Would a mixed NHS / Private model work?

michaels

While I was abroad recently on my 'holiday of a lifetime' I spent most of the time sick with pneumonia. All treatment was paid for by me to be claimed back from the travel insurance later which got me thinking.

Getting a GPs appointment was a doddle, same morning or afternoon as requested no problem and each appointment cost £25. Then there was the chemist, the doctor's certainly prescribed more than would be the case in England (not just antibiotics but pro-biotics, cough medicines etc) so often another 20 quid. Finally I needed a chest x-ray, his required a trip to the local hospital, a wait of less than10 minutes and 30 quid, results were emailed to the doctor.

IN the UK seeing the doctor would have been difficult, each prescription would have been 8 quid and probably any 'extras' I would have needed to buy myself. IF they had bothered to take the precaution of an x-ray (less likely in the UK?) I suspect there would either have been a very long wait at A&E or a wait for an appointment (I am guessing here).

Obviously we don't want to dismantle the NHS but if I were in the UK and I had the option of £25 for a doctor's appointment when suits and £30 not to have to wait for an x-ray I would probably take it. However no doubt for this to happen it would probably be by an NHS doctor and at an NHS hospital and thus the 'payments' would be for me to jump the queue and if I jumped a queue it would mean those already in the queue would have to wait longer. On the other hand it would bring in funds to the NHS providing services that they would be providing to me anyway if I had to wait as now.

So my question is, would it work for the NHS to add a private option at every stage on a 'pick and mix' basis so that those who could and wanted to pay did so?

funguy

Yes it would work and as you say works successfully in many countries. Basically paying for a service makes people use services responsibly and therefore the resource is protected. Completely free access is abused.

J_i_m

I think mixing private too much within public, doesn't make sense in that way.

I know in some cases NHS use private services, but the idea of paying to jump the queue in public is abhorrent and goes against triage and need.

My suggestion is that if you want private and can afford it, then go to BUPA or something.

antrobus

michaels wrote: »

....So my question is, would it work for the NHS to add a private option at every stage on a 'pick and mix' basis so that those who could and wanted to pay did so?

The 'private option' already exists in many cases. You simply have to ask for it.

Generali

It works excellently in Australia where I believe we have possibly the best physical health care system in the world (mental health provision is woeful, almost as bad as in the UK).

When I got cancer I was diagnosed by a private diagnosis centre (all diagnosis centres are private) and had to pay for the tests despite being insured. The cost of tests was mitigated by Medicare, the state health system, but not paid for entirely and it is illegal for health insurance to pay for diagnoses.

I saw a specialist who was partly paid for by Medicare, partly paid by my insurance company and partly paid by me. If I was poor I could have seen the same person in the state system (indeed I did see him in the state system at one point).

I was operated on privately as that was faster than using the state system. I was a day patient for the surgery and my only out of pocket expense was $500 for the anesthetist. That was the gap between what my insurance covered and what the anesthetist charged.

I then had radiotherapy. I had to wait about 2-3 weeks before it could start and that was wholly covered by the state and unavailable in the private sector.

There is a fascistic quality to healthcare here: the private system is used to facilitate state policy. It does work extremely well apart, perhaps, from at GP level. The current Government is trying to introduce a small 'co-payment' so that there is a small cost to seeing a GP; about $5 capped at a maximum of $80 per year. I would also like to see a charge introduced for patients that turn up at A&E with things that should be treated by a GP.

Currently a visit to A&E is free unless you don't qualify for a Medicare card (e.g. you're a tourist or a skilled migrant). To be simply seen by a doctor at A&E without a Medicare card costs something like $1,500 and an overnight stay in hospital costs, again from memory, $2,500. No health tourists in Australia!

Getting a same day appointment with a GP is the norm in Sydney and it's generally simple to get a 'free' appointment on a Saturday morning and, if you know where to go, even on a Sunday.

Healthcare is probably simplified here by the fact that we're a very urbanised population and care in rural communities is apparently nothing like as good as it is in the cities.

michaels

J_i_m wrote: »

I think mixing private too much within public, doesn't make sense in that way.

I know in some cases NHS use private services, but the idea of paying to jump the queue in public is abhorrent and goes against triage and need.

My suggestion is that if you want private and can afford it, then go to BUPA or something.

So this is the heart of my question, I can completely see how unfair it would be but at the same time if it brings in revenue to the NHS for something that they would otherwise be doing anyway for free then I can see that it would also be a 'win' in some ways.

I know basically nothing on how easy it is to get private treatment in the UK or how much it costs or how easy it is to integrate with NHS treatment.

LydiaJ

Generali wrote: »

I was operated on privately as that was faster than using the state system.

I can see where you're coming from with much of what you say, but that bit bothers me.

It doesn't seem to matter very much if private patients get seen a bit sooner than state funded patients (not months sooner, but a bit sooner) for things where the wait isn't a threat to the patient. For cancer, however, where speed is of the essence, how quickly you get operated on should not depend on ability to pay, whether that's paying for the operation itself or paying for the insurance.

Generali

J_i_m wrote: »

the idea of paying to jump the queue in public is abhorrent

Why is it bad if it makes healthcare better for all?

Surely it's better for everyone to get better healthcare even if that means that rich people get more of the additional benefit than poor people. Speaking as someone who was mortally ill I would rather be treated than not, even if someone else gets something better than me.

When the SHTF all you really care about is getting well again, not whether the bloke in the bed next to you is having caviar while you eat bread and butter.

Generali

LydiaJ wrote: »

I can see where you're coming from with much of what you say, but that bit bothers me.

It doesn't seem to matter very much if private patients get seen a bit sooner than state funded patients (not months sooner, but a bit sooner) for things where the wait isn't a threat to the patient. For cancer, however, where speed is of the essence, how quickly you get operated on should not depend on ability to pay, whether that's paying for the operation itself or paying for the insurance.

By being operated on privately I took myself out of the public queue meaning that patients in the public system were also seen sooner. I paid for everything I was allowed to pay for which meant I was seen quicker but also meant that someone in the public system got my place in the queue.

The cancer wing of Westmead Hospital has a lot of posters up encouraging people with health insurance to use it and get out of the public queue. I reckon they know a lot better than me what is best for the system.

It seems a bit odd that it should be a better outcome for treatment to be worse but equal.

Thrugelmir

michaels wrote: »

So my question is, would it work for the NHS to add a private option at every stage on a 'pick and mix' basis so that those who could and wanted to pay did so?

Private health care is already available for those that to wish to pay or receive it through an employer.

LydiaJ

michaels wrote: »

IN the UK seeing the doctor would have been difficult...

My GP practice has a triage system which means that if they judge you (when you speak to a doctor over the phone) to need a same day appointment, you can always have one. It works very well. I would like to see the NHS make all GP practices do likewise (or at least all GP practices with, say, 4 or more doctors in them). I think it would quickly and easily make a bit improvement in access.