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.

If they introduce a paying system it needs to be applicable to everyone no exclusions. If everyone contributes the cost can at least be kept down.

This. The NHS isn't struggling because of a lack of funding. It is struggling because of a massive increase in demand for healthcare. Demand it is struggling to deliver because of lack of investment over the past 20 years or so.

You could throw billions at the NHS tomorrow but you won't solve the problem because you cannot instantly recruit the thousands of trained people needeed to deliver the healthcare.

Making people pay for treatment will only solve the problem if it means less people get treated because they cannot afford it.

I don't necessarily disagree in principle with contributing to healthcare or going over to some kind of health insurance system. My worry around it though is how "frequent flyers" like myself with chronic conditions will be accommodated. As things stand, I would be very likely to get insurance, or if I did it would be prohibitively expensive and most of what happens to me would likely be linked back to "underlying conditions" and would therefore not be covered. There would have to be some kind of government-backed system to take care of people like me, otherwise treatment would be missed and, as others have said, problems would get harder and more expensive to treat.

It all needs long-term and cross-party consensus and planning, but I despair of that ever happening. Until then I support the NHS all the way and am incredibly grateful to have it, imperfect though it may be.

Agree
It’s badly managed with no accountability from those at the top management and in charge of budgets.
Huge wastage and then claim they can’t afford proper staffing.

How will OAPs pay out of their 1K a month. Given that, health insurance for a 70-year-old with health conditions would probably be 1K a month.

The way it works in my country is that you pay a co-pay per doctor visit or per night of hospital stay but the amount you pay is capped (around 600 and something euros a year), once you reach the cap you no longer pay and get the services for free. Certain things are entirely free like maternity clinic (but if you need appointments in the hospital you have to pay, and you pay for the birth depending how many nights you stay - no one gets sent home the same day as giving birth), child health clinic and school health services. People poor enough to be on the last resort benefit (income support) get their health bills and prescriptions paid. Working people usually get occupational health care which at the minimum provides regular check ups for free as well as treatment for accidents and illness at workand good employers have healthcare plans that include specialists, surgery and whatnot. Mine is basic but does include physiotherapy (which i am currently making use of). This takes some of the pressure off the public system.

I previously lived in a country that had a co-pay system. It seemed to work really well and the standard of care that I experienced was brilliant. I was young and healthy, and the costs that I needed to contribute didn't seem excessive at all.

But then I got talking to a colleague who told me that she had decided to have only one child because her first baby had needed to be in the neonatal unit and she just couldn't afford the risk of another bill like that.

And then I spoke to another friend whose family had ended up bankrupt because of her mother's cancer treatment.

And I concluded that it wasn't such a great system after all.

Trouble is, you can be accused of missing appointments that you didn't miss.
A few years ago I was booked in for a scan on Saturday morning. On the day I woke up with D&V. No one was going to be doing an internal scan! I phoned the clinic, the office isn't open on a Saturday so no way to cancel.

More recently i needed to see the GP for MH reasons. Booked an appointment for 2 weeks later. Managed to get an emergency on the day appointment a couple of days later so asked to cancel the later one. They told me they had. Then I got a snotty text berating me for the fall of the NHS. OK thats hyperbole, but being told off for missing an appointment I'd cancelled, along with stats about how much that costs the NHS was a little unfair.

You paint a gloomy picture which isn't the case. The NHS is a beacon of how good healthcare can be, it's affordable and it needs to be funded correctly.

NHS Dentistry was designed around co pay and it's been a utter disaster. Most people are now private paying the highest fees in Western Europe....

Could anyone really contribute to heart surgery or cancer treatment considering the costs involved. I'm France most people are exempt because they don't earn enough.

So let me put it this way, the wealthiest people paying the majority of tax....so we are saying these people who already pay huge amounts into the system should part fund their healthcare.

Free Healthcare is a civil liberty and should be enshrined in law

Yes that is exactly what I am saying. It’s no better in many other countries.

We don’t need more money. We need better efficiency, we need to cut wastage, generous sick pay for staff who are off sick all the time, we need to cut all those management jobs and let medical staff run the hospitals, and most of all we need to stop persistent hospital visitors, who go to the GP and A&E all the flipping time.

most of all we need to stop persistent hospital visitors, who go to the GP and A&E all the flipping time
this!! Especially like on here… with
the advice to lie to 111, 999 etc to get seen quickly

This is just bollocks, if there were easy efficiency wins they would have been taken - the NHS has been under 'efficiency' reform literally my whole adult life.

The people running it are not stupid or ill-intentioned, there are no easy 'common sense' solutions to large and complex problems

The reason why systems like the French are so much better is because they spend about 2% more GDP on them every single year.

It's money pure and simple

Obviously you have never worked in NHS teaching hospitals……
And the French oay a fee everyone they visit the doctor. And are far far healthier than the Brits.

Sorry, but uk healthcare is dire. Not sure who looks to the uk as a shining example. Part of my job entails looking at comparatively standards of care in different disease areas, and throughout the span of my 20 year career the uk has fallen rapidly behind other developed markets to the extent we frequently dont include it in our analysis because it is such an outlier,

And on a personal note as someone who has lived in 6 different countries, each with their own healthcare systems, each with their own strengths and failings, the uk is by far the worst I have experienced. I am settled here for various reasons, but my biggest fear is getting seriously sick in the uk and having to rely on the nhs

My elderly mum needed emergency treatment while on holiday in Greece for early onset pneumonia ( respiratory rate 40) We rocked up quite late at the local clinic a mile away ( open 24hr and numerous of them on the island ) saw a doctor almost straight away, was given emergency nebuliser, steroids and bloods were taken ( results back within the hour ) She was sent away with prescription for antibiotics and inhaler for which she paid £40. Made rapid recovery.
We we’re thankful this didn’t happen in the UK as it would have meant a 14 hour wait in A&E and associated fatigue and dehydration, possibly a prolonged stay in a hospital corridor and by then she’d have deteriorated so much that she’d likely need IV fluids and IV antibiotics ( if she made it )!

The NHS is just too big now and there is no accountability unless you’re a clinician. GP services are a farce too ! It’s an embarrassment.

It certainly isn't bollocks, you've got plenty of examples of gross wastes of resources up thread. Whole sets of scans repeated because they can't be seen in another area, patient history not available in the eye department which has been monitoring glaucoma for 10 years, constant rerecording of history by every new doctor you see, people ready for discharge blocking beds because councils won't take them, new hospitals being built as monuments to civic pride instead of utilitarian and cheaper rectangular blocks like the private hospitals are. It goes on and on.

Throwing more money at it is not the answer.

It already is
Labour let GPs be self employed business

Having just experienced a relative in hospital for over 4 weeks and subsequently the person passing away its not the medics causing the issues in the NHS. The suits are calling the shots and they certainly shouldn't be anywhere near medical decisions.

One of the crackpot ideas was to replace paper menus with an iPad. Seems OK until you try it in practice, the housekeeper was explaining how the trail went. A suit wanted it so she told him to come and do it himself. After 3 hours he'd managed 3 beds for various reasons. Paper based took less than 30 mins.

Copay is an appalling idea, it puts people off getting treatment early on and so ends up costing far more.

My trust have changed the threshold for treating uti's and have placed a 3 day only on gp prescribing. You arrive at the hospital and it's full of people with complications from uti's.

It’s really not.
Private health insurance has just gone up by 4.4%, approved by the gov. For a family of 4 it costs anywhere from $250 a month up to $1000 a month (£125-500) depending on your level of coverage. If you need to see a physio it might cost you $300 but you only get $170 back so $130 a visit still. If you need to take your child every fortnight that’s a lot of money.

Doctors appointments are very hard to get & a lot of Dr’s have their books closed. A short 10min appointment at my Dr’s costs $70 of which I pay $40 once I get a rebate. Longer appointments cost more. An ambulance costs $600 (£300) in my state, you get some back depending on the level of insurance you have.
Waitlists for free healthcare is insanely long just like the UK. The wait times at A&E are also ridiculously long as ppl can’t afford to pay to see a Dr or get an appointment so go to A&E.

Nowhere has a perfect model of healthcare.

So who pays for the NHS bit?
Does the private bit pay for that from their insurance?

The only reason the nhs is broken is because people have entered the country quicker than we can build hospitals and infrastructure. It worked better in the 90s and 2000s with half the money.

"Massive increase in demand" = the population has increased at a rapid rate over the past 20 years

"Lack of investment" the nhs budgit has increased by 384% since 1999 from 50 billion to 242 billion.

The reason the nhs has failed is because of more and more people (demand) and not enough medical infrastructure being built (supply). I've worked on construction sights in hospitals. To refurbish a hospital ward it can take upto a year depending on the size and resources available. Imagine building a hospital. Plus it can take well over a decade just to get planning permission. It then takes years to plan, by which point the hospital is probably obsolete or behind modern standards. Then it costs years to build. The whole process of building a hospital can take close to 20 years!!!! Now imagine your population has increased by 20% in 20 years!!!

This is not sustainable

Wake up people

Co-pay is one way of expressing it - state health insurance is another.

France for example has comprehensive, mandatory state health insurance for all residents, including immigrants who’ve lived there for at least 3 months. It generally reimburses about 70-80% of medical costs with most residents taking out supplementary insurance to cover the rest. Those on low income or benefits or have long term chronic illness or disability are exempt.

Yes, it is down to immigration. Plenty of people already in the UK could work for the NHS. Glad to see many on mumsnet are now seeing this.