Would a mixed NHS / Private model work?

tberry6686

Something does need to be done to reduce the load on the NHS, especially GP's and A&E. I would suggest £10 fee to see the GP and £20 to go to A&E (except in obvious emergencies).

The last time I had to visit A&E the waiting room was full with a 5 hr waiting time. I was taken immediately (non life threatening injury). When I was speaking with the Doc while waiting for X-Ray I found out that the majority of people waiting were there for things that should be dealt with by a GP visit and so they had to wait when any actual A&E case came in got seen to.

This experience has lead me to believe that the only way to sort this out is to start charging. If you do have a need to see the GP or A&E then you will happily pay it. If you have a minor cold etc then you won't bother, freeing up appointments for people who actually need them.

Carl31

I think a private contribution is needed. £25 for a GP appointment is too much, it needs to be affordable so if someone is genuinely ill they will pay it, but not so high it stops people seeking medical advice


I've said for a while that GP appointments should be charged at the rate of a current prescription, with any prescription cost then removed if treatment is required. That may make people that are not that ill think twice before going, after all if people go now and are genuinely ill, they will expect to pay a prescription charge anyway, so it makes no odds


The NHS is a great idea, but people will always abuse freebies. I think that's a big part of the problem with the UK, yes we have great facilities, welfare, healthcare etc... but at the same time it creates too much abuse and expectation from many. How many people really look after themselves? Those that do, and have to pay to do so, are probably less of a burden on the NHS, yet still pay for it, whilst those that don't so much are probably those in the docs week in, week out

Southend1

tberry6686 wrote: »

Something does need to be done to reduce the load on the NHS, especially GP's and A&E. I would suggest £10 fee to see the GP and £20 to go to A&E (except in obvious emergencies).

The last time I had to visit A&E the waiting room was full with a 5 hr waiting time. I was taken immediately (non life threatening injury). When I was speaking with the Doc while waiting for X-Ray I found out that the majority of people waiting were there for things that should be dealt with by a GP visit and so they had to wait when any actual A&E case came in got seen to.

This experience has lead me to believe that the only way to sort this out is to start charging. If you do have a need to see the GP or A&E then you will happily pay it. If you have a minor cold etc then you won't bother, freeing up appointments for people who actually need them.

I don't think it's as simple as that. Firstly a lot of people don't know the difference between a medical emergency and something that can be treated at home. Secondly it's sometimes so difficult to get a GP appointment that people resort to A&E instead. Charging even £10 or £20 per appointment will just deny access to healthcare for the less well off while giving the better off more sense of entitlement because they are paying.

IMO what's really needed is a big public education campaign about what service is appropriate for various situations and a proper network of local walkin centres where nurses can treat minor ailments or advise on the most appropriate service to use while reassuring patients they won't die if they aren't seen immediately by a hospital consultant.

lostinrates

In_For_A_Penny wrote: »

I'm all for evening clinics taking place in the NHS and in many places this is starting to happen.

However, just because a private clinic takes place in the evening doesn't mean the consultant is not on call for hospital cover.

Presumably the same can be said of some seeing private consultants? Those who are taking health care seriously or valued by their employers in this way are presumably not just 'being cuddled up to' by employers but considered economically beneficial in someway to give this care? Many people in management or roles of 'considerable financial asset' to employers or themselves are often on duty pretty much all the time.

Graham_Devon

IMO we should have an emergency service in the UK which is operated as free at the point of use. Strict guidelines would have to be in place here though.

We also need some other services provided for free, such as drug abuse, alcohol abuse, mental and childrens service. (and probably other services, but this is just off the top of my head)

Outside of that healthcare should be fee based. Everyone should pay for medication (the system currently is wholly unfair) and everyone should pay to see a GP / Consultant etc.

So, in this system, if you are involved in a car crash, the ambulance and emergency care is free and you are patched up. Any rehab after that is charged for.

If you need a hip op, a gastric band, plastic surgery etc it's charged for.

Inssurance would be the obvious pathyway here. For those who cannot get insurance, a version of NI should be bought back to give basic care.

The above is all very very basic, it's in no way a plan, more of an indication of what I'd like to see happening.

The waste in the NHS is collosal, and so much of it is patient led as it's "free" so it doesn't matter.

lostinrates

Graham_Devon wrote: »

IMO we should have an emergency service in the UK which is operated as free at the point of use. Strict guidelines would have to be in place here though.

We also need some other services provided for free, such as drug abuse, alcohol abuse, mental and childrens service. (and probably other services, but this is just off the top of my head)

Outside of that healthcare should be fee based. Everyone should pay for medication (the system currently is wholly unfair) and everyone should pay to see a GP / Consultant etc.

So, in this system, if you are involved in a car crash, the ambulance and emergency care is free. Any rehab after that is charged for.

If you need a hip op, a gastric band, plastic surgery etc it's charged for.

Inssurance would be the obvious pathyway here. For those who cannot get insurance, a version of NI should be bought back to give basic care.

The above is all very very basic, it's in no way a plan, more of an indication of what I'd like to see happening.

The waste in the NHS is collosal, and so much of it is patient led as it's "free" so it doesn't matter.

What about when long term conditions are not prioritised by their sufferers and become emergencies? In some cases this would cost more and lead to more loss of life.

E.g. Thinking you have digestive problems, avoiding the GP or investigations etc and it turns out to have been bowel cancer. Like wise for various other things.

The argument is strong against this way round. Its our emergency service struggling MOST not least, as a route around other areas of healthcare which often fail patients ( for what ever reasons) in their provision. Making it the only free access when we ATM its the most popular access seems a fundamentally crippling move?

Graham_Devon

lostinrates wrote: »

What about when long term conditions are not prioritised by their sufferers and become emergencies? In some cases this would cost more and lead to more loss of life.

It could lead to the loss of life - but I suppose to turn the question around, is your health the states responsibility? Or is it your own responsibility?

Secondly, I'm not sure it would be a huge problem. Afterall, if you had insurance, ignoring symptoms early on would render your insurance void - so people would want to protect that in the same way they want to protect their car warranties by paying for preventative servicing. Insurers would want to pay less earlier on to deal with the symptoms than they would paying a huge bill later paying for the fall out.

Were expected to have standard locks on our doors and to lock them if we wish to take out home insurance. If you don't, in the eventuality of a break in, insurance is void.

Regarding your last point, I suggested a free at point of care emergency system with strict guidelines. Therefore, you couldn't just turn up to avoid paying your GP. An asthma attack for instance would be charged for if there was no history from your GP that you were taking preventors. However, if it were your very first asthma attack and you didn't have a diagnosis of asthma on your records, it would be free.

In the first instance, you knew the risk of not taking medication. In the second, you couldn't have possibly known the risk.

Andy_L

Graham_Devon wrote: »

IMO we should have an emergency service in the UK which is operated as free at the point of use. Strict guidelines would have to be in place here though.

We also need some other services provided for free, such as drug abuse, alcohol abuse, mental and childrens service. (and probably other services, but this is just off the top of my head)

Outside of that healthcare should be fee based. Everyone should pay for medication (the system currently is wholly unfair) and everyone should pay to see a GP / Consultant etc.

So, in this system, if you are involved in a car crash, the ambulance and emergency care is free and you are patched up. Any rehab after that is charged for.

If you need a hip op, a gastric band, plastic surgery etc it's charged for.

Inssurance would be the obvious pathyway here. For those who cannot get insurance, a version of NI should be bought back to give basic care.

The above is all very very basic, it's in no way a plan, more of an indication of what I'd like to see happening.

The waste in the NHS is collosal, and so much of it is patient led as it's "free" so it doesn't matter.

So you want the (pre-ObamaCare) US model which has been shown to be more expensive & not as good as the NHS?

Graham_Devon

Andy_L wrote: »

So you want the (pre-ObamaCare) US model which has been shown to be more expensive & not as good as the NHS?

No - and you can't take that from my one short post. Especially considering I've included free emergency care for all.

I'd rather look at Swiss, French and German models - all which appear to work on the same sort of basis and appear to work very well.

LydiaJ

tberry6686 wrote: »

Something does need to be done to reduce the load on the NHS, especially GP's and A&E. I would suggest £10 fee to see the GP and £20 to go to A&E (except in obvious emergencies).

The last time I had to visit A&E the waiting room was full with a 5 hr waiting time. I was taken immediately (non life threatening injury). When I was speaking with the Doc while waiting for X-Ray I found out that the majority of people waiting were there for things that should be dealt with by a GP visit and so they had to wait when any actual A&E case came in got seen to.

This experience has lead me to believe that the only way to sort this out is to start charging. If you do have a need to see the GP or A&E then you will happily pay it. If you have a minor cold etc then you won't bother, freeing up appointments for people who actually need them.

I think you are wildly over optimistic about people's ability to work out what's "an obvious emergency" and what isn't, and hugely underestimating the variation in the extent to which a fee puts people off going - an amount that's a crippling expense to some is trivial to others.

Graham_Devon wrote: »

So, in this system, if you are involved in a car crash, the ambulance and emergency care is free and you are patched up. Any rehab after that is charged for.

If you need a hip op, a gastric band, plastic surgery etc it's charged for.

Rehab after a car accident is not a luxury, and it can be way beyond the means of normal people to pay for. The repeat plaster casts after a few weeks, the surgery to remove the metal work that was put in the broken bones at the time, etc etc. What happens to the people who don't have the kind of job that pays for health insurance, or don't have a job at all, and can't afford to pay for health insurance for themselves? Or the people who took out the best health insurance policy they could afford and then find the small print doesn't cover the things that they need?

And hip ops? Really? The overwhelming majority of people who need hip replacements are retired. They won't have insurance cover from a job, and on a pension won't be able to afford particularly generous policies either. And they are not the sort of thing people should have to manage without either. I vividly remember a conversation I had with my mum a few years after she had hers, which she had a the age of 74.

Me: I know it was a horrible experience at the time, but looking back, are you glad you had your hip replaced?
Mum: Oh yes. I'd probably be dead by now otherwise.
Me: Dead??? From an arthritic hip??? How???
Mum: Like old Mr W down the road, years ago when you were little. His hip got more and more painful until it was so painful he couldn't walk at all, so he was bedridden, and then he got a DVT and died of it. I think that would have happened to me.

Graham_Devon wrote: »

Regarding your last point, I suggested a free at point of care emergency system with strict guidelines. Therefore, you couldn't just turn up to avoid paying your GP. An asthma attack for instance would be charged for if there was no history from your GP that you were taking preventors. However, if it were your very first asthma attack and you didn't have a diagnosis of asthma on your records, it would be free.

In the first instance, you knew the risk of not taking medication. In the second, you couldn't have possibly known the risk.

Wayyyy too complicated, I'm afraid. The savings in medical treatment would all disappear into a black hole of administrative charges, appeals to the inevitable ombudsman, litigation and so on. If this country is spending money on healthcare, whether it's government money, companies' money on behalf of their employees, or private citizens' hard earned cash, I'd rather it was paying the salaries of doctors, nurses, physiotherapists and the like, rather than offices and offices full of claims handlers.

And what happens to people with dementia who aren't capable of remembering to take their medication?