I made a promise to myself when I joined this forum that I wouldnt get drawn into debates on either politics and/or the NHS , but I just cant resist this one . Until last year I worked for the NHS ,for 29 years in total . It is in desparate need of reform . There has been a huge ammount of cash thrown at it in the past few years , the majority of this cash has failed to be used in an appropriate manner , lots of " publicity" around initiatives which boil down to very little real change , sometime just the production of leaflets . The real changes needed are deep rooted and radical , I personally feel the sysytem is unsustainable .
Guest 655- Registered: 13 Mar 2008
- Posts: 10,247
Howard - actually those of us who pay for private medical treatment will have experienced something very different to what you describe.
The people who pay the bills, the insurance company, is not necessarily the same company that is responsible for the care. I believe that this division is an important one.
When I had a minor problem I got my GP to refer me to The Chaucer and a specialist there conducted a whole range of tests and investigations looking at it from every angle. In the end all they really found was high blood pressure now being treated. But, because the treatment provider was not paying the bill no stone was unturned in checking me over. The tests cost a lot of money, I did see the bills that I promptly passed to my insurer!
By contrast I speak to a lot of people who are subject to NHS only treatment who have a very different and inferior experience to mine by NHS staff worried about their budgets. That is not to critisise them, they have a difficult job and do their best in very trying circumstances. The other great thing was the lack of waiting around and always being seen promptly and efficiently, no 4 hours in a waiting room. For me, being self-employed private medical cover is essential.
I will outline my own personal vision for healthcare in the UK that I believe will deliver improved results for everyone. I do not expect any politician to support it - electoral suicide for them sadly and they will not get a fair hearing and it would start a hysterical scare campaign motivated by political aims and vested interests.
Before going on I must add that I do not want a system such as in the USA as I am sure someone will try to use that example to attack my suggestions. There are far better health systems out there in Europe.
It is possible to arrange for a system by which everybody can benefit from a division between care provider and those paying the bills (an insurance company). This can be made accessible to everyone as in Germany for instance and no-one need be left without provision. It is just a matter of how it is set up. I would envisage the first step being to allow tax relief on insurance premiums (in the same way as it is given on pensions) therefore reducing the costs of insurance by 20% for those who want and can afford it and so encouraging a greater take-up. At the same time employers should be encouraged through the tax regime to make employer provision via group schemes. This would extend further the reach of the current PME system without a great deal of difficulty.
The next stage should be a set of minimum cover standards and conditions to be agreed for policies to qualify for that tax relief. I believe that a minimum standard requirement is essential. There can be competition for contracts that exceed the minimum requirements between insurance companies. But that competition should not be in respect of quality of treatment or preference only in additional add on benefits over and above the best you can currently expect on the NHS.
The difficult part will be to extend provision more widely. This would have to be phased in over time but no-one, whatever their health, unemployed, self-employed or employed, whatever age must be left out or without care. I understand that in Germany it is the government who pay for the insurance premiums for those who cannot afford cover and that seems a good idea.
For those who do not know much about insurance with 'group schemes' provided by employers for things like life assurance and Income Protection there are 'free cover' levels so that employees who have health issues can get cover up to that level without underwriting. The minimum standard I suggest for PME could be set as the equivilent to the free cover level for group schemes paid for by employers or the big one, that paid for by the government. As a result there would be no need for anyone to be without cover.
Clearly NI should be cut as well to help offset the costs of private cover and as that should be affordable as the overall health costs to the taxpayer should fall. I prefer heavy use of incentives in a changeover rather than compulsion but at the end of a longish changeover period everyone will have their healthcare funded through an insurance based approach. Yes there are problem in implementation but there is a lot of experience in other countries that can help the learning curve.
Oh, I would also help reduce the debt crisis and sell the NHS hospitals to private concerns to run. There is no need at all for that provision to be in the hands of the State under my system.
All I will add is that there is room for a symbiotic relationship between the sectors.......
howard mcsweeney1- Location: Dover
- Registered: 12 Mar 2008
- Posts: 62,352
i fully concur bern, at least until i find what symbiotic means.
DT1- Location: Dover
- Registered: 15 Apr 2008
- Posts: 1,116
A very thoughtful and articulate post Barry. Great stuff.
My concern would be that what you describe still allows for better provision for those that can afford it. Does it not?
Additionally the idea of selling things off suggests that there is profit to be made from people being ill, something that quite honestly makes me feel sick. Surely this idea, by definition, is exploitation.
Guest 655- Registered: 13 Mar 2008
- Posts: 10,247
DT1, thanks for your comment and the chance to answer - Much as I dislike the American system and flawed as it is, even with their commercialism their health care provision and treatments are second to none.
I made the point about how competition should apply and directly excluded quality of care from that and suggested that the element of competition should be outside the key areas of care but in the 'add-ons'. If you look at policies in a range of different types of insurance products you actually see that now. I have just recommended a Group Income Protection Scheme and key differentials such as 'free cover' levels and support during ill-health with rehabiliative provision were key differentials. Such competition is actually healthy and can create much better products and services to clients. Incidentally the product that I ended up recommending had the highest free cover level and the best rehabilative services while the cost is only 0.98% of payroll, the lowest premium. The one that came second cost 1.34% of payroll. So there was very much a win - win situation for the employees of that company and the employer.... By the way, the beneftis are better than what someone would get from State benefits, higher, longer and are not subject to an 'all work' test after 12 months of disability. Better all round.
As for the sale of hospitals. Once again I would suggest that range of providers in hospital care in competition for referrals can benefit the system by way of that competition (on costs/treatment quality/accomodation quality etc). Not all need be commercial 'for profit' either, providers could be charities/mutuals etc as well as commercial operators. Again I would suggest a multiplicity of options can be highly beneficial. I personally see no problem of commercial operators providing these services for profit after all the great leaps forward in treatment and drugs development are made primarily by commercial companies out for profit. There is absolutely nothing worng with it as long as there are high standards and good results.
I believe that the greatest problems arise from a lack of choice and a lack of competition from monopoly providers whether state providers or commercial providers.
Guest 698- Registered: 28 May 2010
- Posts: 8,664
Doctors make money from people being ill. Drug companies make a king's ransom on a daily basis from people being ill. What's the difference?
Or can it be justified by calling it making money from making people better?
If all else fails, funeral directors are also in the business to make a profit!
I'm an optimist. But I'm an optimist who takes my raincoat - Harold Wilson
DT1- Location: Dover
- Registered: 15 Apr 2008
- Posts: 1,116
Yes Doctors do take a wage from treating the sick, but under the system provided by the state the 'stakeholders' (to use that term) are the same people receiving the 'product'. It is reciprocal and the human process is qualitative. Doctors are paid well (and rightly so) for their expertise and professionalism. Once again political point scoring has attempted to turn this into a quantitative process which has brought us to this point, that ultimately concludes in someone putting a price on a human life. As a society we value doctors not for how many patients they treat but the job they do and pay them accordingly by a pay structure set by the state.
As for pharmaceuticals that one is for separate debate as you could argue them to be commodity (quantitative) or the intellectual property to be qualitative. But as many producers are multinational it doesn't fit this argument.
The second as a society we regard the well being of our nation as a quantifiable profit based exercise is the second we regress. By the nature of maintaining wellbeing, it is entropic and that is why the NHS needs some kind of reform. Remember that the vast majority of british private sector health workers are trained at the expense of the tax payer with no compensation from the private sector to the state. We all know what happened with our transport system being privatised. We pay more in subsidies for a poorer service, allowing shareholders to make a profit...more choice, I think not.
As for charities paying, where does this money come from? Or do we rely on philanthropists? I think Cadburys was sold off by the same bloke who put up our gas bills and then got knighted!
Funeral directors are paid for the qualitative act of dignity towards the dead. Reduce it to a quantitative process then we would see our loved ones being thrown into landfill. Although again don't really provide a direct comparison to the NHS.
Shareholders are concerned with 'The price of everything and the value of nothing'. That Oscar Wilde had a line for everything!
Guest 655- Registered: 13 Mar 2008
- Posts: 10,247
The problem DT1 is that you seem to be very concerned about remote eserotic and philosophical issues.
Personally I dont think those concerns matter at all.
The only thing here that matters is the availablility of health care and the quality of treatment,.
If you had cancer, I promise you, the only question you will have is what are the chances of surviving and you could not care less about who makes a profit from it. That is all that matters.
The possibility of shareholders seems to worry you but as I said in my post even in the US system the commercialism and interests of shareholders does not prevent the highest possible quality of care. Remember those very shareholders also require health care, they are human beings who will have brothers, sisters, sons and daughters in those health institutions as well. Their humanity does not stop because they own shares. Competition also helps maintain the high levels of service and care. Again as I said it is monopoly provision that offers the greatest risk of poor outcomes, private or state.
As for charities, there are many charity organisations worldwide that provide healthcare and are involved in the development of treatments. As part of their programme for instance what if Cancer UK decided to start a specialist cancer hospital, funded from insurance with any profits ploughed into their research projects? It would be as viable a project as any other hospital under my system whether commercial, a mutual or whatever. Strength in the system can come from a range of provision. Indeed for all I know they may have such a hospital now, if not my system would open up a new avenue for them, one that offers them greater potential that the relatively limited PME market does now.
Brian Dixon
- Location: Dover
- Registered: 23 Sep 2008
- Posts: 23,940
the thing i find anoying is the drug companys over charging the nhs,lets say a certain life saving drug costs say £1 to manufacture but charge the nhs £50.dosent seem right to me.
Guest 655- Registered: 13 Mar 2008
- Posts: 10,247
The problem is with the NHS on that one, not the drug companies Brian.
I just got out of the bath, where I do a lot of thinking.... and had another thought on this subject to share with you...
Under my system of universal insurance based care some very different dynamics come into play for hospital and care provision. Suddenly we see a market demand element come into play that is very muted and almost non-existent now. Currently we have a monopoly provider provision worried purely about budgets and we have seen the problems of this over a 'proper hospital' campaign for Dover.
Pfizer, for instance - having the land and the buildings, under my system might well have decided to open a commercial hospital on the site instead of leaving the area all together. It would certainly be an option for them. My imagination did then run a little wild and it occured to me that they could decide to set it up as a centre of European excellence in the treatment of penile dysfunction....
I dont believe viagra is currently available on a NHS prescription for instance and would not therefore be part of the minimum standards under my system but these treatments could be offered as part of the 'competitive element' or as a policy add-on.... !!
As far as Dover is concerned with everyone having their care paid for via insurance any commercial group could decide to fill the demand in Dover for a hospital. It becomes viable. Maybe a management buy-out of Buckland, perhaps a 'Peoples Hospital' or local GPs could decide to make a hospital provision. All this becomes much more possible. In fact I can see a move away from large centralised hospitals and back to more smaller local hospitals, some perhaps with specialisms with the speciaist equipment for that, other hospitals with other speicalisms feeding patients in as appropriate. So not every treatment at every hospital but much more could be done locally than now.
Keith Sansum1
- Location: london
- Registered: 25 Aug 2010
- Posts: 23,942
BARRYW;
I think as iv stated before, no one disagree's the N.H.S. needs reform,
the sticking point being how can this be done.
Your view on private health insurance is the worrying one which many have tried to highlight.
It's always going to be about those that cant afford the treatment, and although as you admit NO POLITICAL PARTY is willing to take the issue on, the less well off for whatever reason are the ones that normally suffer in any such moves.
There was mention of Doctors, and yes they are involved but you will find many doctors are also looking to private medicine where the money is, leaving behind those that can';t afford that treatment.
ALL POSTS ARE MY OWN PERSONAL VIEWS
Guest 655- Registered: 13 Mar 2008
- Posts: 10,247
Keoth - I dont think that you have fully and properly read my posts. There is no question of affordability being an issue and people being 'left behind' and no reason at all for worry over private insurance provision. Look to Germany as an example of where this kind of system works.
Keith Sansum1- Location: london
- Registered: 25 Aug 2010
- Posts: 23,942
barryw
finding the time to look up such things is difficult but i will try to find the time.
ALL POSTS ARE MY OWN PERSONAL VIEWS
Brian Dixon- Location: Dover
- Registered: 23 Sep 2008
- Posts: 23,940
barryw,a large portion of nhs money goes to large drug manufacters,who sell over priced medication for large profits.
Guest 655- Registered: 13 Mar 2008
- Posts: 10,247
That is the NHS's fault Brian - their poor negotiation skills and a failure to maximise the purchasing power they have. Drugs cost a fortune to develop and bring to market, it is a very high risk area of research and most projects fail so you cannot blame the drug companies from looking for the best price. The buyers need to get their act together.
howard mcsweeney1- Location: Dover
- Registered: 12 Mar 2008
- Posts: 62,352
the problem with purchasing go far beyond drugs, figures show that everything from stationery to life saving equipment is bought at widely varying prices depending on the health authority.
i would rather see a national purchasing department that is staffed with people that have private industry experience and can negotiate best rates based on the great purchasing power that the n.h.s. should exert.
Howard thats what suposed to happen now , there is a centralised purchasing agency designed to do just that , unfortuntly it dosnt work suppliers catch on and any order that comes via this agency is at a hugely high price . Also when buying is handeled by " best value" experts you get the sort of choas that means , only the cheapest of each item is purchased , which in one memorable incident ment 1000 catherter tubes and 1000 catherter bags where purchased , at " best value " however the purchaser didnt realise that they where incompatable with each other , as often a supplier makes one part of a sysytem significantly more expensive than another , result 20000 items toatlly unusable , non returnable . As I said before the system dosnt work
I have just remembered what the process id called , it is SBS , shared buisness service , Items that can be purchased from Amazon for a few pence are a few pounds via this service ,
howard mcsweeney1- Location: Dover
- Registered: 12 Mar 2008
- Posts: 62,352
that surprises me sarah i read a while back that each health authority bought their own leeches.
tell us more about your other side of the counter experiences, the rest of us ( bar bern) only see things at the point of insertion.