UK health service finances are a monster that can never be satisfied.
Health financing is a monster that can never be satisfied, and it’s only going to get worse. This isn’t specific to the UK – in fact we spend less on health in the UK than most other comparable countries (e.g. per capita we spend slightly more on the NHS than US citizens spend on the admin costs of health insurance, let alone the costs of the healthcare).
GPs may be clogged up with people seeking advice on every little thing, but the bulk of NHS spending is now on elderly people who are genuinely sick. We can do more and more for people, but at the moment are entering a realm of diminishing returns. However if something can be done, it’s very difficult to justify not doing it.
Ditto for A&E where I work – there are forever people blaming the A&E crisis on young louts getting drunk, falling over and hurting themselves. Well, people have been doing this for decades, but actually young people are drinking less than a few years ago. The timewasters and people who should have seen their GP aren’t much of a problem either – you just tell them to go away, and that’s normally a reasonably quick process. The bulk of the workload is now coming from elderly people with 20 things wrong with them and sometimes a few dozen different medicines. They come in once, then a year later, then 6 months, then ever more frequently until finally they die.
Don’t get me wrong. I like old people. A surprising proportion of them, both male and female, have flown spitfires or explored the Antarctic or done other impressive things. But a lot of the time it simply feels as if we are keeping people in a medically prolonged purgatory before they finally pass away. It isn’t satisfying, but worse than that, it isn’t humane.
Lastly why are we not able to go directly to seek advice from a consultant, we must only go via a GP?
I imagine you can – if you pay. The NHS system depends on GPs as gatekeepers, and in my limited experience most private health insurance policies require a referral too, because it’s expensive to go to a specialist and they’d want to have some confidence that you go to the right one, and that any basic investigations (e.g. scans, blood tests) have been done before the first visit so they hopefully have to pay the specialist for one appointment rather than two.
Besides, it isn’t always obvious. If you’re feeling short of breath, should you see a respiratory specialist or a heart specialist or a haematologist, or is it actually something your GP could have sorted out more cheaply and with fewer dangerous investigations? I’m aware that other countries work differently but there’s something to be said for our system.
If you feel your GP isn’t taking you seriously you can always transfer to another.
I’m aware that other countries work differently but there’s something to be said for our system.
In Switzerland, health care insurances typically offer both options, but plans where you agree to go to specialists only by GP referral are typically about 10% cheaper.
I imagine you can – if you pay
If you go private, and you know what you are doing, the process is that you go straight to the specialist (which your research has turned up as one of the best in the field) and he will welcome you with open arms, tell you his rates, book you in within a few days, and go through the formality of getting your GP to fax a referral letter, which the GP can’t really refuse to do.
I’ve done that a couple of times, once for myself and once for my son who came back from a biking holiday in Canada with a nasty injury and a catheter hanging out of his front.
Otherwise, IMHO,
The NHS system depends on GPs as gatekeepers
is spot on.
If you feel your GP isn’t taking you seriously you can always transfer to another
That can sometimes be difficult, because e.g. every GP you ask is likely to discourage you from getting a PSA test… the well worn public policy / NHS funding stuff. Then when after a few years of this run-around you get pushy and demand one, and it comes back as say 5, they all go into panic mode because their past fobbing-off is on the record.
One has to be fairly pro-active in order to use the system effectively, but you could say that about a lot of other things e.g. aircraft maintenance shops 
Agreed, but the US is hardly the model to adopt.
There really is no ‘model’ in the US, we just have healthcare with user choice of how to pay for our needs. It works well for people I know, and for me. For about $500/month pre-tax and some co-pays my wife and I can go to any doctor or facility anywhere with no preapprovals and no linkage to government records. That works well for me, but that’s all I’ll say because I’ve become very tired of discussing it with those who think there has to be a ‘system’ – regardless of how how constraining, limited and invasive it may be.
Our healthcare costs about same as our hangar and I don’t worry about either.
mdoerr 12-Jan-15 13:01 #56
Achim is right. Ive never heard of a cow with high blood pressure.
My granny had a cow which did on fatty degeneration of heart.
Can happen.
Did Granny try giving the cow high fiber oats? What about exercise? Did the cow smoke? Thats local air pollution Im referring to. May have been genetics. There are a lot of mitigating factors.
Silvaire 12-Jan-15 15:05 #61
Agreed, but the US is hardly the model to adopt.
There really is no ‘model’ in the US, we just have healthcare with user choice of how to pay for our needs. It works well for people I know, and for me. For about $500/month pre-tax and some co-pays my wife and I can go to any doctor or facility anywhere with no preapprovals and no linkage to government records. That works well for me, but that’s all I’ll say because I’ve become very tired of discussing it with those who think there has to be a ‘system’ – regardless of how how constraining, limited and invasive it may be.
Our healthcare costs about same as our hangar and I don’t worry about either.
Last Edited by Silvaire at 12 Jan 15:07
What state do you live in!?!?
In NY we have lousy plans even through the employers companies. The best plans are through the govt for govt officials. If you are a private person who up until recently wasnt given insurance by the employer your premiums were significantly higher than for a group for the same coverage. Thats if you could get insurance.
How about some numbers?
Well for an HMO where you could go out of network it was running about $1700 a month family of 4 in 2011. You still had to pay copays and the endless hassle of trying to get them to pay. They wont cover this or that, I was paying for myself with a $3000 deductible with $35 GP copay and a $50 specialist copay. Lets say you need PT 3x a week for 4 weeks thats $600 extra that month. The PT gets around $30 for the visit from the insurance company or less. So I considered my plan a catastrophic plan for hospital coverage and emergency procedures. I was in a group to get that rate ($600) for a single individual. It would be double that outside of a group if you could even get it. No preexisting conditions allowed.
The Federal govt and the state govts have been bought off by the insurance interests in the US. Instead of picking a model that works that idiot in the WH caved and put in a system requiring everyone be insured. By the way as far back as I can remember that is what the insurance companies have always wanted. Reason “The healthy people dont have insurance and so we are only insuring sick people. Insurance works best when everyone is insured” Back to the idiot, he never put a cap on what the insurance companies can charge for premiums. Nor was he smart enough to cap malpractice awards/premiums.
Thats just the insurance lobby, the drug lobby is even worse.
From what Ive seen I like the Swiss model the best. I know it has warts but its not leprosy. Regarding Healthcare (oxymoron, try sickcare), the Us is a Leper colony.
If I keep this up my blood pressure will rise and Ill have to drink beet juice and mess up the kitchen.
Perhaps it would be better to refer to an US ‘framework’ than a system then?
That is a reasonably low figure, Silvaire. Can I ask whether you pay any extra if you do need to see a doctor, and whether it will change as you get older?
Thank you kwlf. As I said diet and genetics. Too bad they did not include exercise as part of that study.
That is a reasonably low figure, Silvaire. Can I ask whether you pay any extra if you do need to see a doctor, and whether it will change as you get older?
My wife and I will probably be covered within an employer group until I retire. Right now our exact cost is $6200 per year (I just looked it up), deducted from pay before tax so having an effective after tax cost of about $4000/year. That cost is subsidized by my employer by an unpublicized amount. If I retire before 65 (at which point we’ll be covered by Medicare) then I expect we’ll pay about $12K/year for the period until turning 65. Or get a different less demanding job until 65, just for the health care cost reduction. All of that is fine with me, its just something to plan around.
I injured myself a while ago, nothing too serious but they did a cat scan, x-rays etc as well as stitches and etc. I was in and out of the emergency room in a couple of hours but the costs were about $3000. I paid about 10% of that, and despite my wife’s horror that I had to pay for healthcare 
it bothers me not one bit. I was very happy to know my head wasn’t bleeding internally and would otherwise spend the $300 on much less important things. I don’t care whether it was necessary by somebody else’s standard. Good healthcare is a priority for me.
As the saying goes, the reason we in the US pay more for health care is because we can Opinions differ, and I don’t care about that either.
