Thursday, 17 March 2011

Privatising the NHS isn't as bad as it sounds

In the early morning and every now and then in the car, I actually manage to hear some snippets of radio. On it, I've often heard people spouting off about the 'cuts to services' the government has had to implement. (They're not exactly cuts to services anyway, they're cuts to budget, which some councils apply badly - don't get me started). Anyway, everybody seems very concerned at the spectre of using private provision in the NHS. Once I signed a petition to stop parliament from passing an extremely silly law about internet safety and privacy, and now the same organisation keeps contacting me to sign more petitions. Sadly, I haven't agreed with them since, and the same goes for their latest petition to stop the reforms to the NHS. I say bring it on!

I'll shortly describe the system I grew up with (not in England). Basically, all doctors, including GP's, specialists, and some complementary therapists are self-employed. They are paid by each patient they see. Apart from a small set fee (which can vary depending on the service), the patient can recover the cost immediately by sending the receipt to their health insurance provider. For large bills (like hospital stays) you do not have to pay up front. You get a bill afterwards, which you pass on to your insurer. The health insurance providers are private companies but the minimum cover and its price are controlled by law and every person is required by law to have health insurance. There are no restrictions or higher fees for covering people with chronic conditions or high risk. The insurers are supported by government subsidy but they are in real competition with each other, so they offer very good basic and extra cover for quite low prices.

With this system, every patient can access any level of healthcare whenever they like. They are free to choose whichever doctor they wish to see, and can self-refer to a specialist if they desire although the fee is lower when referred. As the doctors get paid by patients, they have an interest in seeing as many of them as possible and treating them as well as possible. The money comes from subsidized health insurance, but the patient decides who gets paid! You'll find you're not rushed out the door because if you're not happy with their bedside manner and/or clinical outcomes, you are completely free to go elsewhere. You do not have to be registered with a GP and most doctors have open surgeries so appointments aren't required. But they are readily available when wanted, because that's good service. There's usually a slight surplus of doctors so the bad ones lose out.

This health system is freely accessible and very patient centred. You have to pay at point of access but can reclaim all but a token sum. The only problems it has at the moment is some difficulty in getting full medical information on a patient to be available to all medical practitioners who treat them, obviously a result of patient choice and mobility. This is being improved through a computerized central registration system. Another problem is over-treatment. Usually not a problem for the individual patient who tends to benefit from extra attention, if only for peace of mind, but more of a problem from a budget point of view. All these medical interventions are subsidized by the state, so the healthcare bill goes up quite high.

The NHS is believed by the English to be a noble institution that provides healthcare to all, regardless of ability to pay, a bastion of equality, well worth the tax money spent on it. Except it's not. Everybody pays a lot of tax to run the NHS, which treats anyone and everyone for free, badly. If you want to be treated well, you pay extra to go private, in essence paying twice to get the care that you were supposed to get on the NHS but didn't. In reality, England has a two-tier health system where good care is only available to the rich. How exactly would using a private but state-supported system such as I described be a bad thing? With that system, everybody has access to the best doctors because they earn the same set fee from seeing and treating any patient, rich or poor.


  1. Sorry have to disagree with you on this one, and I'll also try to not get you started on service cuts as its quite obvious we wouldn't agree on that either. Other to say you seem to be making wide sweeping assumptions about councils behaviour, which from my knowledge are unfounded. I would have some respect if the cuts where had been decided from a review of each councils current efficency, instead of punishing those councils that are more efficent than their peirs by hitting them just as hard.....sorry i'll get back on topic now.

    Although the other system you describe has a lot of plus points. It has many negative points. As you point out privatisation would lead to profit driven care. For example my father fell ill on holiday, underwent hundreds of tests and than treatment for a heartattack. On return to the UK he found out he had not had a heartattack but only had complications from his asthma medicine and the doctor said this would have been obvious from the first batch of tests. So he had been subjected to hundreds of unnecessary tests and treatment, and also had the worry of thinking he was seriously ill just to boost his medical bill. This than drives increased insurance costs. Many people don't seem to get that by the NHS being centrally funded and controlled, means this sort of profiteering does not happen.

    On your other point i have personally had nothing but exemplary service from the NHS and no at least two people who where treated by world leaders in their field for life threatening illnesses on the NHS. Hardly a two tear system.

  2. I find sometimes it's hard to explain how much better service is (and conversely, to people at home how much worse it is). For example, if I'm feeling poorly and my GP feels I need a blood test, I have to get up early the next morning to go to the phlebotomy clinic at another location who will draw my blood on a first-come-first serve basis, so I can't plan for how long that will take. Then they send the blood to a lab at a third location, who will take their sweet time getting the results back to my GP. Then I have to manage to get another appointment because they won't tell me on the phone.
    In my home country, I can show up at any GP I choose, see them without an appointment within hours, they will take my blood themselves and a non-urgent lab result can be back by tomorrow.

    Even when the NHS is doing everything 'right', that level of service they don't even aspire to achieve.

    I did admit that there is some level of overtreatment, but in most cases, as a patient, that is well appreciated. Although your father's case seems an example to the contrary. However, it does not significantly raise the insurance bill directly for patients because the insurance fee is kept low by government rules. Also, because everybody is legally required to have insurance, the companies have a guaranteed large customer base, most of whom will be quite healthy, so it even makes economic sense. Of course, government money is raised through taxes so it comes from the people anyway. As the NHS goes, we already spend so much on it in taxes, and it seems that budget ought to be sufficient for better service than we are getting.

    Glad to hear you get good treatment. My experience is different. If we had not insisted on getting Kirk looked at privately, he would have been diagnosed with depression and they probably would never have noticed he had Addison's until he had a severe crash, possibly discovering their error post-mortem. His condition is so rare, they refuse to test for it because it is statistically unlikely.
    For myself, less serious, but I have had medically prescribed orthotic insoles all my life, until I moved to England, where the GP told me to take a paracetamol for the foot pain and go home. I pay for insoles privately now.
    So for us, definitely a two-tier system. If we want care, we pay for it twice.

    That said, I am quite happy to be living here as the work prospects are better and my kids go to an excellent school!

    By the way, I do like your point about efficient councils. It would be more fair to cut budgets only for real wastrels.

  3. Thanks for your response. These sorts of discussions tend to degenerate quite quickly into arguments. Its quite refreshing to have someone keep it quite firmly in discussion territory (Again thanks.)

    Particularly on excepting my point about efficient councils being hit just as hard if not harder than wastrels. Most on the right wing side of the argument will not accept that there may be efficient (or at least more efficient) councils.

    It is a very interesting system your home country had. I would argue the point that the difference between forcing someone to pay insurance premiums and taking tax to that same amount is psychological.

    Something that was highlighted for me recently, A man who bemoaned the inefficiency of his council, that he had to separate his rubbish for recycling took the decision to pay for private collection of his refuse and was more than happy with the service. When asked how much he was paying for this service he smiled winked and said "Why only £50 per week." He was not happy when it was pointed out that not only was the cost of this private refuse collection around 3 times his council tax bill, but that refuse collection is only a marginal part of what your council tax pays for. As you can see a lot of people would rather pay double for the same services as long as this was a payment not a tax.

    I think i would be interested in seeing how the system you describe would impact service levels and cost though. Unfortunately i would argue this is not what the Tory's are implementing. They are doing nothing more than opening the NHS up to private industry to bleed profit from it. Instead of tiers of bureaucrats soaking up front line money we instead will have plutocrats leaching it away. As many Tory MPs have said they see universal healthcare as communist or even evil and something to be disposed of. They want a system where those that are to sick or to poor to afford treatment remove themselves from the surplus population.

  4. On a complete side point, and feel free to tell me to mind my own business. Do you do ok from your ads? I try and click every-time i visit.

    I personally am not doing to good from them, i get decent page views for a small blog in its early days but that doesn't seem to convert into ad clicks?