Govt White Paper on NHS-reforms will cost billions to implement and will see further privatisation of healthcare.

[ArcticRoll]

Government are selling this to the public that it is about giving power back to clinicians rather than managers but really their main objective is to break up the NHS and line the pockets of shareholders in the private sector.
If the plans go through the focus over the next couple of years will be all abour re-organisation diverting resources from the frontline.

but ArcticRoll, the nhs is sadly a long way from providing an excellent universal service, not least because poor providers keep on going because they are (almost) never obliged to stop. The question is how to get closer to excellence than today the answer this time round is to give the GPs the lead in saying what services thrive and which ones wither and make the latter a real possibility. We shall see...

Making a note to read this later.

TheCubAwakensTiggaxx

Just read through this thread.

So - the money that we pay for the NHS is going to flow out of the NHS into private companies in order for them to make a profit. This is really scary because making a profit then becomes the most important thing, not making people better. Even if competition for contracts pushes up standards, if profit is the motive savings will have to be found somewhere. So the cheapest drugs, rather than the most appropriate ones; one night in hospital, rather than two; we'll treat you because you can be in and out cheaply, but we won't treat you because you need long-term expensive treatment. Etc.

Just trying to understand ...

In America if you come into A&E after a car accident, for example, they will save your life (basic CPR). But if you need to stay in hospital overnight, or you need any other follow-up treatment like surgery, you have to pay. So if you are unconscious, someone searches through your pockets for your health insurance card, before you get the treatment, before they notify your family. If you don't have the card, you don't get the treatment. Your family come and take you home.

People do die because they don't have health insurance in America. My American friends look at our NHS and drool with envy. Well they used to.

We have a social insurance health system (in the Czech Republic) and you get to stay in hospital as long as you need to be there. Five days after a standard birth.

Czechs look at the NHS and recoil in horror.

I don't understand why people even mention America when it comes to health policy. You'd think there were only two systems in the world - the UK's and the US's. Both are crap.

What happens in the Czech Republic if you don't have insurance?

Everyone has to have insurance - it's compulsory. That's why it's called a social insurance system - like in France, Germany, Belgium etc. (although in Germany you can opt out over a certain level - it's mandatory for everyone to be covered). If you're a child, unemployed etc. the state pays your insurance.

So if you can't afford it, the State pays?

Essentially it's the same as here, then, only we pay taxes instead of health insurance.

there is a co-pay, though, equating to 1 pound per doctor's visit and 2 pounds per day of hospital stay, with a maximum ceiling of c. 165 pounds per year (double those amounts to get a feel of what it would be like in equivalent salary terms in the UK- i.e. 2 pounds per doctors' visit, 4 pounds per hospital stay). That was introduced a few years ago and is controversial. Otherwise it's free at the point of delivery.

"So if you can't afford it, the State pays?"

sorry, x-posted - yes. The difference is, though, that the insurance premiums (which are a % of income, paid partly by the employer, partly by employee like NI) are paid to insurance companies which compete between themselves to provide better terms, but are regulated by the state in terms of what they have to provide (and that's pretty generous - i.e. no minimum age limit for IVF, more generous provision during pregnancy etc.).

Most hospitals/facilities are private except for the large teaching hospitals. There's a lot of choice in the system.

These systems all have their faults, though. Still, the Czech one has been ranked the 5th best in Europe, adjusted for per-capita spending.

Vesella -I would rather have the NHS which in my experience has been excellent than the system in Czech republic which you are describing with charges for hospital stays and gp visits-also I'm sure such a system would cost much more to administer than one which is completely free like the NHS.

It doesn't cost any more to administer - as far as I've seen, spending per capita as a % is about the same. And it provides a better service. No waiting lists to speak of, very easy to see a specialist. The co-pays are controversial, but they're smaller in many other European countries, as far as I know, even accounting for salary differences.

no postcode lottery either.

2006 figures for health care spending are 6.5% of GDP for the Czech Republic, 8% in the UK.

I agree, vesela, that we should look to other countries for examples of best practice.

Tell us more about the Czech Republic/rest of Europe?

grannie - would love to but I'm not an expert (and I should be working) although the subject fascinates me. I just know that there are lots of ways to skin a cat, and that although everyone has had a good experience(s) with the the NHS, I also read peoples' experiences here, the sort of limitations in health services that they're taking for granted, how difficult it is to get to see, I don't know, a paediatric food allergy specialist, or someone who can't have IVF because they're under 30-something and it makes me want to say: it doesn't have to be like that.

vesela, grannieonabike, there are lots of comparisons of different health systems available -- eg www.healthpowerhouse.com/

Thanks, slhilly - I'll have a look. I've learnt a lot from this thread.

Thanks, slhilly!

All these systems have their shortcomings, and they vary considerably within wider types - the variation between ones broadly labelled social insurance systems seems to be pretty wide. Some of the post-Communist countries have had a good look round and chosen the ones or the bits of the ones they like the best.

(meant to say above that co-payments here are smaller than in many other countries, not vice versa).

Most of Scandinavia has tax-funded systems, but the difference I think is that they are very decentralised compared to the NHS.

A pleasure. NB, healthpowerhouse.com is just one among many sources of comparison information. There is no definitive answer to which is the "best" health system as yet. FWIW, Singapore is often cited -- great outcomes, high satisfaction, very low spend as % of GDP. But culture makes it possible.