What do people believe is so special about the NHS?

GadgetObsessed

Point out to your socialist friend that s/he wants to restrict the freedom of the Dr to work for whoever they please.

Then ask if s/he would be happy to have the same restrictions on who s/he works for.

GadgetObsessed

This is something that I hear quite often. People assume that if we changed the NHS then we must move to a US style system where the poor can end up with no health care coverage. I don't think that anyone is suggesting such a system in the UK. Instead they are suggesting systems that are based on social insurance like those in other European countries such as France or Germany.

I didn't say that there were not any private hospitals in the UK I just said that private provision in this country only accounts for about 4% of total health expenditure. We are unusual in having such a tiny private sector. In Germany for example 50% of hospital beds are privately provided.
(Nursing homes should be considered separately.)

Another point I often see is people saying that the NHS saved their life, or the life of a loved one so they feel a commitment to it. To me there is a difference between being grateful to a system for what it has done for you and being committed to that system being run in a particular way.

From the Nuffield report:

"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death [including cancer]"

"[The NHS] is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’)."

The sad truth is that the NHS has higher rates of death from common causes than other healthcare systems. If you or a loved one are being treated by the NHS for one of these conditions then survival rates are lover than the average healthcare system.

For example have a look at the graph below.


                                                                       

Skyehammer

I suppose the difficulty that most people have with talking about the NHS is that like you (and me) they don't have any personal experience of other healthcare systems so assume that the NHS is good because that is all they know.

However, you don't have to have any personal experience of a healthcare system either here or abroad to judge healthcare systems. There is a lot of information out there comparing health systems. One of the best that I have seen is this report.

                                                                                                                                                                                                                                                                                                                                                                                                                                NHS receives mixed scorecard in major analysis of international health systems                                                                                                        Comprehensive new report finds NHS is world-leading in ensuring people are protected from financial hardship when they need treatment, but underperforms compared to other similar countries in preventing deaths from killer diseases.                                                                                                                                                                                                                                                                                                                www.nuffieldtrust.org.uk                                                                               
These comparisons will always focus on statistics. In summary, the NHS is efficient (good value) and good at providing access to all. Unfortunately though, outcomes are poor. For many diseases if you are being treated by the NHS then you are more likely to die than if you were treated by other healthcare systems.

Skyehammer

Can you explain to me what the differences are between the ' Social Insurance ' of Germany and the ' National Insurance ' of that in the UK ?
Is Social Insurance taken at source , are the Unemployed given a payment ?
Instead of changing the system why not up the NI payments and look into ways ' Management ' could save monies .
Britain's population is rising and its occupants are living longer so yes I agree that changes need to be made , new hospitals need to be built and instead of discouraging folk from moving into Britain let's welcome more talented immigrants .

GadgetObsessed

Well , I've lived in 3 of the UK countries , grew up in Wales , spent 10 years living in England and have spent the last 32 years living in Scotland - I have spent time in hospitals of all 3 countries - so yes I do have experience of English NHS Hospitals albeit over 30 years back !
I presume by ' here ' you mean England - or do you live outwith the UK ?

The population of England is growing and getting bigger , I understand the NHS in England struggle because of this - we need to invest more in Hospitals and increase National Insurance payments to offset the cost .
Whether Healthcare comes from a different type of ' Insurance ' or the one we use in the UK presently the people and the state need to pay for it - I say improve on what we have rather than make wholesale changes .

Zoea

Under the UK system everything is paid for publicly and provided publicly. The money comes from general taxation (there is no specific tax tied to health care) and it is spend on hospitals that are all provided by the state. (I believe that GPs are all private groups paid by the NHS.)

In most other developed countries (not just Germany) money comes from a national mandatory health insurance system. (This is nothing like national insurance here which is not insurance at all - it is just another income tax.) This means that everyone pays a proportion of their income into a health insurance scheme. When they use the system the insurance scheme covers most of the costs (e.g. 80%) - people then have to pay the rest themselves. For some things and for some people the state insurance will cover 100% of the cost. The vast majority of people in countries like France also have their own second insurance to cover this cost. These systems are "co-payment" - the majority of the cost come from the state insurance system but a small proportion is paid by the individual - depending upon their circumstances.

In most other systems the provision of hospitals is mixed - some provided by the state and some provided by private companies. In France around 62% of hospital beds are state provided in Germany it is 50%. I have not see figures for this country but I would guess that state provision is something like 97% as we have such a tiny private sector. To someone receiving treatment it doesn't matter whether they go to a state or private hospital - the costs of using each is the same.

What is interesting to me is the UK government spends a higher proportion of GDP than average on healthcare. However, in the UK our overall expenditure on healthcare as a proportion of GDP is lower. This is because in this country individuals do not spend much on private health care or paying towards their care.

GadgetObsessed

Freely keeps you alive. Is Canada's system better?

We are world-beating with the NHS (I'd like to think!).

krish

I am in England/UK. (BTW I love the term "outwith" - it is something I only ever hear from Scottish people - that term seems to have died off in England.)

You would expect the NHS in Scotland to provide a better service than in England as the Barnett formula ensures that whatever is spent per head in England, the rate in Scotland is fixed to be around 20% higher.

Overall, changes in population should not have much of a difference on providing for healthcare. If the population goes up 10%, then broadly speaking you would expect the economy and tax revenues to rise 10%.

If that population increase was caused by immigration then that should actually benefit government expenditure as immigrants are known to generally make less use of the NHS than the resident population - only because they are on average younger - and immigrants are on average more economically active e.g. more likely to be employed.

The main change in stress on the NHS is the aging population. For example, someone aged 85 costs the NHS around 7 times as much as someone in their 30s. There are around 5 times as many people in that age bracket now as their were 50 years ago and that number is expect to go up another 5 times in the next 50 years. Rising obesity is also likely to increase costs for the same size of population.

Any estimates that I have seen on Health Tourism always come up with very low numbers in terms of costs to the NHS e.g. a couple of hundred million a year. This sounds a lot to some people (e.g. a Daily Mail headline) but represents around 1/10 of 1 percent of NHS costs. (There are stimates that it would cost more to put systems in place to check everyone being treated to make sure that they were not health tourists.) So Health Tourism has never been a significant cost drain on the NHS.

Note that national Insurance does not have anything to do with NHS funding. The money is not specifically allocated to the NHS, or anything else. It just goes into the general pot and gets spent on defense, schools, NHS, etc. like any other tax.

There does seem to be something structurally wrong with the NHS. For example, it is pretty sad that it is the worlds largest user of fax machines and pagers - technologies that other countries ditched decades ago. Faxing seems to be the worst possible way of sending around records and ppatient data in this day and age.

Personally I would like to see the NHS monopoly on providing care split up. Private companies should be allowed to build and run hospitals that are not under NHS control but take NHS patients. We could then have a mix of private hospitals and state hospitals - as most countries do. A GP could refer a patient to either a private or a state hospital. A patient would not care which one they went to as both costs would be covered by the state. Doctors could work wherever they wanted - under NHS contracts or under contracts at private hospitals.

GadgetObsessed

I was going by the Nuffield report that I provided a link to:
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Loading…                                                                                                                                                                                                                                                                                                                www.nuffieldtrust.org.uk                                                                               
"Reflecting the NHS’s principles of being funded from taxation and free at the point of use, health care spending from taxation and compulsory insurance is slightly above average in the UK, at 7.7% of GDP compared with an average of 7.5%. But spending from charging patients and from private insurance is below average, at 2%, compared with 2.7% across the comparison countries."

When they refer to average they are referring to 18 countries that they have decided are comparable economically to the UK. This is not the same set of countries as the OECD or EU15 - so their average will be different.

Overall though we are so close to the combined average (based upon OECD figures from 2016 for the 18 countries selected - though not comparing to the OECD average) that it seems simpler to say we spend an average amount on health.

In either case though, whether we spend an average amount or more - it is very disappointing that for an average level of spend we get significantly worse than average outcomes.

GadgetObsessed

I doubt that the NHS are using the fax machines for signed documents. (And anyway an email is legally binding too - even without an explicit signature.) I thought that they were using them to send details of patients medical histories, scans etc..