Would a mixed NHS / Private model work?

tincans6

Here's the intriguing thing about USA cancer mortality rates.

If you look at mortality rates for cancers in the under 65's - then the USA hasn't got the best record at all, in fact, its pretty much in the middle (still better than the UK mind). The same applies to childhood cancers - USA is pretty similar to Western Europe.

For over 65's the USA has a significantly better cancer mortality rate than anyone else.

What could this suggest ?

It could be that American medicine offers the world’s best cancer care, but only to patients with access to that care.

Does aged 65 matter ?

Well yes - that's the point where US citizens qualify for that filthy commie idea of socialized healthcare otherwise known as Medicare.

Generali

jamesd wrote: »

From the OECD data, cost of medical care per person, per year: USA: $7662, UK: $4033.

That $3,600 difference in spending can deliver other benefits or health benefits in different ways, like giving older people free heating in winter.

That's a false dichotomy though. The choice isn't between the NHS or the US system, it's between the NHS and anything else either existing or not.

lostinrates

Generali wrote: »

That's a false dichotomy though. The choice isn't between the NHS or the US system, it's between the NHS and anything else either existing or not.

I'm not sure I've understood the figures tbh, but does it also presume that all breast cancer care is received through NHS in UK?

jamesd

The observation I was addressing was the difference in 5 year survival rates US vs UK so naturally I compared those costs. I agree with you that there are alternative blends of costs that could be used. The mention of free heating wasn't a joke, NICE reported 24,000 excess deaths (page 15) on average in winter. According to Cancer research UK there were about 11,700 breast cancer deaths in the whole of 2012. If you want to reduce deaths and also improve quality of life, heating and insulation look like a great investment compared to more money spent on breast cancer treatment to get the relatively small additional increases in survival rates for the UK vs US.

antrobus

jamesd wrote: »

From the OECD data, cost of medical care per person, per year: USA: $7662, UK: $4033.

That $3,600 difference in spending can deliver other benefits or health benefits in different ways, like giving older people free heating in winter.

That would have to be total spending on health care. So the difference would not be available to "deliver other benefits" unless the government raised taxes by $3,600 per capita.

antrobus

jamesd wrote: »

... The mention of free heating wasn't a joke, NICE reported 24,000 excess deaths (page 15) on average in winter. ....

Yes, but there is litle evidence that excess winter deaths are the result of lack of heating. Which is what that NICE guideline says if you read it.

Kittycat1981

In_For_A_Penny wrote: »

I'm afraid it doesn't quite work like that.

The same numbers of patients need seen by the same number of doctors. In the time that a patient is being seen in a private clinic, that consultant specialist is not available to see patients on the NHS.

It might be argued that private clinics are undertaken in a consultants "free-time". Very often that is not the case and they have merely delegated work to a more junior colleague in their absence.

Exactly my experience. My son had an anaphlaxis episode at new year, 999 and A&E- given very high dose steroids and antihistamines, an emergency referral made to immunology- more than an 8 week waiting list. He is still on a very high dose of the steroids and antihistamines, GP has sent in another referral- still no joy- she is monitoring him weekly for the next 8 weeks.

I enquired about a private referral - Bupa, Spire and Nuffield- neither do the testing he needs within a 100 mile radius of where we live, the GP went on to say that we could pay privately to see the same NHS doc in the NHS immunology clinic in the same NHS hospital and be seen quicker.

I personally think its disgraceful and is one of the contributory factors to waiting lists being so high, i could pay to "jump the queue" but at the expense of someone else??

I firmly believe that the private option should be available but in a private hospital with non nhs docs, the nhs should not be compromised at the cost of privatisation.

So in the mean time we are taking up a GP appointment slot weekly while we wait for his emergency appointment in March.

Generali

Kittycat1981 wrote: »

Exactly my experience. My son had an anaphlaxis episode at new year, 999 and A&E- given very high dose steroids and antihistamines, an emergency referral made to immunology- more than an 8 week waiting list. He is still on a very high dose of the steroids and antihistamines, GP has sent in another referral- still no joy- she is monitoring him weekly for the next 8 weeks.

I enquired about a private referral - Bupa, Spire and Nuffield- neither do the testing he needs within a 100 mile radius of where we live, the GP went on to say that we could pay privately to see the same NHS doc in the NHS immunology clinic in the same NHS hospital and be seen quicker.

I personally think its disgraceful and is one of the contributory factors to waiting lists being so high, i could pay to "jump the queue" but at the expense of someone else??

I firmly believe that the private option should be available but in a private hospital with non nhs docs, the nhs should not be compromised at the cost of privatisation.

So in the mean time we are taking up a GP appointment slot weekly while we wait for his emergency appointment in March.

The only way the NHS got off the ground in the first place was by paying doctors ridiculous amounts of money to join in whilst allowing them to keep their private practice too.

You just need to look at NHS dentistry to see what happens when the Government tries to pay doctors at rates that are rather more reasonable.

http://www.telegraph.co.uk/news/health/10334773/Thousands-of-GPs-paid-more-than-the-Prime-Minister.html

Statistics from the Health and Social Care Information Centre found that in all 3,620 GPs were paid over £150,000 a year, down from 3,920 in the year before.

Of that total, 670 GPs received more than £200,000 a year in 2011/12, up from 730 in the previous year

GPs! Their expertise tends to run as far as prescribing antibiotics for viruses (facepalm), advising patients to come back if it gets any worse and sending people with chest pains that should have gone to A&E to A&E.

Graham_Devon

Generali wrote: »

The only way the NHS got off the ground in the first place was by paying doctors ridiculous amounts of money to join in whilst allowing them to keep their private practice too.

You just need to look at NHS dentistry to see what happens when the Government tries to pay doctors at rates that are rather more reasonable.

http://www.telegraph.co.uk/news/health/10334773/Thousands-of-GPs-paid-more-than-the-Prime-Minister.html



GPs! Their expertise tends to run as far as prescribing antibiotics for viruses (facepalm), advising patients to come back if it gets any worse and sending people with chest pains that should have gone to A&E to A&E.

Those stats cover a tiny minority of GPs.

I doubt those GPs will actually be running surgeries either. If they are, they will be once a week. More likely that those particular GPs are directors in NHS England etc rather than simply writing prescriptions for antibiotics.

From the same paper....

http://www.telegraph.co.uk/news/health/9300823/Most-doctors-are-not-paid-six-figure-sums-figures-show.html

Or a more reliable source...

http://www.hscic.gov.uk/catalogue/PUB14924/gp-earn-ex-1213-rep.pdf

That gives a GP Partner an average pay of 92k a year.

However, that's basically turnover for these people. Out of that they have to pay their numerous expenses, such as insurance. Medical defence for instance is just shy of 7k a year which is just one expense they cannot avoid.

Many other costs too. Many have business loans in their partnership to pay for buildings etc. Again, these costs will not be factored for. So it's basically just their income without taking into account any of the expenses they have to shell out to function. That's not to mention staff costs.

Salaried GPs are paid lower amounts as they don't have those business expenses. Therefore, their pay is running at an average of £56,400.

It's important to note that there is something of a crisis in GP partnerships, with most prefering to go down the salaried route.

http://www.pulsetoday.co.uk/your-practice/practice-topics/employment/crisis-point-gp-partner-shortage-hits-practices/20006889.article

If it were the case that you could gain an extra 40k a year for being a partner, most would be wanting to go that way, but you don't. You get more income, but your expenses are much higher, hence most prefering to go down the salaried route and take 40k less a year.

The figures you refer to basically make out a mechanic who owns a garage is on 300k a year as thats what the garage took in in the year. In reality though, he may be on 30k, after all the costs of running a business. It's unfortunate that GP's pay is measured on turnover in this way as it provides public backlash.

jamesd

antrobus wrote: »

Yes, but there is litle evidence that excess winter deaths are the result of lack of heating. Which is what that NICE guideline says if you read it.

I read it before posting here. Where do you believe that the NICE guideline says that there is little evidence that excess winter deaths are the result of a lack of heating? Page number and exact quote please.

What it says among other things is:

"This guideline makes recommendations on how to reduce the risk of death and ill health associated with living in a cold home. ... The health problems associated with cold homes are experienced during ‘normal’ winter temperatures (when outdoor temperatures drop below 6°C), not just during extreme cold weather" (page 1)

"4.5 Interventions to address the health effects of cold homes include:
policy (such as providing free boiler replacements); services (such as local efforts to implement policy and changes to buildings and heating);; and changes made by individuals. (The latter could include loft insulation, double glazing or installing more efficient boilers.)
4.6 The Committee noted the importance of considering cold-related illnesses (as well as deaths from the cold). There is a lack of evidence on the former. However, evidence does indicate that changes in home heating, insulation and temperature can have a beneficial effect on illnesses from a range of causes" (page 22)

Which specifically addresses their belief that there is a relationship between cold homes, hearing and excess winter deaths and illnesses and observes that there is evidence of excess deaths related to cold.

They then make a series of recommendations, note how many of them refer to cold homes, heating and insulation:

1. Strategic planning (covers identifying those at risk from cold homes, assessing how heating and insulation needs to be improved.)
2. Provide a local health and housing referral service for people living in cold homes
3. Provide services via a 1-stop local health and housing referral service for people living in cold homes (covers providing access to insulation and heating, links to the Cold Weather Plan for England which on page 17 says 'In their recent report, The Health Impacts of Cold Homes and Fuel Poverty, the Marmot review team estimated that “excess winter deaths in the coldest quarter of housing are almost three times as high as in the warmest quarter”. with 21.5% of all excess winter deaths attributable to the coldest quarter of housing because of it being colder than other housing"')
4. Identify people at risk of ill health from living in a cold home
5. Health and social care professionals should ‘make every contact count’ by assessing the heating needs of vulnerable people who use their service
6. Others visiting vulnerable people should assess their heating needs
7. Use new technology to help reduce the risks from cold homes
8. Ensure vulnerable hospital patients are not discharged to a cold home
9. Train health and social care professionals to help people whose homes may be too cold for their health and wellbeing
10. Train housing professionals and voluntary sector workers to help people whose homes may be too cold for their health and wellbeing
11. Train heating engineers, meter installers and those providing building insulation to help vulnerable people at home
12. Raise awareness among professionals and the public about how to keep warm at home
13. Ensure buildings meet ventilation and other building and trading standards

The Cold Weather Plan For England notes on page 15 that 53.7% of the excess winter deaths are among those who are 85+ (page 15), so one measure to save lots of lives would be giving this group free winter heating, in addition to schemes that provide insulation, even though that is not medical treatment.

antrobus wrote: »

That would have to be total spending on health care. So the difference would not be available to "deliver other benefits" unless the government raised taxes by $3,600 per capita.

That's the spending difference on healthcare, so if it is desired to have a US system that is the cost increase that could be expected. The money on alternatives doesn't have to be spent by the government. At the moment we get to keep that $3600 per person per year to spend as we wish. That could be on direct health care or it could be on other things.