How does private health care/insurance work?

lessonlearned

Jlawson118 wrote: »

At the beginning of his diagnosis I did think to myself that I know this is one of the worst cancers a person can have and takes many years to grow without the person knowing. It's just annoyed me more how the GPs have turned him away for well over a year. It might not have made much of a difference if this is so far advanced but he still shouldn't have been turned away in the first place. And just seeing him in hospital now, the way the nurses are being towards him and just the general lack of care that seems to be there shocks me. My grandad has worked hard all of his life, paid his taxes and national insurance and then this is how he gets treated? It's all of this that makes me wonder if it's worth going private.

I'll definitely shop around though, thank you

Sorry to hear this. Have a word with PALS. Also maybe contact the Macmillan unit. Plan ahead and look at hospice end of life care. Just watch over him and do all you can to make sure he’s kept comfortable.

ripplyuk

Jlawson118 wrote: »

I just wish I could see a private GP

You don't need insurance to do that. Just ring one up and book an appointment. In my area it's around £80.

MonkeyDr

Hi OP.

Sorry to hear about your grandfather. I don't know the ins and outs of his presentation, but as others have said, pancreatic cancer is most often a terminal diagnosis. Initial symptoms can mimic so many other things that it is not uncommon for diagnosis to be "too late", despite best intentions.

I am an NHS Dr, and in my opinion private cover can have some value, but I would think carefully about what you want it for. I have no idea how much it would cost.

As others have alluded to it is best for situations when you want quicker / more convenient access to something specific and non-critical. e.g. physio for a minor injury, or the ability to schedule an elective procedure or operation at the time that suits you (to fit around work or other commitments). Increasingly (sadly) would also be useful to pay for procedures (e.g. arthroscopy) that are being rationed and delayed due to scarce resources, but as your mum etc already have knee problems a new policy wouldn't cover for these.

I think that the expensive cancer treatments is a slightly grey area: a) a lot of people would pay a lot of high premiums and only very few ever use that bit of the policy - up to you and your attitude to risk, and b) if there is an evidence-base for treatments being beneficial they tend to be available on the NHS. Re the latter I totally accept that there is sometimes a lag between evidence and getting approved by NICE. And that some people might want to pay £100,000 themselves for a 1 in a 100 chance of success when I wouldn't think that that was a good use of public resources.

I don't really know about nursing care in private v NHS hospitals, beyond that you are more likely to be in your own room, with TV and better food etc in a private ward. But being isolated isn't necessarily a great thing for an elderly man your grandfather who is prone to falling over.

I do know that while doctor care is more "consultant led" in private hospitals, that basically amounts at most to the patient seeing the consultant slightly more often (in my NHS specialty all patients are seen or discussed with the consultant twice daily anyway!). The basic doctoring is either done by the same juniors as in NHS (if a private bit of NHS hospital), who will typically go there last on their list as it is out of the way and often their only patient there vs 20 on home ward, or in private hospitals all the juniors (anyone up to consultant) will be ones who aren't in training posts, and by and large (but not always) that = less good.

Further, best practice guidelines for investigating symptoms will be the same in NHS or private. Many investigations carry their own risks of harm and risks / benefit balance always has to be considered. I do not know your medical history but can guess from your previous posts that you are a man in your early 20s, and I am not sure what more you wanted from your GP in terms of your recent chest pain visit? Assuming you are generally healthy it sounds like they have given you quite a reasonable possible diagnosis; things like a heart attack would be extremely unusual. While it is quite possible for people to make mistakes, I have no reason to think that a private GP would have done any different. As with all these things, if it doesn't get better you should go back - ongoing symptoms over a period of time change the likelihood of the possibilities and is important to note in itself.

So, I don't have private insurance. I am 100% certain that in an emergency, or if I were really unwell (admitted to hospital) the NHS would be the best place to be. Again from my own experience, many of the treatments I do in my specialty are simply not available in private hospitals in an acute setting.

If I had lots of money I would consider using private healthcare to buy access to appointments at times that suit me, and quite possibly for things like knee or eye operations that I would eventually get on the NHS but might affect my quality of life while I wait.

MD

BorisThomson

Jlawson118 wrote: »

I may have got the figure wrong, the phone call about my quotes was around a month ago come to think of it, but I've had so much on lately it's slipped my mind for a bit until I visited the doctors on Monday with severe chest pains and he told me it was heartburn :mad: I think I know the difference. I just wish I could see a private GP

If you genuinely had severe chest pains you'd be calling 999 and they'd be blue lighting you to A&E (or straight to cardiac care in some areas). You wouldn't be waiting for a GP appt and then moaning about it on the internet. You wouldn't even be able to get yourself to the GP surgery!

How is the severe pain now? Have you booked a private appointment or sought more help? You'll need a sick note if you have been off sick for a week now.

Jlawson118

BorisThomson wrote: »

If you genuinely had severe chest pains you'd be calling 999 and they'd be blue lighting you to A&E (or straight to cardiac care in some areas). You wouldn't be waiting for a GP appt and then moaning about it on the internet. You wouldn't even be able to get yourself to the GP surgery!

How is the severe pain now? Have you booked a private appointment or sought more help? You'll need a sick note if you have been off sick for a week now.

I'd been awake all night with it, sharp pains in my stomach and chest, just booked an emergency doctors appointment to be seen to within the hour and I was seen to, told it was heartburn which I knew it wasn't. But as he checked everything else and said they were okay, I knew it wasn't anything too serious hence why I didn't call 999 and it was a good job I didn't otherwise it'd be classed as wasting their time. Just like the NHS seem to class everything as.

It gradually eased off as the week went on. Now I am back at work and get the odd twinge. But I think it was just stress related. I've got so much going on at the moment it's unreal

Jlawson118

MonkeyDr wrote: »

Hi OP.

Sorry to hear about your grandfather. I don't know the ins and outs of his presentation, but as others have said, pancreatic cancer is most often a terminal diagnosis. Initial symptoms can mimic so many other things that it is not uncommon for diagnosis to be "too late", despite best intentions.

I am an NHS Dr, and in my opinion private cover can have some value, but I would think carefully about what you want it for. I have no idea how much it would cost.

As others have alluded to it is best for situations when you want quicker / more convenient access to something specific and non-critical. e.g. physio for a minor injury, or the ability to schedule an elective procedure or operation at the time that suits you (to fit around work or other commitments). Increasingly (sadly) would also be useful to pay for procedures (e.g. arthroscopy) that are being rationed and delayed due to scarce resources, but as your mum etc already have knee problems a new policy wouldn't cover for these.

I think that the expensive cancer treatments is a slightly grey area: a) a lot of people would pay a lot of high premiums and only very few ever use that bit of the policy - up to you and your attitude to risk, and b) if there is an evidence-base for treatments being beneficial they tend to be available on the NHS. Re the latter I totally accept that there is sometimes a lag between evidence and getting approved by NICE. And that some people might want to pay £100,000 themselves for a 1 in a 100 chance of success when I wouldn't think that that was a good use of public resources.

I don't really know about nursing care in private v NHS hospitals, beyond that you are more likely to be in your own room, with TV and better food etc in a private ward. But being isolated isn't necessarily a great thing for an elderly man your grandfather who is prone to falling over.

I do know that while doctor care is more "consultant led" in private hospitals, that basically amounts at most to the patient seeing the consultant slightly more often (in my NHS specialty all patients are seen or discussed with the consultant twice daily anyway!). The basic doctoring is either done by the same juniors as in NHS (if a private bit of NHS hospital), who will typically go there last on their list as it is out of the way and often their only patient there vs 20 on home ward, or in private hospitals all the juniors (anyone up to consultant) will be ones who aren't in training posts, and by and large (but not always) that = less good.

Further, best practice guidelines for investigating symptoms will be the same in NHS or private. Many investigations carry their own risks of harm and risks / benefit balance always has to be considered. I do not know your medical history but can guess from your previous posts that you are a man in your early 20s, and I am not sure what more you wanted from your GP in terms of your recent chest pain visit? Assuming you are generally healthy it sounds like they have given you quite a reasonable possible diagnosis; things like a heart attack would be extremely unusual. While it is quite possible for people to make mistakes, I have no reason to think that a private GP would have done any different. As with all these things, if it doesn't get better you should go back - ongoing symptoms over a period of time change the likelihood of the possibilities and is important to note in itself.

So, I don't have private insurance. I am 100% certain that in an emergency, or if I were really unwell (admitted to hospital) the NHS would be the best place to be. Again from my own experience, many of the treatments I do in my specialty are simply not available in private hospitals in an acute setting.

If I had lots of money I would consider using private healthcare to buy access to appointments at times that suit me, and quite possibly for things like knee or eye operations that I would eventually get on the NHS but might affect my quality of life while I wait.

MD

I guess there's pros and cons about both the NHS and Private. Though my recent visit wasn't anything too serious in the end, I went because I was worried about the pains in my chest because they were unusual. There probably wasn't anything more the doctor could have done, but my point raised earlier about my grandad and what they seem to do with everybody is that they just make no effort with patients even when they return numerous times with the problems ongoing.

I know there's not a lot they could have done with my grandad's diagnosis, but had they not been turning him down for over a year there might have been some kind of treatment available for all we know, but again, we don't know how the outcome would have turned out, but my point is that he kept persisting them about his symptoms and yet they did nothing. Just by the off chance he saw a Locum doctor who sent him for a scan and they found it. I've been going constantly for the past 18 months about constant headaches and dizziness and they just repeatedly tell me it's stress so I've stopped trying.

In 2014 I was having stomach problems myself, about 3/4 stone in weight dropped off me within a couple of months. And yet all they did were try me on as many tablets as they could.

I guess my problem is with my local doctor's surgery and not the NHS itself

BorisThomson

Jlawson118 wrote: »

I'd been awake all night with it, sharp pains in my stomach and chest, just booked an emergency doctors appointment to be seen to within the hour and I was seen to, told it was heartburn which I knew it wasn't. But as he checked everything else and said they were okay, I knew it wasn't anything too serious hence why I didn't call 999 and it was a good job I didn't otherwise it'd be classed as wasting their time. Just like the NHS seem to class everything as.

It gradually eased off as the week went on. Now I am back at work and get the odd twinge. But I think it was just stress related. I've got so much going on at the moment it's unreal

You got an appointment with an NHS doctor within an hour and you still moan?!! Acid reflux can be stress related. What more did you want the doctor to do?

One wonders why you need a doctor when you think you know better than them.

Next time you're ill book a private GP appt, ask for a referral to a specialist and make sure you get every test you feel you need. Then report back to us with the cost. Paying for yourself will give you an idea of how valuable the NHS is, and how they don't have the resources to deal with people making spurious self diagnoses.

Jlawson118

BorisThomson wrote: »

You got an appointment with an NHS doctor within an hour and you still moan?!! Acid reflux can be stress related. What more did you want the doctor to do?

One wonders why you need a doctor when you think you know better than them.

Next time you're ill book a private GP appt, ask for a referral to a specialist and make sure you get every test you feel you need. Then report back to us with the cost. Paying for yourself will give you an idea of how valuable the NHS is, and how they don't have the resources to deal with people making spurious self diagnoses.

I didn’t diognose myself. But I can tell the difference between heartburn/acid reflux than chest pain. Yes after a week I know the chest pain wasn’t anything serious but the doctor could see himself I was in a lot of pain and he just shrugged his shoulders at me. I get heartburn quite often and this wasn’t heartburn. I don’t know what it was, but I know it wasn’t that.

I mentioned chest pain though. You haven’t responded to many of my other problems I’ve constantly visited the doctor about. Constant headaches and dizziness. And even carpel tunnel syndrome in my hand. That the doctor himself told me I had. But to treat it myself. And self treatment isn’t working. As far as I’ve always known, carpel tunnel syndrome requires an operation, as I’ve known many people go through it.

indiepanda

I've had private healthcare through work since I started, when I was younger I went years without claiming but I've used it a few times in recent years and I don't think I would have got some of the treatment at all on the NHS based on friend's experiences of trying to access things like physio and CBT on the NHS - the waiting lists are so long they restrict access to those in a more serious condition.

However, you can't use a private medical insurance policy to replace the NHS. Firstly I've yet to come across a PMI policy that covers private GP access. I use a private GP service through work, but I pay separately for that and it's not something my previous two employers provided. Also there's no such thing as emergency treatment in private health care - if you need A&E that will always be the NHS. Most critically, and not everyone realises this, private health insurance policies typically cover acute conditions only not chronic. They will cover the initial diagnosis and stabilising of a chronic condition and acute flare ups but not the ongoing management.

Useful guide to PMI here:
https://www.moneyexpert.com/private-medical-insurance/private-medical-insurance-chronic-conditions/

MonkeyDr

Jlawson118 wrote: »

I didn’t diognose myself. But I can tell the difference between heartburn/acid reflux than chest pain. Yes after a week I know the chest pain wasn’t anything serious but the doctor could see himself I was in a lot of pain and he just shrugged his shoulders at me. I get heartburn quite often and this wasn’t heartburn. I don’t know what it was, but I know it wasn’t that.

I mentioned chest pain though. You haven’t responded to many of my other problems I’ve constantly visited the doctor about. Constant headaches and dizziness. And even carpel tunnel syndrome in my hand. That the doctor himself told me I had. But to treat it myself. And self treatment isn’t working. As far as I’ve always known, carpel tunnel syndrome requires an operation, as I’ve known many people go through it.

I appreciate that your chest pain was more severe / different to what you have thought of as heartburn before, but that really doesn't mean that it wasn't some sort of gastro-oesophageal reflux, so I am not really sure what you mean. The reflux could be in a different anatomical location, or there might be greater acid imbalance etc etc, giving different symptoms. I have had a bit of heartburn intermittently over the years, but the reflux I got late in pregnancy felt like something else entirely. You really can't say with certainty that what you had wasn't just further along the same spectrum.

Further, it still sounds to me that your GP treated you entirely reasonably for your chest pain. When faced with a patient with a new symptom you first try and exclude the really serious stuff (by history / examination / whatever). You think about what is most likely in that demographic with those symptoms, and are frequently left with being pretty certain that whatever it is is benign, but not really sure what the exact diagnosis is. Depending on the history and examinations findings, heartburn (or reflux, but they are just different names for the same thing) or stress-related would be top of my list for a young healthy man. In my experience most people prefer a putative diagnosis of something physical to being told that it is likely stress. In either case, watching and waiting (maybe with some gaviscon) is entirely sensible, and, as expected, you got better. As I have said previously, if it persisted or got worse that is relevant in itself and you would return.

And I don't really see how the headaches and dizziness are particularly relevant to the chest pain, unless you suspect that they are all stress-related. I bet your GP thinks that is a possibility if they have found nothing sinister. As i have said earlier (and on other threads) investigations have side-effects and consequences and should only be ordered in the right circumstances.

There are lots of things in medicine that we don't know or don't fully understand. Maybe in 50 years there will be well-recognised disease called Jlawson118 disease, comprising of all your symptoms, and we will know the underlying pathophysiology (what causes it) and how to fix it. Lots of people right now could be ill from it, but because the investigations we have right now don't detect it they don't help us. No point doing a CT scan of your head when we don't really know what we are looking for (1 in 1000 CT scans gives someone cancer).

I know that uncertainty is difficult, especially when you have a really sick relative and very reasonable worries about your own health. But I really think that the NHS has been perfect for your chest pain: seen very quickly, checked over and serious things excluded, so you were reassured and it got better. Lack of certain diagnosis doesn't really matter in this instance (and I still think it could have been heartburn or similar anyway).

I am not a carpal tunnel expert (not GP or orthopod), but I think that surgery is indicated in some cases. If it is getting worse / conservative measures (splint? avoiding trigger movements etc?) not helped then go back and see GP non-urgently. I bet there will be a standard referral pathway. Have a GP appt only on that; it is possible that with your multiple symptoms it may have got buried a little, and GPs have to focus each appointment and can't possibly deal with multiple things properly in just a few minutes.

And I am sorry again about your grandfather. Please be reassured that even if he were diagnosed earlier pancreatic cancer is a real nightmare, and full cure is rare (and involves extensive life-changing surgery that i probably wouldn't want for myself, let alone someone elderly and frail). It may even have just meant more months of living with a cancer diagnosis and going through gruelling treatments, not more months of living a full and happy life.
(Interesting and difficult concept that earlier cancer diagnosis isn't always good: only beneficial if affects outcome. diagnosis in Jan and death in December = a full year of cancer, and debilitating chemo etc. Diagnosis July and still death in December = same ultimate outcome but less time knowing about the cancer and fewer treatment-related side-effects).

Nonetheless, I am all in favour of medics being questioned if potential error made or something missed. For now, just spend time with your family. Afterwards you might want to consider asking for GP notes to be reviewed etc, or for a meeting to discuss to see if anything could have reasonably been done differently. Ask the practice manager for the process. Be prepared for the answer that everything was in order (sometimes people are just unlucky), but if you think that's not the case there will be a way to escalate.

I digressed.
Best wishes

MD