NHS should be a co-pay system.

[PeonyPatch]

Who agrees? Other countries who use this model include France, Germany and the Netherlands and they are some of the highest ranked healthcare systems in the world. The NHS is no longer fit for purpose, and it hasn’t been for a long time. I am proud that we have a free at point of access system here but it’s no longer sustainable and has been mismanaged and inadequately funded for a very long time. The only way I think it could improve is by gradually making it co-pay - perhaps capping it like Germany does.

They would need to sort the systems first.

I sent phone and email records to a rheumatology department last year to prove that I had made three attempts to alert them that I didn't need the apointment, after they sent me a snottogram for failing to turn up.

I am still recorded on the NHS app as a no show.

Thin end of the wedge. It'll be 'Oh its just a £10 charge' to get us used to the principle. and it would mushroom. See also student loans...

100% about the comms too. I was booked in as part of the same diagnostic process to 2 separate appointments 40 minutes apart. But in 2 different hospitals in towns 15 miles apart. I rang the team and they told me to just turn up at one hospital and get it done all at one.

I was sceptical - so I rang again when the hard copy letters still showed 2 appts- and the senior person told me that it was entirely impossible for me to do that and then took 40 minutes to sort out a proper appointment for each procedure.

I get so frustrated as there are areas of the NHS where the care just isn’t good enough. For example, the NHS generally doesn’t want to pay for surveillance for people at high risk of a primary cancer returning as metastatic. The rationale for this is that there is an absence of clinical trials showing survival benefit and there are risks of picking up incidental findings. But there have been leaps in recent years in the efficacy of drugs available to treat metastatic cancer, and many oncologists who keep up with the latest developments will say that early detection, and therefore a lower disease burden, is crucial to maximising the benefits of treatment for metastases. It’s often too late by the time you go to your GP because your spine has broken due to bone mets, or you’ve turned yellow because of liver mets.

I think we need to be more honest about the shortcomings of what the NHS offers, and what the options are for people who want better care than that offering. For some stuff it’s not currently easy to go private, as the pathways and integration with the NHS provision aren’t there.

The co-pay system in Germany is hardly worth mentioning, it's €5 for prescriptions, €10 a day for hospital stay, and 10% of the cost for physio, occupation therapy etc. The total amount you have to pay is so low that most people on benefits or low income are quickly exempt, it's a tiny % of household income.

What a lot of people don't know abroad is that state insurance funds in Germany often reimburse you for dental hygienist appointments, I get €50 back twice a year, just upload the bills to the app. Some funds also have a bonus programme where you "earn" money for getting vaccinations, going to the gym, 35+ checks, health courses that are also paid by the insurance.

This is bizarre. All European healthcare systems are in difficulties and all European healthcare professionals are under significant pressure. Study after study shows that. It’s a fantasy that everywhere else is doing better.

There are Europe wide shortages of healthcare workers, everywhere has an ageing population. There are far more expensive treatments available than there were 50 years ago and far more expensive ways to diagnose illnesses.

There isn’t a single country where people are satisfied with treatment and waiting times and the expectations are always increasing.

I look at the NI i pay each month. That's my contribution.
I'm late 50s so too old to be able to afford private health care cover.
I have in the last year paid privately for an MRI on my back., £400, and for private physio due to a long wait.
Part of my pension planning is to have £20k put aside to cover health care, eg knee/hip replacement.

DH was booked in for a CT scan. His haematologist knew he couldn't tolerate the dye/marker and said she'd put it on the referral for the CT scan. When he turned up for the scan, the guy running it told him he'd first put in the dye/marker, so DH pointed out it was a scan with NO dye/market, but the guy wouldn't do it without as that didn't agree with his "day sheet", so DH had no choice but to go away as the guy refused to try to contract the oncology dept to get the referral order changed. He then got a "did not attend" letter - not only that but at the next appointment, the haematologist asked why he hadn't attended! That despite him phoning the oncology dept immediately he got home after the aborted scan to tell them what had happened and to ask for a new referral - clearly whoever he spoke to hadn't bothered doing it nor noting it on his records!

I simply don't trust the NHS statistics - same happened with waiting list data which likewise we know had been fiddled for our respective parents who had to wait a hell of a lot longer for urgent cancer referrals/treatments by being moved between hospital/consultant lists!

in switzerland you pay around 300 quid per month for healthcare. you can choose different co pay amounts (from 0 to max 2500 per year). completely private, amazing hospitals, no wait lists. but here the salaries (and quality of life) are insane, unlike in the uk. so it might be true that the uk simply cannot afford a good healthcare system

Absolutely not. It would be yet another way of working people subsidising everyone else. The people who take up most of the resource would not be paying anything.

I would be open to it, if it came with some of the other elements, such as being easier to choose a doctor, not restricted to postcode and being able in some cases to go directly to a specialist

I look at the NI i pay each month. That's my contribution.

Look at what most people pay though? it’s nowhere near enough for the healthcare & state pension costs particularly with an ageing population.

They do in a lot of countries yes, but my point more being we need higher wages and higher contributions from businesses to be able to fund into healthcare.

But look at the outrage at the recent NI increase.

I can see some possibility that a small charge for GP appointments might stop some time wasters. But I think the additional cost of administrating a co pay system and chasing up non payers etc would off set some of the revenue

Fine to co-pay, end final salary pensions, cooperatives boards for repair and maintenance to ensure that expenses are being waved through.

I think we definitely need to start paying for our healthcare. The current system is unsustainable.

I work in the NHS and there are so many people who take the piss by not turning up for their appointments and either don’t let us know or let us know like 5 minutes before their appointment was due to take place so we can’t book anyone else in for that slot. The waiting list is so long for the service I work in so it’s really annoying when people waste our time. I doubt they’d do that if they had to pay for the appointments.

However, I don’t think it is achievable due to high housing costs. I earn above national average salary but because half of my take home pay goes on rent, there’s no way I would be able to pay for healthcare costs. I can’t even afford a check up at the private dentist (no NHS dentist), never mind any dental treatment!

There are a lot of us working in professional jobs who are struggling financially - this would have been unheard of in the not too distant past. Someone in my job would have had a pretty good standard of living, own their own modest home with enough disposable income to afford a holiday each year and other luxuries.

Yes, everything is a mess.

It would hurt people like me, my prepayment certificate is over £10 a month as it is, the dentist and optician I have to save up for, I earn £1400 which is too much for any help, I have savings (from divorce settlement) which means I’ll never get help which is fine but I can’t afford £20 for the dr - I’ve been 3 times already this year because I’ve got some health issues. My friends in France say their system is terrible btw as does my Australian relative

The thing is, the NHS now is focused on running more cheaper to save costs etc. if much of it becomes privatised it becomes about making a profit, not about balancing the books.
a big problem is all the IT infrastructure and how shite it is, shortage of staff. More money isn’t going to be invested in those things unless it makes a colossal amount of money in profits, which it won’t do under a co pay system, so I’m not sure what the answer is!

define co-pay.
And tell me how it works in Germany?

https://www.chroniclelive.co.uk/news/north-east-news/four-women-share-horror-stories-32973828

You could presumably achieve this without taking us all along with you @PeonyPatch ? Just put some money aside each month for private healthcare and use it for anything you don’t want to use the nhs for. Call it “co pay” and live happily ever after.

Absolutely yes. To raise money but also to reduce pressure on the system due to time wasters and no shows.

we should also be able to pay the nhs for different standards of care - premium appointment slots, private rooms, enhanced physio, longer appointments, etc. we effectively have a two tier system in place already and private healthcare is booming as the nhs declines. I would much rather pay my local gp for some of this (with funds going back into the local practice) rather than having to drive 45 minutes to the nearest city with a private gp

The Australian system is good I am told. A certain level for poor people but people who are well off are expected to go private. The Government controls the insurance companies and makes sure the health policies are affordable.
Anyone able to describe how it all works there?

so absent PPs description of "co-pay in Germany" i am going to call bullshit.

We do have prescription charges, and unfortunately dentistry has gone the same way as the UK. But aside of the EUR 10 per night hospital stay, there is no co-pay.

We have a system of health insurance, which is mandatory but you can choose which one to join. Employee and Employer pay the contributions to that (around 14% gross salary). You can have private insurance if you earn enough, where you either pay up front and are reimbursed, or you agree the fees in advance.

Several years ago they introduced a system of payment of EUR 10 per quarter, the first time you went to a doctor (and then got a receipt so you didn't have to pay again if you went to a different one) - exceptions were OB/GYN IIRC - and that was too costly and onerous in the admin, and lead to people not going to the doctor for some things which they should have gone for. So it was scrapped pretty quickly.