[Closed] if you can afford private healthcare, should you use it?

In theory I believe so.

Two effects: first, it may have saved his life. Second, the queue gets a bit shorter for those who can't afford private healthcare.

Ethics doesn't really come in to it, you've already paid to use the NHS in most cases. My parents are doing the same of paying for private health care for scans and the like primarily to skip the NHS queue.

They've already paid their bit in to the pot for the NHS so it's a shame they effectively have to pay twice for their healthcare but the benefits of doing so far outweigh the issues that may be caused by waiting for the NHS to get them an appointment.

Was the private healthcare provided by an otherwise NHS employed medic, thusly having no effect on the queue?

Likely, but the choice for the otherwise NHS employed medic is do PP in your own time, or don't do it at all; if you want to do any you have to offer your NHS employer an additional session per week first.

DOI one of the 55% of NHS consultants who don't do PP.

Ethics aren't an issue imo.

My mother was in agony and could not walk for 6 months and NHS/GP wasn't interested. She would not go private on principal. Eventually MRI was prescribed with a 12 week wait and we did manage to pursued her to go privateoy with a 1 week wait. She got the cortizone injection she needed on the NHS but she wasted 6 months (I have a relative who is back soecialist and he diagnosed her 5 months previously but she insisted on relying on the NHS)

A friend who contratced for the NHS always said to pay for a private consultant appointment (often same doctor) to jump the queue, that's basically what my mum did eventually.

The NHS is broken and has been increasingly so for 20 years. If you need treatment and can afford it just pay. To argue things on principal is just daft. My French wife paid high French taxes and has always had private health insurance on top which she pays herself. DrP on here suggested if you can afford it you should do the same in the UK. One of the big advantages in France is if you go private the state still pays a portion (ie the same they would pay is you went "nhs"), in the UK theybpay nothing.

jambalaya - Member
Ethics aren't an issue imo.

Quelle surprise

No good being ethically correct and in pain or dead. There is a saying in sailing that being correct on the rules of the sea (power gives way to sail) but being crushed by a super tanker doesn't help you

My mother was in agony and could not walk for 6 months and [b]NHS/GP wasn't interested.[/b]

We had a talk from "Vitality" private healthcare provider at work.

He spent about 10 minutes explaining the healthcare side... If you choose to use the NHS rather than a private hospital, they give you 150 pounds back per night, and you jump the queue. The next 20 minutes was used to explain about the free cinema tickets, half price bikes, iWatch etc etc..

It was also cheap to take the healthcare, as we just pay tax on the cost. Seems to be happening in more and more jobs, even my girlfriend's who is a Teacher.

Feels like we were being bribed into taking private healthcare.

Tragedy of the commons!

We have PMI, as a work benefit.

Having used it a couple of times now rather than the NHS, I think I would happily pay for it in the future.

The convenience is very much worth it IMO.

Here in Austria you have employer contribution to health insurance, a bit like the NI system in the uk.
They operate a E card system that allows you to go wherever you want.
If you have a back problem, you go to the back doctor, eye problem, eye doctor and so on. You don't have to wait to be referred. The longest you wait is maybe a week for a really busy doctor.
I had a problem in my jaw last year. I went to the doc on Friday and I was operated on 2 days later - a Sunday.
There are zero waiting lists. Dentists and opticians are covered too.
This is probably the main reason I moved here.
Why the hell have the uk got it so terribly awful?
We finally paid for my mum to go private as she had to wait over 7 months for referral to a pain clinic as she could hardly move.

The NHS is broken and has been increasingly so for 20 years.

Sorry, but that is total bollocks! My family has had the misfortune to need the NHS many times over the past two years and its been magnificent. From heart attacks to skin cancer, to eye problems, to foot ops etc. We've been treated quickly and extremely well. No complaints here!

Trouble is you're not paying the full cost of your treatment. You're being treated by people whose training has been mainly taxpayer funded, and with the back up, if things go wrong with a procedure, of NHS resources.

I hope the NHS isn't broken. My old mum broke her hip on Sat and is being treated by them now. Reports so far 10/10 and the nurses and staff seemed great to me yesterday. Hope it's the same today as on my way. We did the xmas raffle yesterday so they are planning ahead for 25th

Interestingly seems that the consultant surgeons here and at the local private hospital are the same people.

Trouble is you're not paying the full cost of your treatment. You're being treated by people whose training has been mainly taxpayer funded, and with the back up, if things go wrong with a procedure, of NHS resources.

But these bits that you didn't pay for privately, you did pay for via taxation.

If you have a back problem, you go to the back doctor, eye problem, eye doctor and so on. You don't have to wait to be referred.

you can walk into the eye department a Northampton General and be seen no appointment or referral required. I had to go there once on christmas eve and the service was fantastic.

Trouble is you're not paying the full cost of your treatment. You're being treated by people whose training has been mainly taxpayer funded, and with the back up, if things go wrong with a procedure, of NHS resources.

And more importantly.... whatever private options you take the NHS is always your safety net. If the things go wrong in a private op you'll be rushed in an NHS ambulance to an NHS hospital to put things right. My mum used to run an ICU and she had a constant flow of private patients coming in- sometimes because of bad decisions, sometime because of natural complications...... sometimes because the local private hospitals didn't bother with backup generators. In a power cut they just shipped all their patients - even the ones on the table - to the nearest NHS hospital.

So if you're paying for private treatment you're not 'paying twice', you're just paying extra, because the service you're paying for within the NHS is still part of the package when you take private treatment - you're just lucky if you don't have to use it.

teamhurtmore - Member

I hope the NHS isn't broken

Don't worry, it isn't. It's not perfect, but show me a big organisation that is.

There's an aspect of it that is both good and bad - it treats patients, it doesn't have customers. Which means that if you turn up in A&E walking and talking and not bleeding to death you can, and will be told to wait whilst resources are spent elsewhere, but you will be seen. No amount of willy waving or money offered will change that. Trust me though, turn up bleeding, broken, dazed and confused and they can move so fast your head will spin. Same goes for Scans and Consultant Appointments, I've got a slightly dicky liver - I see one every 3 months, if I can't make it, I have to wait - when I was admitted with suspected meningitis my wait time could have been measured in seconds, not weeks. The ‘bad’ is that a lot of people think it’s broken because they expect to be treated like customers – “9 hour wait in A&E!” because they turned up with a cut or waiting 6 months to see a Consultant because their arm feels a bit funny.

As for 'going private', I don't have a problem with it - I've done it myself, my Wife (NHS Nurse) had no problem with it. Paid about £800 in total for 2 consultancies and a load of scans and x-rays. Transferred onto the Consultants NHS list, waited 3 months for an op like everyone else. Got me away from an NHS Consultant who was a dick and onto the list of one who wasn't.

Whatever you do though, don't have an Op in a private hospital - yeah you get nice rooms, soft furnishing and better food - but their infection rates are high and if anything goes wrong about the best they can bring to bear is a 999 call to take you to a proper hospital with a resus team, a full team of specialists, an ITU etc.

Oh goody, another religion thread 😉

if you can afford private healthcare, should you use it?

Yes.

Yes, coz it's another option. i.e. another choice that I can choose from.

[i]Whatever you do though, don't have an Op in a private hospital[/i]

Blimey, if only I'd have known that before the 3 ops I had in Spire/BUPA. I'd probably still be alive now.

The NHS is broken and has been increasingly so for 20 years. If you need treatment whether you can afford it or not, and want some quality of life, just pay.

FTFY jambalaya

Was the private healthcare provided by an otherwise NHS employed medic, thusly having no effect on the queue?

Are you suggesting the medic is moonlighting whilst they should be in NHS time? Otherwise, not sure what your point is?

Are you suggesting the medic is moonlighting whilst they should be in NHS time? Otherwise, not sure what your point is?

[i]the service was fantastic[/i]

Maybe I should drive up to Northampton next time I have a problem

Can people not negotiate shorter hour/ part time contracts these days?

Yep medics/clinical staff can work any number of hours. Most consultant contracts are 40/48 hrs per week (full time) and they still can do private practice on top of that, even an afternoon mid week, because they don't just work Monday to Friday 9-5pm.

Maybe I should drive up to Northampton next time I have a problem

If you are resident in England, you can choose any hospital in the country to have you treatment. However knowing which are the good ones, or getting referred isn't always straight forward, or necessarily the best thing to do.

Unfortunately our family has had need of the NHS and Private health care, both have been brilliant most of the time. One has been difficult and a little tardy on certain things and one had made a right F..k up and then been massively difficult when trying to get their mistake sorted (this bit does not include the MRSA from ICU). On balance I'd say we are better off with both but neither are perfect. What I would say though is that the NHS needs work doing to it and not just more money, I just wish the vested interests could get together and work on whats actually possible. There are better systems than the NHS, the French system being one of them.

These view are purely from experience so cannot be proved so feel free to disagree.

edit, crap spelling (again)

But these bits that you didn't pay for privately, you did pay for via taxation.

re you suggesting the medic is moonlighting whilst they should be in NHS time? Otherwise, not sure what your point is?

A couple of years back my local hospital built a new private wing on what was the staff car park. The patients' car park has been halved to accommodate staff parking and as a result it is very hard to find a parking space, resulting in missed/delayed appointments, and an inability to recruit/retain staff.
The knock on effects were dramatic, just as the hospital was starting to provide a decent service again.

For every example of people saying the NHS has done a great job there are just as many people who's opinions and experiences differ. I personally have been lucky so far not to need the NHS, but judging by the experiences of my family and close friends the NHS experience is largely not particular good and varies considerably across the country and is not as good as other countries. My dad was lucky to survive at the hands of the NHS earlier this year when an infection after a routine operation was not diagnosed a total of 4 times. It culminated in an emergency evacuation from his place of work before the issue was properly diagnosed. It is a real tale of woe and incompetence, and just leads to complaints and claims for compensation which doesn't help the NHS' cause.

I hope the NHS isn't broken beyond all hope. I am all for a system that delivers the same service to all, free at the point of use, but it needs improving and it needs to be more consistent. We need to get over the usual NHS debate of throwing more and more money at it - money alone is not the solution to the NHSs current problems and the NHS shouldn't assume there is a bottomless pit of money available to it just because it's our national obsession - it ultimately has to get to a point where it can manage on a limited budget or it is doomed. There are plenty of non-US style public health service models in operation around the world so I really don't see why we can't look at examples of best practice from those countries and incorporate some fundamental structural changes to the NHS to improve it for everyone concerned - patients, those who work within the NHS.

The biggest threat to the NHS are those who claim to be absolutely pro-NHS who are determined to close down any form of sensible debate or discussion about how we might change and adapt the service to meet and suit the needs of the modern world.

None of the current political parties have the solution at the moment. They all need to grow some balls, rise above the politics around the NHS and start working together to make it work and make is sustainable. The public would be fine with paying a bit more into it, but there is a limit to the number of items the government can keep coming back cap in hand to the public to keep funding an inefficient and bureaucratic organisation (which it is) that fails to deliver a world class service consistently (which it doesn't).

None of the current political parties have the solution at the moment.

I think you will find that the conservatives know exactly what they are doing with the NHS.

None of the current political parties have the solution at the moment.

If only someone could put it on the side of a bus.

How much does a person cost NHS in his/her lifetime?

Drac - Moderator
If only someone could put it on the side of a bus.

I might have a solution or something for everyone to think about. 🙂

Maybe I should drive up to Northampton next time I have a problem

I was advised, when waiting for an angiogram,
"The next time you have a chest pain, make sure you're near St Georges..."

This is an interesting debate/discussion..

I've been quoted above - not sure it's verbatim, but I DO agree that if you can afford pay privately to see a specialist, AND (this is key) if's appropriate, then I think you would be wise to.

I'm not saying you MUST, but often the conditions you would pay privately for are
a - not life threatening, but will have nasty symptoms
b - likely to improve your quality of life if dealt with sooner.

If paying will manage the above issues, then why not.

RE this:
[i]If you have a back problem, you go to the back doctor, eye problem, eye doctor and so on. You don't have to wait to be referred.[/i]

This is where I would disagree - I know there's the collection of GP haterzzz on here, but you must remember the GP and specialists are essentially trained to deal with different patient populations - once you start seeing a specialist IN PLACE of a generalist, your costs, investigations, and risks from such investigations will increase massively.
If you wish to pay this, then knock yourselves out, but you'll find that if that practice carries on, it will simply make private healthcare prohibitively un-affordable.

I know it's the perception that seeing a specialist is 'the best' - just rest assured that for the most part, it's not that black and white.

Secondly, and more importantly, is the NHS failing.....
Well, there's lots going in (STP formations, drastic changes in the setup of primary care etc) that would suggest it's not working and unafordable as it currently is.

Basically, we're not set up for the 'rectangular shaped age demographic' (similar distribution on young, middle, and old ages) as were were used to a more triangular distribution (more young, less middle, much less old age).

We need to get better at being realistic on health expectations, and quite frankly that message needs to come from high up (government etc).
In the CCG and in our surgeries we try to explain that unfortunately, you "can't have it all", but the message doesn't always get across.

You can have two of the three: [b]convenience, quality care, and affordable pricing...[/b]

Where's it all going..i don't know.
I doubt the NHS will be here when my kids are old.

Another thing I think about is 'will primary care turn private'.
At present there's no real demand as people just raise voices and complain, and they get seen at 'a convenient time' by their GP - shoult loud enough and your GP is likely to squeeze you in in place of having lunch.
These same things don't happen in specialist care - we accept it's a 14 week wait for the thing we've 'forced' our GP to see us about that week.

I often toy with the idea of private GP care - I think for those who use it (staff and patients) it would be better. But there's be loads of people who CAN'T use it, And that seems wrong.

I don't know.

No real answers are there..

DrP

[i]If you are resident in England, you can choose any hospital in the country to have you treatment. However knowing which are the good ones, or getting referred isn't always straight forward, or necessarily the best thing to do.[/i]

I was being facetious. It's bloody miles away. So the choice is [url= http://www.cqc.org.uk/content/portsmouth-hospitals-nhs-trust-ae-rated-inadequate ]inadequate[/url] local NHS, or private, paid for through my work.

[b]How much does a person cost NHS in his/her entire life?[/b]

The solution might be simple but it depends on whether people are opened minded about it.

NHS-trained and employed consultants can choose to do fewer NHS programmed activities in order to do private work.

Actually, they can't. As I said above, you have to offer to do an 11th (and so be on 110% of full time) before you're allowed to do PP.

STP formations

Oh the latest NHS buzz word has even permeated to GP land 😉

A couple of years back my local hospital built a new private wing on what was the staff car park. The patients' car park has been halved to accommodate staff parking and as a result it is very hard to find a parking space, resulting in missed/delayed appointments, and an inability to recruit/retain staff.
The knock on effects were dramatic, just as the hospital was starting to provide a decent service again.

That's a shame, but it's the result of parking provision decisions, and had very little to do with private healthcare.

you have to offer to do an 11th (and so be on 110% of full time) before you're allowed to do PP.

https://www.bma.org.uk/advice/employment/contracts/consultant-contracts/part-time-and-flexible-working

The basis of the contract

Trusts can offer part-time consultant contracts of between one and nine programmed activities. For appointments where the request to work part-time is in order that the consultant can undertake private practice, part-time contracts should not normally be for more than six programmed activities. Employers have the flexibility to agree part-time contracts for more than six programmed activities. Where a consultant wishes to work part-time mainly for reasons other than private practice, but still wishes to undertake some private work, they can be appointed on a contract for more than six programmed activities.

How much does a person cost NHS in his/her entire life?

The solution might be simple but it depends on whether people are opened minded about it.

I think once you tip 70 you become part of the demographic that become very expensive to 'keep running'.

If you don't use your GP much then as a 'bloke in your mid-30's' demographic your average cost to the NHS is around £1000 per head. I think it's 3 times that for the 70-74 years old's and twice again for the 85+ group.

Logan's Run?

Another thing I think about is 'will primary care turn private'.
At present there's no real demand as people just raise voices and complain, and they get seen at 'a convenient time' by their GP - shoult loud enough and your GP is likely to squeeze you in in place of having lunch.
These same things don't happen in specialist care - we accept it's a 14 week wait for the thing we've 'forced' our GP to see us about that week.

The situation primary care is in now is where dentistry was 15 years ago and look what happened there.

Right now, if Ethel, a hypothetical 70 year old well off woman want to come and see me, her favourite GP who knows her and her medical history, she's gotta queue up outside the door at 8am with the rest of them and she still might not get to see me. There is no mechanism for Ethel to get her wallet out and pay to see me at a time and location of her choosing - infact the GMS contract forbids it essentially by the 10% restriction. There is demand we're just contractually forbidden from tapping into it.

Of course if Ethel could pay to see me, I could do 4 days NHS 1 day private. As I got more senior or more of a "following" I would increase private days. Ethel would be happier, I think I'd be happier. But as Dr P says those with not money queuing up outside the door would have worse health outcomes?

Right now as a newly qualified GP I've got the option of a salaried job - which is an effective pay cut for me with a unlimited workload and unlimited patient demand. Tried it for 6 months and its rubbish.

A "partnership" investing considerable amount of my time and capital in a business model its clear the government are trying to destroy. Also with an unlimited workload and unlimited demand.

Or locums - flexible, seeing more of my young family than I ever have throughout the last 8 years of postgraduate training and with more money than the first 2 options (excluding the few high earning partnerships left) This gives me time to develop my skills towards something that will be billable once the inevitable happens to the NHS.

If I was a martyr, I'd choose one of the first two options but right now option 3 suits me just fine. More and more of my generation of doctors are choosing option 3, which will destroy the NHS as we know it.

If I was a martyr, I'd choose one of the first two options but right now option 3 suits me just fine. More and more of my generation of doctors are choosing option 3, which will destroy the NHS as we know it

And like wise so are many hospital doctors. You can't blame them... unless like some on here suggest, it should be a race to the bottom.

Johnx2, I'd never heard of anyone requesting to go part time to do private work. I suspect this is because I'm not in London where the rules are different.

Round here, the bit of the contract that everyone's familiar with is:

Under the framework agreement, consultants wishing to undertake remunerated clinical work outside the main contract are obliged to offer their first spare professional capacity to the NHS.

The solution might be simple

Raise tax and fund the NHS and social care properly?

Can you not retire from the NHS and then come back part time and increase private activity?

The elephant in the room here for consultants is the new contract negotiations.

At the moment a surgical colleague of mine is doing NHS waiting list initiative work at the local spire. Better T+C's there apparently, better kit and most of his old theatre staff. He does his straightforward cases there (lack of ICU/sick person support as alluded to above) and saves his complex cases for the NHS hospital where ITU is waiting if it gets messy. Presumably both paid on the same tariff?

Buy Buy Buy Spire healthcare shares - its like being paid the same price to service a brand new car v and 20 year old banger thats never had any work done on it. Systematic destruction of the NHS.

HoratioHufnagel - Member

The solution might be simple

Raise tax and fund the NHS and social care properly?

Isn't that the tried and tested which has never worked properly?

I am trying to find the data of the average NHS cost of a person per life time.

A quick search only managed to find a piece of news from [url= http://news.bbc.co.uk/1/hi/programmes/breakfast/4898158.stm ]BBC 2006[/url] regarding the charges ...

Anyone has the average cost of a person per life time?

Anyone has the average cost of a person per life time?

Nothing wrong with having private medical insurance if you can afford it. Whether the net effect of it is to reduce waiting lists elsewhere, I'm not entirely sure. But at least *you* are no longer on that list. You're still paying your taxes to support the NHS whether or not you use it.

Mind you, do bear in mind that, even when you do want to use your PMI, you might not be able to. I wasn't when I needed it. I had to sit in a waiting list for 14 months...

Rachel

How much does a person cost NHS in his/her lifetime?

I seldom visit hospitals or GPs

The more interesting question is [i]when[/i] does a person cost the NHS. Spending your healthy working life complaining that the NHS isn't quick or convenient enough for you is moot. Most people will get by far the largest portion of 'value' from the NHS in the weeks before they die. Nobody seems all that interested in the votes of the dying though.

NHS is underfunded [url= https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/health-care-spending-compared ]Health care costs[/url] so how about we have a referendum and see if people are willing to pay a bit more ?

Labour may have bankrupted us but at least they did raise the amounts going into health care over the time they were in power, the conservatives seem to want us to go backwards to a private system like the americans (twice as expensive and worse than ours !)

No, I wouldn't pay more when the NHS is poorly managed. Look at what is going on:

http://imgur.com/a/U42vD

That's not poor Nhs management that's multinational corporations having more power than mere nation states. I agree it's wrong but it's bigger than the NHS/department of health

yup, nhs is cheap in world term

CG - that's not the NHS being poorly managed.
That's drug companies holding the NHS over a barrel.

That's (almost) similar to blaming crime victims for the crime they suffered!

I'm hunting for the newspaper article written by one of our CCG GPs berating and challenging Phizer for overcharging our CCG for several million for epileptic drugs, and winning!
I think they are having to backdate 'overcharges' for quite a bit...

DrP

[url= https://www.theguardian.com/business/2016/dec/07/pfizer-fined-nhs-anti-epilepsy-drug-cma ]This is the story, but not his article...[/url]

The more interesting question is when does a person cost the NHS.

Did you know..if 'full seven day working' in the NHS was a drug, NICE wouldn't deem it cost effective?

DrP

How true DrP, and yet the promised extra money in the GP forward view is being wasted on it for purely political purposes. I estimated it cost the tax payer £400+ for each contact with the local prime ministers challenge fund service, but it will be deemed a success because a few people saw a GP who wasn't employed by the preexisting out of hours provider on a Saturday morning. Just not my patients as we work hard to see everyone that needs seeing in the 56.5 hours we are open every week...
The mismanagement in the NHS starts at number 10 Downing Street.

What about a Singapore style system where everyone gets an allowance (say £1000 per year) to spend as they wish on healthcare. If not spend it is kept and the amount in your healthcare account just mounts up until you do need it (when older for example).
This then brings in true patient choice so we can see the value of the various NHS offerings to the people that want them whereas today it is guess work. All at the same cost.

It also acts as an incentive to maybe not rely on healthcare and do a bit more personally to be healthier.

Catastrophe insurance (paid by government) covers the very large medical costs

Not exactly a vote winner tho is it?

Much better to stoke the expectations of the public - ref 7 day nhs, Skype your GP 24 hours a day, demand more all the time, tightening regulation(Cqc) and demonising the workforce in the media, until the inevitable happens - the " GP led" ccgs have to balance the books with some savage cuts and bingo you've got your fall guys for the demise of the nhs.

You have to remember a majority of the electorate believed the brexit pitch so the idea of operating the nhs 24-7 on less money and with less staff that the nhs fails to operate at now seems very reasonable to them.

Turkeys Christmas.

[quote=kerley ]What about a Singapore style system where everyone gets an allowance (say £1000 per year) to spend as they wish on healthcare. If not spend it is kept and the amount in your healthcare account just mounts up until you do need it (when older for example).
This then brings in true patient choice so we can see the value of the various NHS offerings to the people that want them whereas today it is guess work. All at the same cost.
It also acts as an incentive to maybe not rely on healthcare and do a bit more personally to be healthier.
Catastrophe insurance (paid by government) covers the very large medical costs

You're pretty screwed if you're on expensive medication though.

The most interesting question is why are we doing a cost ananlysis on the NHS.

Because we say we can't afford it, when what we mean is 'I'd rather have a bigger telly' and because most people put the biggest part the NHS will play in their lives outside their frame of reference. Its a service they don't want to think they'll need for a person they don't want to think they'll be.

^Up there ^ we're talking about 'little old ladies' as if they are someone other than ourselves.

Once the majority of people believe it is acceptable to have to top up the NHS with their private insurance then there will be no one pushing for a better NHS because they already expect it to be ineffective. IMO this is not a good thing.

Also where does it stop? If you have enough cash what else should you pay for? It's already accepted that the best educations need to be bought (with monetary or cultural capital) once health is segregated like the USA, perhaps people can have their own private police...

If people are prepared to pay for private healthcare then they are prepared to pay more tax for the NHS...

DrP did a long thoughtful piece and then proclaimed not to know the answers.

Others have steamed in with solutions.

I suspect DrP would get to a sensible answer sooner than some of those who steam in.

And I certainly don't know the answer to this one.

I have not read the whole thread.

Overall no - the private sector leeches of the NHS because it does not pay for the trained staff it poaches and often outcomes are worse - and if you get complications you end up in the NHS anyway.

some consultants also game the system - deliberately racking up delays or telling patients porkies to get them into the private system as the consultant makes more money

However for individuals it can often be a very good thing - my mother had her hips done privately after having her NHS date moved back 3 times. she was reluctant for ethical / moral reasons but I persuaded her to do so as at 82 she doesn't have much time to spare and delays lead to muscle wastage and slows recovery and she had the money - £25 000 for two hip replacements

Sometimes pragmatism trumps ethics

You're pretty screwed if you're on expensive medication though.

Indeed or even quite basic care. There should be no limits.

Haven't read through the whole thread but what the OP is asking about (and it's an excellent question to debate) is means testing of health care (voluntary or otherwise).

The problem with means testing is that there will always be a large number of people on the margin of "qualifies for free health care"/"pay for it yourself, you scrounging bastard".

This would lead to a large degree of preventable suffering among those people, huge opportunity costs - "I couldn't go to university because Dad needed a new kidney" - leading to wasted potential and stunted lives.

On a national level, such a policy would lead to worse health outcomes, particularly among the "squeezed middle" who would most likely be on the margins of the means test.

This would then provoke a very divisive debate:

"Why does that chain-smoking, sedentary unemployed person get free health care, whereas I lead a healthy life and pay my taxes and NI but get nothing?"

It would be an enormous step away from the principle of universal health care.

kerley - Member
What about a Singapore style system where everyone gets an allowance (say £1000 per year) to spend as they wish on healthcare. If not spend it is kept and the amount in your healthcare account just mounts up until you do need it (when older for example).
This then brings in true patient choice so we can see the value of the various NHS offerings to the people that want them whereas today it is guess work. All at the same cost.

It also acts as an incentive to maybe not rely on healthcare and do a bit more personally to be healthier.

Catastrophe insurance (paid by government) covers the very large medical costs

That's what I have in mind but must be customised to the British society because Unions will go up in arms citing danger to lives etc ... defend their jobs whatever.

If this looks viable then all parties will want to claim credit or try to sabotage it depending on whether the idea works well and usually nobody should come out smelling full of roses because nobody should succeed. NHS is everyone's political football where it is both their strength and the weakness.

Therefore, the must be very strong political will as well as letting the people see the benefit of another system otherwise nothing change.

Besides, there should be a number somewhere that shows the amount a person cost in their entire NHS lifetime. Funny this is not available.

I think that's the way it's going.
I have private health cover as a work benefit. I've used it twice and each time, I reasoned that someone else would get the benefit of "my" nhs time if I went private.
I also pay extra for my family.
Sadly, a work colleague hasn't and is now regretting that decision .

You're pretty screwed if you're on expensive medication though.
Indeed or even quite basic care. There should be no limits.

Yes - but only if there are alternative treatments that are available and work.

When you have a system that provides care to everyone at no cost to the individual then there has to be some mechanism for capping costs otherwise it would be completely unmanageable - and those decisions are made on a clinical basis. For example some of the cancer treatments that are often mentioned in the papers - the drugs an be tens of thousands or hundreds of thousands for something that is not a cure - but prolongs life / dying by months only.

also Germany spends more per head of population on healthcare - significantly more. 12% of ( a higher) GDP compared to our 9% of GDP

Ideally I would like to see us matching German levels of spending on healthcare. this would lead to a vast and noticeable improvement in the NHS. then some of these rationed treatments could be made available. But in a cash limited system then if you spend £250 000 on one persons cancer treatment thats 25 hip replacements you cannot do. Thats the sort of horrible judgement NICE has to make

But there are limits though. I have a client who works in the medical supplies industry and according to him there are a lot treatments routinely available in Germany that aren't in the UK becauae of cost.

Did he also tell you that there are often cheaper alternatives or that there may be no benefits to these routine treatments?

Having said that my brother in law had prostate cancer treatment in Germany that is not available on the NHS and has are better outcomes than the NHS treatments. But then if the NHS budget increased by 30% to meet german spending levels we could have the latest state of the art treatments as well.