Problems with UK National Health? Inquiring Yank Wants to Know.

A good read Jim. Towards the end of the report our Health minister(Hunt) says overseas freeloaders are costing the UK 500 million a year. Nothing to add.

Mista H

Mista,

The figures are highly disputed......

http://www.theguardian.com/com...h-tourism-propaganda

http://www.newstatesman.com/po...s-its-not-£2bn

£60 - £80M here.....these days that is not a lot and how much would it take to operate and mange the scheme?

I'm not taking sides here, just pointing out that the scale of the problem is not properly defined.

David,

A very practical and workable solution.  Very inventive.

Regards

Jim

The proposed solution to curb health tourism sounds a lot like the system used in the US during the days of mass immigration. The shipping lines would health check the passengers before they were allowed to board the ship.

However a bit of humanity does  have benefits.

Although there maybe some resource & cost issues due to health tourism you can’t blame these people coming over here to be cured if no opportunity for help exists in there own countries, and at least these people have real health issues that need fixing. What they cost the tax payer is slight compared to the ever growing percentage of UK citizens who have elected a very unhealthy lifestyle choice for themselves causing many billions of pounds worth of expense with obesity, drug addiction, alcoholicism, and the shirkers who waste GPs time by swinging a leg. These are probably the biggest reasons by far the NHS is overburdened.

Debs

Hi Russ

No, the NHS EMPLOYS 1.5 million people, including 147,000 fully-qualified doctors.

Everyone here (out of a population of about 62 million) is entitled to use the NHS, and the vast majority (99.99%) do at some point. Foreigners in the UK are entitled to free emergency  treatment if their accident or emergency occurs while they are here.

Foreign nationals also receive free treatment if they have been legally resident in the UK for 12 months, have recently arrived to take up permanent residence, are claiming asylum or have other legal resident status. Citizens of European Economic Area nations, as well as those from countries with which the UK has a reciprocal arrangements, are also entitled to free treatment by using the European Health Insurance Card.^] Foreign nationals usually have to undergo an interview before non-emergency treatment can commence. Patients who do not qualify for free treatment are asked to pay in advance, or to sign a written undertaking to pay.

Treatment for injuries caused in a road traffic accident is chargeable (usually to an insurance company) Patients are involved in the charging process even though they are not personally billed for treatment - the bill goes to the insurance company.

A few rich people opt out of the system and exclusively use private healthcare; others have some form of private cover - usually provided by their employer - and use it for non-urgent treatment, or treatments which have waiting lists (eg hip replacements and the like).

According to the UK government, the NHS treats 1 million people every 36 hours. There were 14.9 BILLION hospital admissions in 2009/10, so you can see the scale of the operation.

I wish everyone who thinks the NHS is rubbish would stop using it. That would be of some help to those of us are proud of it and treasure it. But not much help, because the UK private sector is full of staff who are NHS trained, appointed, accredited, educated and pensioned. So perhaps if everyone eschewed the private sector our clinicians would be obliged to work full time for the NHS again.

Health Tourism, or whatever people want to call it, is a trivial diversion.

Under Blair the NHS paid for people to have treatment abroad-losing those funds to the UK health economy by the way.

Successive governments have ignored the debate and so is this thread. We cannot afford all the heath care we might aspire to. We can fiddle round the edges with 'efficiency savings (cuts to you and me) but that basic fact remains-and is the same in every developed nation. It is time not for reform or re-configuration but an honest apolitical debate that includes all the vested interests in medicine and pharma and, crucially, the population at large. That debate needs to define what we want a modern NHS to cover, and what it will not.

At the moment we still labour under the delusion we can have it all, and somehow not really pay for it. Throwing money at the NHS is absolutely not what I suggest-more medicine is often bad medicine (see the USA) but we have to define the priorities and fund them properly. We also have to say that some things cannot be NHS funded in future. I hate saying that because it feels alien to my philosophy but I see no alternative.

Bruce 

Thanks for the information, Kevin.  I read that wrong--need to take a dumbass pill.  Another question: In addition to the relatively wealthy who self-insure, are there any in-betweens? In other words, is it legal for an employer to pay, say 2/3 of an employees private insurance, he or she paying the remainder, and see whatever private doctor he wishes--covered by the plan, of course?

Best regards,

Russ

Employers pay the full amount of the medical insurance. The payment is classed as a benefit, the employee pays income tax on the benefit.

Russ

It is hard to see the UK system through US eyes.

Private health care here is almost always seen as a luxury add-on, and mostly for elective care. I advise many of my patients that the NHS will usually give them better care in urgent and emergency situations. In the UK it does not encompass Primary Care either (to any meaningful degree). Generally you cannot access a private specialist 'of your choice' unless you get a referral from your GP. This saves a huge amount of costs in the system and over investigation and over-treatment that is so endemic in the USA because I act as a filter and can sort simple issues, and hopefully make sure they see the right speciality if they do need a referral.

The key difference is also that you can be 'insured' to the hilt but you never lose your right to NHS care. So the systems are 'complimentary' rather than in parallel.

Hope that makes sense.

Bruce

The main benefit, as far as I'm concerned of private health care, is the food is immeasurably better.

I don't know, really; why should you? Perhaps because a trivial cost might have a positive humanitarian outcome. Perhaps because there are other scams that are costing far more and deserve intervention more than this one. Perhaps because the cost of preventing it would far outweigh the benefits?

Bruce,

I advise many of my patients that the NHS will usually give them better care in urgent and emergency situations.

Not only that but most private insurance won't pay for emergency care.  In the last 6 months my retina has detached twice (my insurance company would not and could not cover that eventuality) and the treatment I got got in Aberdeen Royal Infirmary and in particular from my consultant was first class.  

The first time i met him I thought he was an arrogant arse...how wrong could I be - he was a star as were most of the ward staff (apart from one really grumpy staff nurse!).  Unfortunately he has now moved on to a new job in Warwick and I will have get to know a new surgeon when I next visit the eye clinic and with another op ahead to remove the silicon oil that is currently replacing the vitreous fluid in my right eye I'm not looking forward to having start again with someone i don't know.  Dod's law in this case I guess.

On another note, having lived in the US for 12 years I have pretty good experience of both the NHS and the US private health care system.  While I do agree with Bruce regarding the "over treatment" than can happen in the US, I do miss the speed of access to quality healthcare and I haven't quite adjusted back to the UK system and NHS waiting times although BUPA does provide a bridge for me if needed.

Interesting dialogue/debate.

Regards

Jim

Until you have experienced a problem with the NHS, it is a rather glib comment you make. 

When i got cancer a few years back i had my 1st 4 ops in my local hospital,and the place was a total frigging joke. i was then lucky enough to get a transfer to the Royal Marsden and the treatment i got was superb. The 2 hospitals were worlds apart as far as quality of care.

Mista h

I have experienced issues with NHS treatment. I have also experienced top quality service and care from the NHS. If my observation is glib I think it's a damning indictment of so called journalism and on that score I'm happy. The private sector makes a vanishingly small or non existent contribution to the training, qualification, in job development and career structure of nurses, practitioners and clinicians. Can't think of a private medical provider that does pre clinical training or PGE education. If they had to underwrite the true cost of harvesting and maintaining the tallent they bleed out of the NHS they would be out of business quickly.

Of course, there are other ways of making the NHS more efficient. We can start by turning falling down drunks away from A+E departments. Or refusing to treat all those expats who minimise their tax requirement to the UK Treasury, complain about the shit hole they left behind and rubbish the NHS, yet come galloping back at the first twinge. Glibber still perhaps, but still comfortably ahead of the drivel printed in the media. I can't believe so many people still read newspapers.

Interesting information.  I definitely agree that it is difficult for people in different countries, used to different delivery systems to understand each other.

I sympathize with the notion that persons who do not pay into a system should be able to take advantage of it and then leave without paying a dime farthing. 

Highlander: Man, I know what you went through.  My wife had a total of 5 retinal separations, in both eyes.  She ended up with silicone bands around each eyeball and a blind spot in her left eye where the retina became overly thin.  She too had an outstanding specialist who literally saved her eyesight.  So she and I know how frightening that must have been for you.

In the U.S. we have two Federally run health care systems, one for veterans under auspices of the Department of Defense (mainly for active duty personnel) and the Department of Veterans Affairs (for Veterans).  I worked for the latter agency off and on for over forty years--in I.T., not actual health care.  And to be fair, some of our medical centers were outstanding and some--especially those in inner cities, were atrocious.  I considered the wide variety in quality itself to be atrocious and I note some of that in comments about the NHS.  Again, to be fair, the comment that some bad stuff happens in any huge organization is correct.

One problem with the U.S. system is that we could easily combine the two systems I mentioned above, but both groups of patients scream whenever that is mentioned.  So we keep both and lose a great deal of efficiency.  (This is mirrored by the fact that in our government, there are many scores of agencies but all staffed with employees paid in the same grade levels--and each agency pretty much has its own payroll system.  Ah me.

Best regards,

Russ

Mista h

Your comments are exactly what I would expect from someone who reads the Daily mail or any other tabloids.

Regards

Not entirely correct. My private company provided specialist clinical rehabilitation care to the NHS under contract and us, like many other such organisations, were responsible for the recruitment, training and ongoing education of our staff. Indeed, our clinicians regularly trained their NHS colleagues in various aspects of our work. 

The NHS is a wonderful organisation and we should treasure it perhaps more than we do. I'm all for increasing the funding but I have concerns around exactly how additional money is spent and it never ceases to amaze me how much resource is swallowed up by inefficiencies within the various management structures. I have the deepest respect for many of the people I dealt with in the Trusts but there was a disturbing lack of accountability at senior levels. This resulted in staff who were quite frankly incompetent being moved around within their organisations to positions where it was supposedly felt they would do the least harm.

Under the Freedom of Information Act we tried to ascertain the costs of certain NHS services but in each case the answer was "We don't really know". Personally I find this worrying and, given the pressing need to ensure the NHS is appropriately funded, unacceptable. It would also help the situation if the NHS didn't have to suffer the continual, ill-informed meddling from political parties of any flavour which deflects resources into continual reorganisation.

Give it a rest, you're beginning to come across as very left wing and anyone with any other opinion is not allowed a view point.

Thanks for that Tony. I don't think anyone can be entirely correct with something as complex as the NHS and I appreciate the clarification. It's always going to be a political animal and it's never going to run in a straight line for long. I think that the private health picture in the UK is a bit of a con. It is for the greater part staffed by NHS personnel who leave their NHS posts across the road (or sometimes in the same location) for half a day or half a week so that the people who pay for their careers can be charged for providing services they have made unavailable or in short supply by walking across the street. 

£500 to see a Neurologist immediately or wait six months. Same Neurologist, same facilities, it's just that he does four private clinics a week and four NHS clinics a week - at the same location. That's a get rich scheme in my book. He pays the Trust to use his facilities for private consultation, but why not just run more NHS clinics? Wait four months for a CT scan or pay £800 to have one next week. Same NHS location, same scanner. A diabolical abuse of patients in need. £500 for a consultation and minor op for cosmetic surgery in a private hospital. That's fair in my book. A privately run treatment centre which is contracted to take NHS patients for elective investigations and surgery also seems entirely practical. 

We don't know what we've got until it's gone or broken beyond repair. We are closer to losing the core 1948 principles of the NHS than we have ever been. If the moaning seems loud now, just wait. At the end of the day I suppose that we get what we deserve. The private sector has access to a huge pool of talent and experience at bargain acquisition and ongoing development costs. If they had to bear the cost of what the NHS (and general taxpayer) pays to make a fully formed Consultant, Midwife, Sister, etc and keep them in post and trained, what would the health insurance premiums be like? And regardless of that we are all still paying twice. One for the price of two (or more). 

If the private sector runs so much more efficiently than the falling down NHS it's not because of a lack of clinical talent or facilities. So that leaves administration and management. Let's drag all these clever people over into the NHS. It didn't work in the 80s but we're much wiser now. Sorry, getting glib again - but I am just a regular simple punter. 

LOL

Nothing wrong with the Daily Mail sunshine. Other half also enjoys reading it,and she is an extremely inteligent and clever person.

Mista H

My own view is that, conservative or liberal-progressive, in order to maximize one's comfort level, one should take one's news and views only from sources which one can be reasonably certain will comply with their own established opinions.  Then, when one is forced to assume the position thrust upon them, as it were, by either the opposition--or for that matter, their fellows, they might not even notice the growing pressure and subsequent abrasion in their lower abdominal areas. 

Best regards,

Russ