Reform Of The Nhs

[Anna B]

3 hours ago, Baron99 said:

The main issue with the NHS is that it is still using the same business / funding model from when it first started back in 1948 & even then it was clearly going to become a continuous financial black hole that we have to keep pouring money into. 

 

It started with 144,000 staff with a budget of £130 million to treat a population of around 50 million, the majority of which were lucky, if they saw their 65th birthday.  By 1950 the budget was already at £400 million. 

 

Today the budget is around £135 billion with a staff of 1.4 million to treat a population of 67 million who, although we're living longer, are generally in better nick than our ancestors as only around 15% die before we're 65.

 

As with all public bodies, there are vast amounts of money wasted.  That sort of waste could be tackled from today & then let's see how that money could be reallocated to other areas of the NHS? 

However, as the NHS knows that the taxpayers money will still role in regardless, there is no urgent compulsion to tackle wasted money & resources. 

 

I think we all agree it badly needs reform. I just don't want to see it go down the American route. (Why do we always look to America as the best example in all sorts of things?) 

As Harvey 19 says on another thread, there are many more Health services and systems in other countries that we could examine and learn from. I'm all for that.

[L00b]

1 hour ago, Anna B said:

I think we all agree it badly needs reform. I just don't want to see it go down the American route. (Why do we always look to America as the best example in all sorts of things?) 

As Harvey 19 says on another thread, there are many more Health services and systems in other countries that we could examine and learn from. I'm all for that.

The first and main item of reform that you should be considering, is decoupling ‘free’ from ‘point of use’, because that is how free health services have been working in most other OECD states for a long time, and why/how they are ‘better’ managed.

 

You can keep it free. But you need to relieve some of the cashflow strain on the public purse, and disincentivise serial system abusers and assorted other hypochondriacs. So make it payable -even if only token in amount according to set scales- and refundable after-the-fact. In full, if you want it to be fully free. Else in part according to capacity, again as is done in most other OECD states. So obviously, with some form of verified means testing, to maintain access for the poorest. PS: that also implies personal identification, as in a standard ID card, to mitigate against fraud.

 

Some of Econoob’s earlier arguments were also on point, as in scale down the volume and type of electable procedures (“boob jobs for breast cancer patients only, not psychologically-fragile 15/20/30/40- somethings”) and responsabilise users (“Want to jump off your roof for a TikTok? Better get health insured first and check the small print, cos the taxpayer ain’t paying for that one”).

Basically, start charging for idiocy. Think of it as a Darwin Award tax.

 

Bonus point: with the transactional implementation done, you’d also soon put a stop to the copious volumes of expats living and paying tax abroad, coming back for a loud-ish op free on the NHS whenever needed.

Edited November 22, 2022 by L00b

[Anna B]

3 hours ago, L00b said:

The first and main item of reform that you should be considering, is decoupling ‘free’ from ‘point of use’, because that is how free health services have been working in most other OECD states for a long time, and why/how they are ‘better’ managed.

 

You can keep it free. But you need to relieve some of the cashflow strain on the public purse, and disincentivise serial system abusers and assorted other hypochondriacs. So make it payable -even if only token in amount according to set scales- and refundable after-the-fact. In full, if you want it to be fully free. Else in part according to capacity, again as is done in most other OECD states. So obviously, with some form of verified means testing, to maintain access for the poorest. PS: that also implies personal identification, as in a standard ID card, to mitigate against fraud.

 

Some of Econoob’s earlier arguments were also on point, as in scale down the volume and type of electable procedures (“boob jobs for breast cancer patients only, not psychologically-fragile 15/20/30/40- somethings”) and responsabilise users (“Want to jump off your roof for a TikTok? Better get health insured first and check the small print, cos the taxpayer ain’t paying for that one”).

Basically, start charging for idiocy. Think of it as a Darwin Award tax.

 

Bonus point: with the transactional implementation done, you’d also soon put a stop to the copious volumes of expats living and paying tax abroad, coming back for a loud-ish op free on the NHS whenever needed.

Personally, l am not against some sort of reasonable 'token ' payment, but l think people are scared of where it will lead.

When people see how much they have to pay for dental treatment, and are reduced to selling their houses to pay for social care you can't blame them. Remember charges for prescriptions started at less than £1 but are now around £10 an item. The doctors dish pills out like smarties and 3 or 4 items soon add up.

 

Boob jobs are not available on the nhs, and never have been, only medical treatment like the one you mention. Whether 'back ache' still counts l don t know, but l can tell you from experience it can be a very real thing. (No l haven't had it done but l could do with it.) Neither are a number of procedures that used to be possible on the NHS.

Even knee and hip ops are in such short supply some people are having to go private because they just can't wait. Pain can be unbearable.

It's no surprise either that people are choosing to go abroad for treatment too. (How come they can afford to do it for a fraction of the price?)

 

My biggest concern is that if personal health insurance comes in, a whole raft of people won't be eligible for it. The elderly for instance', and those born with congenital (and expensive) illnesses. And those that develop long term conditions which require frequent hospital care.

 

As for the irresponsible users 'who go jumping off roofs...' l don't disagree, but where do you draw the line?  Do you include Rock climbers? ...Skiers What about smokers?  Drinkers, the Obese - (does that include people on steroids?)  Mountain Bikers? People who don t get any exercise at all...?  You see what l mean? Life is dangerous, nobody gets out alive.

It would be a legal minefield. Insurance companies are driven by profit and do their best to refuse paying out. The only ones getting any money would be the lawyers.

 

There has to be a better system than that.

[harvey19]

With means testing it could mean those paying most into the system get the least out of it.

[Anna B]

5 minutes ago, harvey19 said:

With means testing it could mean those paying most into the system get the least out of it.

The problem with means testing is there is always somebody on the margins. Not only that, but the cost of any current operation for example would be well outside the pocket of the average person.

[L00b]

31 minutes ago, harvey19 said:

With means testing it could mean those paying most into the system get the least out of it.

Unless I am mistaken, this is already the case with e.g. free prescriptions for qualifying persons.

 

Anna you should inform yourself about the ongoing Palantir deal/scandal. Everybody was too busy looking and getting excited at dinghies in the Channel, and now it looks like it’s too late, Palantir has got the NHS patient data. So, in terms of impact on private healthcare insurance prospects, today or x years’ time, that horse has bolted.

[harvey19]

7 minutes ago, L00b said:

Unless I am mistaken, this is already the case with e.g. free prescriptions for qualifying persons.

 

Anna you should inform yourself about the ongoing Palantir deal/scandal. Everybody was too busy looking and getting excited at dinghies in the Channel, and now it looks like it’s too late, Palantir has got the NHS patient data. So, in terms of impact on private healthcare insurance prospects, today or x years’ time, that horse has bolted.

Seriously is the health service in Luxembourg similar to our NHS ?

[L00b]

52 minutes ago, harvey19 said:

Seriously is the health service in Luxembourg similar to our NHS ?

No. And it’s not really a good comparison basis, a healthcare service catering to a population of 650,000 and visitors, relative to the UK’s 65m (=Lux pop x100).

 

It’s “expensive free”, for people not qualifying for free-everything at the point of delivery (there are a fair few; means-testing in effect). E.g.

 

A&E stay for 20 mins, on the spot meds and prescription = €180 invoice. To be paid within 30 days. Then refunded 100% within days of submitting a refund claim (with evidence of payment of the invoice, ofc) to the social security office. Dunno if an ambulance trip would be extra or not. Used twice for the kid this year. Within 2 weeks.

 

GP visit clocks in at €57, IIRC. Refunded 80%.

 

Most dental work is refunded, little of it 100% (basic check & clean, €50-ish I think), rest in part (varies according to type of work; all of it is codified and set-tariffed; e.g. braces for kid for 2-3 years and you’re looking at €4.5k easy, 70-ish% refunded).

 

People here have an idea of the cost of the healthcare service that they’re getting, because they’re paying for it at the point of use, all subsidised that it already may be, and irrespective of its refunding after-the-fact. That helps towards not taking it all for granted.

 

The counter points are: there’s no waiting lists, no waiting in A&E, no under-staffing, no black hole in the annual budget, everything is state of the art, all staff from the topmost consultant to the lowliest porter is overqualified and speaks 4 languages minimum, and they have to fight off immigrant healthcare staff at the recruitment doors.

 

The healthcare service is managed like most other public services: for a population who knows both the cost and the value of things, who doesn’t mind paying more for better quality, who hates paying too much and who doesn’t suffer fools: it’s a *very short* political feedback loop, in our *very small* country 😉

Edited November 22, 2022 by L00b

[harvey19]

17 minutes ago, L00b said:

No. And it’s not really a good comparison basis, a healthcare service catering to a population of 650,000 and visitors, relative to the UK’s 65m (=Lux pop x100).

 

It’s “expensive free”, for people not qualifying for free-everything at the point of delivery (there are a fair few; means-testing in effect).
 

E.g. A&E stay for 20 mins, on the spot meds and prescription = €180 invoice. To be paid within 30 days. Then refunded 100% within days of submitting a refund claim (with evidence of payment of the invoice) to the social security office. Dunno if an ambulance trip would be extra or not. Used twice for the kid this year. Within 2 weeks.

 

GP visit clocks in at €57, IIRC. Refunded 80%.

 

Most dental work is refunded, little of it 100% (basic check & clean, €50-ish I think), some at least in part (varies according to type of work; all of it is codified and set-tariffed; e.g. braces for kid for 2-3 years and you’re looking at €4.5k easy, 70-ish% refunded).

 

People here have an idea of the cost of the healthcare service that they’re getting, because they’re paying for it at the point of use, all subsidised that it already may be, and irrespective of its refunding after-the-fact. That helps towards not taking it all for granted.

 

The counter points are: there’s no waiting lists, no waiting in A&E, no under-staffing, no black hole in the annual budget, everything is state of the art, all staff from the topmost consultant to the lowliest porter is overqualified and speaks 4 languages minimum, and they have to fight off immigrant healthcare staff at the recruitment doors.

Thank you.

Two final questions if you don't mind.

What happens if the patient is unable to pay upfront ?(in the 30 day period)

 Are the population happy with this type of service or do they call for any changes ?

 

Edited November 22, 2022 by harvey19

[L00b]

1 minute ago, harvey19 said:

Thank you.

A final question if you don't mind.

 Are the population happy with this type of service or do they call for any changes ?

 

Sorry harvey, I was editing - see my final paragraph in my earlier post.

 

The population is generally happy with the way things are. Even with the extension of social and healthcare cover to border workers (people working in Lux but living next door in France, Belgium, Germany, who are entitled to Lux social security cover and benefits with their families - which is better than FR/BE/DE, by some distance).

 

They know which side of their socio-economic bread is buttered. So do their MPs.