> More simply want better customer service than British GPs tend to provide, with their brief consultations and frustrating systems for booking appointments
I can definitely sympathise with this, although it isn't a UK wide problem. My local surgery (in a remote part of the country) consists of a couple of GPs who both know me personally and making an appointment involves a quick phone call (and chat to the receptionist who I also know personally).
When I was living in London it was completely different, getting an appointment involved phoning up the surgery the morning you wanted an appointment and hopping somebody hadn't done so before hand so they had space. There was no way to book an appointment in advance. It was easier to go to an NHS walk in centre, wait for a few hours, see a nurse, and have them refer me to A&E to see a doctor if need be.
One thing that's quite improved it in Denmark is that a company came out with a whitelabel hosted-health-portal SaaS product (http://www.mithelbred.dk/) that has really caught on. Doctors can sign up with it and reskin it on their clinic's website, and the product handles the backend interaction. You can book appointments, cancel or move them, send/receive notes to the doctor (if you have a question/worry but aren't sure you really need to go in person), check and renew prescriptions, etc. There are even mobile apps! They claim to have >50% of all doctors in the country signed up with them. I think it's caught on to such an extent because from the doctor's perspective it lets them outsource the patient-management / administrative part of their clinic's work for a price that's lower than it'd cost to do in-house, and the fact that patients now get some online convenience is just an added bonus.
Not entirely related, but UK's NHS holds a crown for (probably) biggest IT project failure ever. It took 11 years and £9.8b to reinvent patient record system.
At least they can finally sell the patient history to third parties.
"At least they can finally sell the patient history to third parties"
Not sure your sarcasm is all that clear. To those not aware the UK government is passing this off as a way to improve your care within the NHS via centralised records. They have made it opt-out and have sent out a confusing leaflet that leads the reader to believe their care will suffer if they opt-out of selling patient records.
Records are already centralised within the NHS. What is happening is the government is setting up a free for all with easily de-anonymised records being sold off to third parties (read: private health providers and insurance companies).
GPs in London seem to be at breaking point. I move house every year, staying in the same area, but even though it's only a short walk from my current flat to my old one I no longer fall within the catchment area of my GP. In fact, I am right on the edge of the catchment area of my nearest GP! My local A&E is absolutely swamped with people going straight there instead of even bothering with their GPs. You get told off for doing that but at least you can see someone.
the problem with A&E is that its used as a dumping ground for a lot of problems that would have been handled else where.
I few years a go i got sent as an emergency admission to our A&E and there where kids with sprained ankle that woudl have been seen by the school nurse a few yeas ago - but due to cuts schools dont have their own medical staff at all and just clog up A&E
- A&E is meant to cover accidents and emergencies. Spraining an ankle is (usually) an accident.
- Is there an argument (based on efficiency or something else) for schools to have their own medical staff, over and above some proportion of teachers trained in first aid, and maybe a full-time person to make decisions on next steps for more complicated cases?
No schools in the UK are gaming the system to maximise the outcome, a school nurse doesn't help get a nice but dim kid get a grade C in English and Math. Uk Schools put all their effort in turning D's into C's
Very true - this is still the case now. The added an "Urgent Care Centre" to our local hospital to absorb people coming in because their GP was overbooked. They're really good though to the point people just go down there straight away rather than going to their doctor. You can get in and out within an hour with a prescription handed over to you with no prior appointment.
Ultimately, the GP should disappear and more of these centres tied to the hospitals should appear. They are more than walk-in-centres as well at which they are sometimes limited to what they can prescribe. Our local walk-in-centre can't even prescribe antibiotics or provide any help to anyone under the age of 3.
When I was a child, my GP (in South London) didn't have an appointment system. You just showed up, took a number from the hook, and waited until your number was called. You would always be seen the same day if you showed up before closing time.
When I went to university (in another town) I registered with the GP surgery recommended by the college. When I had occasion to use their services, I was _shocked_ to discover that (i) I had to make an appointment and (ii) I would have to wait a week to get one.
I was recommended to see the college nurse (who, if I recall correctly, was unable to prescribe medication). I ended up going back to my parents' home in London for almost a week. I got better, but it would have been quicker and less disruptive if I could have just seen a doctor and got some medicine soon after I became sick.
I can add Argentina as a good location, where there are many excellent doctors and very good clinics. If you are looking for international "karma" many of them publish in top journals.
UK health care is disgrace. Patients dying by starvation in hospitals corridors. Waiting period for some operations is months. Even simple xray took 6 hours of waiting at emergency. My polish friends in case of problems head to airport, not British hospital (insurance would cover it).
Also SS wolfs are on hunt and it is serious risk to bring children to UK doctor. GP broke hand to Slovak baby during vaccination, parents took it to hospital, where doctors called social services. Couple had to run from country to keep baby.
Also France with exceent health system is just few kilometers away.
I'm sorry but this is just completely false. The UK health system has flaws yes but it is free at the point of use for anyone in the country and provides an extremely high level of care at a very low cost.
You have to wait for non-essential operations yes, and the less essential the longer you have to wait. That's because it's not a private health care system where your treatment is based on your ability to pay.
Of course you can always get better treatment if you want to pay to use it. You can do that in France if you like or you can do that in the UK.
As for your baby story I would like to see some evidence that a GP broke a baby's hand and then forced the parents to flee the country to avoid having their baby taken by social services.
What is extremely false? This was said at British parliament. To quote Cameron: "people had to dring from flower vase, not to die of thirst". There are thousands of deaths because of basic neglect.
As for my personal experience. I only wanted rentgen to see if my hand is broken. I could not just 'walk in' and buy a service, I would had to go through GP referral than booking specialist appointment and finally week latter have xray.
The Emergency Room is used by everyone who needs prescription for flu, so I had to wait 6 hours in bloody line full of coughing people. I should have probably just walk in front of the hospital and call myself ambulance from parking lot.
The healtcare is not free, as visitor from other EU country, my insurance company has to pay. Also local cresidents pay higher taxes. Sure there is no lawyer overhead, but that will only impress someone from US.
As for waiting for non-essential operations, you probably meant non-life threating. Some procedures solve crippling pain, but are rated non-essential.
And on top of that you can not choose hospital where you will go. Some hospitals are better, some are really bad. Obviously the elite lives in areas with better hospitals.
The story about baby was in national Slovak news, and forced embassy to step in. I am too lazy to look for english translation, but there are other similar cases. The time line in this case is this:
1) Slovak couple comes with six months baby in hospital, it cries and has something with hand. They claim it had vaccination one day before at the same hand.
2) Doctor makes xray, finds hand is broken and fixate it.
3) Hospital calls SS and police. Couple is escorted by police to court straight from hospital with baby.
4) They get advocate assigned from court and the hearing starts at the same evening (5 hours after they come into hospital)
5) Their defendant is arrogant, tell them to shut up and does not explain anything. Plus he does not speak slovak and their english is not adequate for this stuff
6) Court postpones decision into other hearing. They are free to leave. At outside police is waiting to seize baby, officers do not believe court did not made decision.
7) At 11 PM they finally arrive home from hospital with baby.
8) At 4 AM they decide to leave country, at 6 AM they are on airplane to continental europe.
9) At 7:30 AM police came at their london door with order to seize baby
10) 2 days latter they contact slovak police, disclose their location and ask for help. They also contact media.
I am really not going into more of those shit. I know several people who fled UK because of fear for their baby. Embassy even recommends to avoid giving birth in UK, since you could say something stupid, which would be held against you.
This was 'majority white' slovak couple. Slovak gypsies have situation much much worse in London. I am sometimes called racist, but what SS is doing to gypsies, is miles behind the line.
> What is extremely false? This was said at British parliament. To quote Cameron: "people had to dring from flower vase, not to die of thirst". There are thousands of deaths because of basic neglect.
That is not a direct quote, as I said there are flaws with the NHS but I dispute that there are thousands of deaths because of basic neglect. Feel free to provide data to backup your claims.
> As for my personal experience. I only wanted rentgen to see if my hand is broken. I could not just 'walk in' and buy a service, I would had to go through GP referral than booking specialist appointment and finally week latter have xray.
> The Emergency Room is used by everyone who needs prescription for flu, so I had to wait 6 hours in bloody line full of coughing people. I should have probably just walk in front of the hospital and call myself ambulance from parking lot.
You went to accident and emergency at a busy time and were treated based on the severity/priority of your injury/illness. I'm sorry you couldn't just buy your way to the front of the queue but that is a feature of the NHS.
> The healtcare is not free, as visitor from other EU country, my insurance company has to pay. Also local cresidents pay higher taxes. Sure there is no lawyer overhead, but that will only impress someone from US.
That is why I said 'free at the point of use'
> As for waiting for non-essential operations, you probably meant non-life threating. Some procedures solve crippling pain, but are rated non-essential.
No I meant non-essential, how fast you are treated is based on how urgently you need treatment.
> And on top of that you can not choose hospital where you will go. Some hospitals are better, some are really bad. Obviously the elite lives in areas with better hospitals.
Actually yes you can choose where you go. Of course some hospitals are better than others, that is true in every country in the world.
> The story about baby was in national Slovak news, and forced embassy to step in. I am too lazy to look for english translation, but there are other similar cases. The time line in this case is this:
Once again I would like to see some proof that this story ever happened.
> Embassy even recommends to avoid giving birth in UK, since you could say something stupid, which would be held against you.
Really, which embassy? Please point me to where they recommend that you avoid giving birth in the UK.
You obviously have an issue with the NHS and I am more than happy to admit it is far from perfect however I would appreciate if you're going to criticise it you do so based on facts not fairy stories.
Did not Cameron just apologize for several deaths?
I have no issue with NHS on its own. It is pretty much average European health care system. But I hate smuginess surrounding it and connection to fascist state.
Fascism is a fairly specific thing. The UK has many problems, but I do not think you could reasonably claim that it is a fascist state. While there are some extreme nationalists in the UK, most people seem to regard them as a joke. Most people in Britain don't take its leaders and institutions seriously enough to give fascism ground to flourish. Fascism requires keeping a level of serious respect of the state and it's representatives, that leaves its supporters wide open for general piss taking.
Of course the UK does have some appalling bigots, some of them in positions of power, and it also has some appalling history, especially in connection to empire, but that does not make it a fascist state.
One of the definitions is that government has total control.
That's the definition for totalitarianism. You need to couple that with populist extreme nationalism and state corporatism to really be properly fascist though.
If you want to understand how the UK social services manages sometimes to be quite so completely fucked up (and I am in no way denying that they can be scary fuckers), you need to understand the confluence of the British jobsworth, combined with really bad incentives. Using the epithet fascist doesn't really tell you anything about this though.
To put it simply, the professional penalty for wrongly taking kids away is much much lower than the professional penalty if something goes wrong through inaction. This is due to a series of high profile cases where kids died after not being taken from their parents. Unfortunately there are also a lot of jobsworth box tickers throughout the UK bureaucracy.
This is not all of them, but there are enough that when coupled with a system that doesn't really punish them as long as they are seen to be doing something, encourages some really dark Kafkaesque insanity.
I'm fairly certain that France's health service also has problems.
I should also point out there is not one NHS, but four: The National Health Service (which is English), NHS Scotland, NHS Wales/GIG Cymru and Health and Social Care in Northern Ireland, the latter three being run by devolved Governments, not the UK Government.
Public health system in Poland has same problems as its UK counterpart. It's free, but public hospitals and clinics have notorious problems with service limits, wait times, financing, care level etc. But at the same time qualifications of doctors and other medical staff are quite high so they somehow make up for the shortcomings of the system (however, the long wait problem is unsolvable). I hope medical tourism improves the situation a bit by stimulating growth of non-public specialized clinics.
Don't know about Poland but back in Lithuania solving that by a little bribe was a common way around, judging from what I've heard. Once I had to get off the dentists (private not public) chair because someone came in and gave a 'bribe' of... $8 (20LTL).
That's weird isn't it? I always imagined private dentists to work more like shops: you get your service for a list price. The idea of giving bribes during shopping baffles me.
Russia here, which isn't known as being bribe free.
Maybe it is extra regulated or price-controlled so non-market forces kick in? You needing them more than they needing to retain you as a customer, because supply becomes limited.
Don't think so. I'm not talking about grannies spending a day socializing in the waiting room, but rather about people waiting for months or years for treatment, surgeries or transplants. Currently public healthcare logically assumes that many procedures will become unnecessary if you wait long enough.
Wow, this is really surprising to me, considering it's the UK. Sounds exactly like the Brazilian SUS (our extremely dysfunctional universal healthcare system).
Without implying too much other than what can be directly inferred from this line
Private health care is sold as a luxury for the affluent
and usually only covers hospital treatment, not primary
care—that is, visits to a doctor.
I'd like to reiterate that this is where the American model of healthcare delivery is headed.
The Affordable Care Act just made this abundantly inevitable.
We will soon have a tiered system - if it already isn't here - where the wealthy shall be catered to by doctors and health professionals, who have completely removed themselves from the insurance model and thus only serve in a Direct-Pay model.
The best surgeons and experts will exclusively cater in a on-demand model, flying down to multiple locations a day to offer their premium services to wealthy clients. Concierge medicine is already here. [1]
Even with things like Telemedicine and Remote surgery, I don't see why the doctors will behave any differently in how they choose to split their precious hours.
In the UK, while there are some that provide only direct-pay services, most of the private healthcare is operated by, or contracted by, large private insurance companies, that offers quite cheap "add-on" insurance offered as perks by companies, or which you can buy separately.
Most of the private health-care offerings are also deeply incestuous with the NHS. Large part of the surgeons are NHS surgeons that offer additional services on their own time. Many of the surgeries happens in NHS facilities that make excess capacity available to help offset operating costs, and so on.
Additional private cover in the UK is well within reach for most people that are not that far below a median salary.
Private stuff in the UK is also reasonably common in employment contracts for anyone above middle manager level, since you effectively get the same treatment as the NHS for the reasons mentioned, but with a much shorter waiting period, so companies can get their employees back to work faster.
I guess it's some UK thing but I expected "middle manager" to be something pretty exclusive with not many people above. And this is where it loses relevancy to many people on HN.
Maybe you call shop clerks middle managers or something.
You would have to be somewhat out of touch to think we haven't had a tiered system in the US since long before the ACA. The fact that people can talk about "good insurance" and "bad insurance" where the deciding factor is how good of a job you have - and still keep a straight face - is pretty telling.
You would have to be somewhat out of touch to think we haven't had a tiered system in the US since long before the ACA.
Yeah, but that interferes with the narrative, that the ACA is responsible for everything bad that's happening in the US. It is appalling to me how much is blamed on the ACA.
If you really want to figure it out you have to go back to WWII when wage controls were implemented. Employers had little way to compete for talent so for some reason the IRS said that various benefits like health insurance weren't taxable. Now your insurance changes with your job, rather than by your decision.
Imagine how often car insurance companies would try and deny claims and generally be shitty if their customers were locked in and couldn't switch unless they changed jobs.
I think that's one of the biggest problems with healthcare right now. The employer is the "customer" not the employees, so fuck 'em!
That was part of the initial motivation for tying insurance to employment, but the main reason it's persisted is that it's a way of solving the adverse-selection problem. If you let individuals choose when to buy insurance, on average people buy it when they need it and risk going without when they don't. But if you insure a company's whole workforce at once, with individual employees not being able to opt out, you have a risk pool not specifically selected for high-risk patients.
This is also a reason group coverage typically has a minimum size for coverage, because small companies still have the adverse-selection problem— founders more worried about their health are more likely to buy their company group insurance than those who think their health is fine. But once a company reaches a certain size, those individual factors get less important since everything's averaged over a large mandatory-coverage pool.
That's an excellent point. Adverse selection is a real problem because some people can have a very good idea of what their bills will be. If it's cheaper to pay out of pocket they'll do so, but if they could save money by buying insurance they would do so.
Another part of that problem is that the price is all wrong. People who have very little risk of dying regularly buy health insurance in part because the premiums are so reasonable. $200 a year (or whatever it costs) is such a small amount of money for so, so many people that you're a fool not to buy it if you have dependents.
If you could pay the actual market rate at the doctor's office -- the rate the insurance companies get -- you could afford most medical problems out of pocket. I mean it's demonstrably true, the insurance companies don't pay out more than everyone pays in so by default we can all afford to pay for healthcare. What we can't all afford to do is pay $50k for big procedure X or $200k for cancer treatment Y. But those are major medical type issues which we can insure for not horrific amounts of money.
The adverse selection problem can be solved in large part by having affordable major medical that makes you an idiot not to take it. I can totally understand why single people in their 20s aren't keen on shelling out $450 a month for insurance. But $20-$50 a month? That's less than car insurance or a cell phone or cable. Save $400 a month on insurance and you could afford to get ACL surgery every couple of years!
But here's the thing: if you want to buy your own insurance you can't 1) because of the adverse selection issue and 2) because an already high price would get about 30% higher as you get taxed on that money.
> We will soon have a tiered system - if it already isn't here
That has indeed been the case in the U.S. for years. The three most common health-insurance structures, EPOs, PPOs, and HMOs, each have very specific lists of doctors who accept "in-network" coverage (they differ largely on the terms by which you can pay out of pocket to go "out of network"). How big those lists are and what kinds of doctors they include is pretty noticeably correlated with price: the cheapest insurances don't get you access to a wide range of top-quality "in-network" doctors. And there are a handful of boutique clinics and surgeons who don't take any packages at all. (There's an additional negative impact of this "networks" system in that companies seem to change networks semi-regularly as they renegotiate packages, and people change networks when they change jobs, which interrupts continuity of care.)
Where I live now (Denmark) the whole system is just run publicly, except for a handful of elective things (non-reconstructive plastic surgery, etc.), which are allowed to be done in private practice since they aren't properly considered part of the healthcare system. That removes the possibility of any tiering among "regular" care, and somewhat simplifies bureaucracy (plus, kids can keep the same doctor throughout their childhood, not having to switch every few years). I wouldn't actually mind a multi-tiered system, though, as long as the "free" tier can maintain sufficient quality. I particularly don't mind differences in amenities (if people are willing to pay a lot to go to boutique hospitals that have luxurious private suites, like some of the medical-tourism-oriented hospitals in Jordan offer, that's fine). Tiering does have potentially bad consequences for the quality of the free tier, but to me those consequences are what matter more than the tiering itself, i.e. if System A provides everyone level-7 quality healthcare, while System B provides everyone level-8 quality healthcare and those who pay extra level-9, I'd prefer System B despite its inequality, due to the higher absolute standard of its generally-available care.
In terms of your worry of doctors dropping out of the insurance system to make higher incomes, I think that is something to watch out for, although afaict the big monetary lure currently isn't to keep the same general profession but go out-of-network, but rather to leave "regular" healthcare entirely and go to super-premium boutique stuff like plastic surgery, IVF treatments, sports medicine, etc., which is where the real "superstar doctor" money is. Some of this may be because it's harder to become a superstar doctor in areas like cancer treatment without being at a top research hospital, and research hospitals tend to see themselves as having a public-service (rather than income-maximization) mission, which impacts their policy decisions. If necessary the government could also probably lean on those kinds of hospitals (places like M.D. Anderson, Johns Hopkins, etc.) by adding strings to NIH funding.
For Polish doctors it's also a chance to work for tolerable wages, escape paperwork and underfunded hospitals. In Poland, a doctor is a subcategory of bureaucrat who is primarily concerned with health and occasionally glances at you over a pile of papers.
I can definitely sympathise with this, although it isn't a UK wide problem. My local surgery (in a remote part of the country) consists of a couple of GPs who both know me personally and making an appointment involves a quick phone call (and chat to the receptionist who I also know personally).
When I was living in London it was completely different, getting an appointment involved phoning up the surgery the morning you wanted an appointment and hopping somebody hadn't done so before hand so they had space. There was no way to book an appointment in advance. It was easier to go to an NHS walk in centre, wait for a few hours, see a nurse, and have them refer me to A&E to see a doctor if need be.