system. If I've understood correctly the 'poorest'areas get the biggest govt.subsidy so therefore the families 'pay' little or nothing towards schooling.It sounds like a more positive support system for the education of children of lower earners than the reverse system in UK of moving into the cachement area of the best local school which most definitely only helps the high earners.. It also I assume means that those who don't have children in education don't pay this.Which I believe is a complaint of many tax payers in UK who have no children or older children out of education.Its like an education tax that is only payable at point of supply!

ON the health side I suppose that after so many years of living here where to get any decent health care you have to pay I'm intrinsically used to the idea so don't find it as strange as someone in the UK. I would certainly be willing to pay a proportion if it meant getting better service.I worked in the NHS for 8 years in late 70's early 80's and can not believe some of the stories i read here on mn. It wasn't like that then.I can't imagine phoning for example, about a small child with a high temp and being told the doc would phone back in a few hours. Or as you say waiting 6 days for a GP appointment.Changes to these problems I fear mean that either people will have to start to pay or resources must be cut from elsewhere.And thats a whole other subject....

IME your son would probably need to see a doc far less frequently after 6 years of age. I would be interested to hear though what happens to patients with long term disability adult and children?

I can see your point logic about the NI contributions it must be maddening. That is why i especially like the system ghosty describes for the schools - because as I understand it the extra that you pay is going where you want it to go - the school.And as that is a local point of supply i assume that it is also easier for interested parties like parents to have some say in how it is used?

here in Ireland, we have a two-tier system for health. some people on lower incomes have medical cards which means that they see the GP for free. The rest of us pay 40-50 euro a visit. The trouble is that there are some people who are just above the threshold for getting a medical card but who struggle to pay their GP. If they are ill they put off going to the GP until they are REALLY ill so don't always receive adequate treatment on time. Also, about half of us have private healthcare schemes because we don't have faith in the public health system. The doctors and nurses do their best but they are under-funded and what funds they have are mis-managed. Also we get no school dinners, all kids bring packed lunches. Our school has a healthy-eating policy, so no crisps, chocolate or fizzy drinks are allowed in luncboxes. And we don't get Jamie Oliver visiting our schools!

You're right, grmum + ghosty, I do also like the idea that the money you pay for the school transparently goes to the school rather than disappears without trace. I would support the system here if our taxes were reduced a bit to compensate. Don't understand why people without children complain about paying for education though - they went to school too!

I am just tired and grumpy because my son's temp peaked at 40.7 degrees last night and I knew that there was absolutely no point in calling a doctor.