Would a mixed NHS / Private model work?

Graham_Devon

LydiaJ wrote: »

Rehab after a car accident is not a luxury, and it can be way beyond the means of normal people to pay for.

Putting the car back on the road or buying a new one is way beyond many people too.

That's precisely why people take insurance out.

I'm not saying the individual would pay themselves. Rather they would have insurance to cover the fee based aspect of care. What I'm trying to avoid here is people being left on the side of the road in an emergency should they not have insurance. I never suggested rehab was a luxury (the emotional argument), I'm just stating what I feel the insurance should pick up and the free emergency cover should pick up.

There are indeed endless scenarios which can be bought up in these discussions, and sometimes, we have to seperate the emotional aspect in these debates. Hip Ops are paid for by insurance perfectly adequately all over the EU, so not sure why it's obhorrent to suggest we used the same system in the UK.

If we void everything from being chargeable based on the emotional argument, we end up basically paying for everything, as in every case there will be a scenario where it's unfortunate to charge. So we may aswell keep the NHS. But if that's what we want, we HAVE to face up to paying more tax to keep it running. We also have to accept that a lot of the increase in taxes we pay will be wasted by the few.

LydiaJ wrote: »

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.

Which suggests all the systems in the EU are unworkable? Yet many appear to work well AND be fully funded.

Andy_L

Graham_Devon wrote: »

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

Emergency care is, despite stories of ambulances checking credit cards, free in the US.

Graham_Devon

Andy_L wrote: »

Emergency care is, despite stories of ambulances checking credit cards, free in the US.

Don't beliueve the drugs you may require are, or were, though?

It was a bit like those free servicing offers when you buy a car. Free LABOUR, but you still pay for the parts and consumables (and often over the odds to cover the labour in these cases!)

My take on this is from within the system. I've had to hire a van before now to pick up wasted food replacement shakes because, put simply, there was, by no stretch of the imagination, half a transit van full of packaged bottles of the stuff at a single persons home. That's thousands of pounds sent to the incinerator. One person. I cannot imagine this happening if that one person had to pay (and I had nothing against her, she was basically at the mercy of the pharmacists and didn't have the capcity to make decisions, so just kept taking it in when it was delivered).

Andy_L

Graham_Devon wrote: »

Don't beliueve the drugs you may require are, or were, though?

Everything to stabalise you is free. Anydrugs you'd need for long term recovey (eg antibiotics, pain killers) would be charged.

LydiaJ

Graham_Devon wrote: »

Putting the car back on the road or buying a new one is way beyond many people too.

That's precisely why people take insurance out.

I'm not saying the individual would pay themselves. Rather they would have insurance to cover the fee based aspect of care. What I'm trying to avoid here is people being left on the side of the road in an emergency should they not have insurance. I never suggested rehab was a luxury (the emotional argument), I'm just stating what I feel the insurance should pick up and the free emergency cover should pick up.

There are indeed endless scenarios which can be bought up in these discussions, and sometimes, we have to seperate the emotional aspect in these debates. Hip Ops are paid for by insurance perfectly adequately all over the EU, so not sure why it's obhorrent to suggest we used the same system in the UK.

If we void everything from being chargeable based on the emotional argument, we end up basically paying for everything, as in every case there will be a scenario where it's unfortunate to charge. So we may aswell keep the NHS. But if that's what we want, we HAVE to face up to paying more tax to keep it running. We also have to accept that a lot of the increase in taxes we pay will be wasted by the few.

Which suggests all the systems in the EU are unworkable? Yet many appear to work well AND be fully funded.

But Graham, if people can't afford car insurance, they don't have to have a car. If you can't afford health insurance, then what? It's not an emotional argument, it's a practical one. Hip ops and post accident rehab are not things that citizens in a country as rich as ours should have to manage without if they aren't in a job that pays for health insurance and don't have the means to insure themselves.

I don't know much about the systems in the EU. If you can tell me who pays for the insurance or the hip ops of the poor and elderly, I'll be happy to discuss further. I hear from Generali that in Aus the poor get free treatment, which is what makes me feel that what he's saying is sufficiently well informed and the policy he's describing is sufficiently thought through to be worth listening to.

Most people I read on here advocating a "insurance pays for everything but the emergencies" strategy seem to me to basing what they say on an assumption that everyone can afford health insurance, but that isn't true.

The crucial problem ATM is to do something about the pressure on emergency care. A bunch of 24 hour GP walk in centres to which A&E departments could send anybody they felt would be better dealt with by a GP would help, especially if located in or near hospitals so people could easily be told to go to the other one if they were found to have misjudged the severity of their problems (in either direction).

We also need to so something urgently about social care and elderly care. If people don't have the kind of care they need to cope in the community, then they will clutter up hospital beds and A&E departments, which will cost more than the support would have done if it had been provided. Rethinking the way these things are funded so that there's an incentive to think about these things in a properly joined up way would be a good start.

For example, a friend of mine has a son who was born with cerebral palsy. There was the possibility of an operation to improve his mobility. The op was likely to cost a few tens of thousand pounds, but if done before the age of 5 would very likely improve his condition in such a way as to save the NHS hundreds of thousands over his lifetime. The NHS couldn't do it, though, because the budget that would save money was nothing to do with the budget that would have to pay for the op.

In fact, it was OK. His parents set up a charity and all their friends (mostly middle class people earning middle class salaries) raised the money for him to have the op. It took a few years, but they made it before he was too old to get maximum benefit. But if they hadn't, the NHS would be looking at a lifetime of unnecessarily high expense for his care.

Graham_Devon

LydiaJ wrote: »

But Graham, if people can't afford car insurance, they don't have to have a car. If you can't afford health insurance, then what? It's not an emotional argument, it's a practical one. Hip ops and post accident rehab are not things that citizens in a country as rich as ours should have to manage without if they aren't in a job that pays for health insurance and don't have the means to insure themselves.

In my first post on this subject describing what I'd prefer to see, I stated...

Graham_Devon wrote: »

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.

I must point out, I'd rather see the NHS too, it can be a very good system. However, theres no point burying heads in sands here. It's unaffordable now and some could describe it as in crisis.

Certainly I think it's fair to say it's out of control.

Healthcare in, say Switzerland is insurance based and insurance is compulsory for every citizen. One of the main points of their system is that it's very roots are setup to promote personal responsibility - something which I have touched upon.

The insurance the person has pays most of the cost of treatment, but the person still has to pay a certain amount (dependant on the reason and need for treatment). You can buy either basic, or tiered levels of insurance. So something for everyone. It should be said that Switzerland has the longest life expectancy in Europe. http://www.forbes.com/sites/theapothecary/2011/04/29/why-switzerland-has-the-worlds-best-health-care-system/

I didn't bother replying to the rest of your post considering I'm not worth listening too.... presumably why you mssed out what I suggested about a state funded insurance?

BobQ

michaels wrote: »

Ok, lets be even more provocative.

Suppose I need to go to a&e to get my kids ankle x-rayed in case it is broken. This is clearly not life threatening so the odds are there will be a long wait but the child will be seen eventually. Suppose I was willing to pay £100 to avoid having to wait. The NHS takes in £100 which helps pay fr more staff and does not give my child any extra treatment it just does things in a different order. I am happy to pay as I value 4 hours of my time plus my child not being in pain at least at £100. The NHS benefits, someone else waits an extra 30 minutes as we have queue jumped. Not 'fair' but is the overall benefit worth the unfairness?

Well if you were the mother of a child with a broken ankle who is sitting there in pain how would explain the wait while a few rich people were getting their children to the front of the queue. You see darling, they are rich basta"ds who cannot be bothered to take their turn. Never mind we will get their eventually. It is that kind of conditioning that will cause the child to grow up with a big chip on their shoulder determined to make those rich people suffer when he gets to become a voter......

Or put it another way how will you feel when you have paid your £100 and are then asked to wait because someone else has just come in who is prepared to pay £150?

I grant you it is a model of how to run the NHS, but it is not one I would like to see adopted.

lostinrates

Nothing to stop a bit of waiting room benevolence. £100/£150 for a kid you've watched wait.

If I'm sitting there with a possible broken ankle and my debit card watching a kid who isn't being paid for with a possible broken ankle chances are I'd consider if I could budget for them to go just infront of me.

BobQ

tberry6686 wrote: »

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.

No, the A&E solution is a triage system that tells the GP cases to go to the GP.

I object to a blanket charge at A&E. Of course it might make sense to say that the patient should go to their GP but could be seen as a low priority case in A&E for £200. This would only affect people who were stupid.

Equally a blanket charge to visit the GP is in my view unnecessary. If the GP thinks the patient is wasting their time they should tell them.

PasturesNew

LydiaJ wrote: »

AFAIK, boob jobs are only available on the NHS if (a) your boobs are so heavy they are knackering your back, or causing similar actual health problems, or (b) for reconstruction after having one or both boobs removed for the treatment (or, I think, prevention if you've got the v high risk gene) of cancer etc. You can't just get them resized on the NHS because you happen to fancy it.

https://www.google.co.uk/#q=josie+cunningham