NHS vs Private

[AllenRH]

Good morning/afternoon everyone.

I have read a few posts here and articles on other sites about the NHS. Opinions range widely between lovely and horrible. I am interested in people's experiences and comparisons between using straight NHS or NHS and private insurance. Also, comparisons between NHS and the American system. I have had some horrible and some good experiences myself with the American private system.

Ease of use, promptness, quality of care etc.

Thank you,
Allen

[ilyusha]

Allen,

I wrote a few articles on British medicine in my blog, found in the "Other trivia" section: http://burlaki.com/blog/index.php?s=expat+other+trivia&sentence=1.  Only a small bit of it is experiential, on account of little need of medical services in my family (knock on wood!!!).

The way I see it, for trivial situations, NHS is likely to work as well, if not better, as whatever insurance you may have in the US.  For chronic illnesses, serious surgeries, etc., depending on how good your US insurance has been, you may find even the Private Insurance in the UK rather lacking.   The more medical attention you require, the likelier you are to wish for a good American PPO.

Ilya

[Howard]

Hi, Allen!

One of the problems that leads to great difficulties in forum discussions about the NHS is that people rarely say which part of the NHS they are talking about:  thus you have one poster talking about, say, "the role of socialized medicine as part of the civilized infrastructure of a liberal Western democracy", and another writing about "why I hate my doctor's rude and unco-operative receptionist"!

So it's often a bit like the parable of the Blind Men and the Elephant:

In various versions of the tale, a group of blind men (or men in the dark) touch an elephant to learn what it is like. Each one touches a different part, but only one part, such as the side or the tusk. They then compare notes on what they felt, and learn they are in complete disagreement. The story is used to indicate that reality may be viewed differently depending upon one's perspective, suggesting that what seems an absolute truth may be relative due to the deceptive nature of half-truths.  (http://en.wikipedia.org/wiki/Blind_Men_and_an_Elephant )

Not that I want to stifle debate and discussion in any way at all -- quite the reverse -- but be prepared for lots of opinions from people who from necessity have only been able to touch a small part of the elephant! 

[Howard]

And having written all the above, I find Ilya has got his reply in before I got mine in!  But, reasonable man that he is, he specified which parts of the medical service he was giving an opinion on, just as if he had read my mind!    

[steveg]

   The more medical attention you require, the likelier you are to wish for a good American PPO.

Not overly wishing to disagree with you right off the bat on our first interraction Ilya.....

But I don't find it so, nor does my (American) wife Paula (on this forum as Windsong)

We both require quite a deal of medical attention, much more than an average person, with many conditions, just some of which include - Chronic Arthritis (causing Paula to be registered as disabled) - Both have type 2 diabetes (insulin treated) - Fibromyalgia - Coronary Heart Disease - etc etc (and trust me there is a deal more) yet we have no problem with access to either physicians or surgeons as is necessary. Nor do we feel that we are lacking in skilled clinicians to treat our needs, quite the reverse. About the only thing we can point out that the US system would beat this on is speed of treatment for non urgent conditions/surgery. In the US it can be virtually immediate, whereas in the UK it can be a few weeks or months before you "number" comes up!. However, for urgent life saving treatment there is no difference whether you pay or not and the treatment we have had has been first class.

As Howard points out though - we may be only touching part of the Elephant (I wonder which?), but we feel that without the NHS and it's free at the point of entry system, we would likely die through lack of insurance and/or money to finance our treatment.

Cheers

Steve

[AllenRH]

Ilya - yes, your family is fortunate to be healthy. I read from your blog that your company provides health insurance, and the exciting taxation adjustments as a result. I found it enlightening on how your situation plays into the over all situation. Not wishing it in the least mind you, I believe if someone with your situation were to fall and break an arm or leg, they would be seen immediately with either private insurance or through the NHS. If someone requested lasik surgery, private insurance may allow it to be scheduled relatively soon while NHS may have you on a list lasting for a number of months.

Howard, precisely what I am looking for. Experiences and opinions; the good, the bad and the ugly. Being an analyst by trade/nature, I go by the motto that there is no such thing as bad intelligence/information as long as it is accurate. Right - the elephant. They said it was the trunk; so as to not spoil lunch.

Steve, sounds as though you and your wife have done more than the moderate use of NHS. I find your positive experiences with health care to be assuring. The positive experiences I have had here were more related to a decent Dr cleaning up the mess of another. Which I am sure happens no matter what medical system you have. The only voice that is heard by the average American is how terrible the NHS is. Of course there could be politics involved there.

What I find very appealing of the NHS is medical treatment availability is not based on what company you work for.

[Howard]

Of course there could be politics involved there.

Indeed, I am sure that is right.  And there are also the vested interests of those who make a big fat living out of the 'medical industry', and would rather not have their licence to print money curtailed.  Or am I being a bit too cynical? 

There's an interesting dialogue in the blog of an American living here which attempts to answer some of the political questions posed by Americans who feel that socialized medicine is somehow 'unAmerican':  http://whatdoiknow.typepad.com/what_do_i_know/2006/06/a_dialogue_abou.html

[cheryls]

I've had good and bad experiences in the states and I have had mostly good experiences here with the NHS. Free Birth Control is fab to have. I paid $25 a month in Calif for just those pills alone. I was scheduled to have sinus surgery in the states (for a deviated septum and constant allergies) but my mom died and I had to put it off. I was sick quite a lot. I was told by my employer in the states that I would have to cover the deuctable and schedule the surgery and recovery over my holiday time which would be approx 10 days. I never had it done there. I came to the UK and got sick several times and then last July they gave me the surgery. I was signed off work for 10 days and paid for it, I went in hospital and spent the night, had the surgery and never saw a bill for it. 3 follow ups with the specialist that did the surgery and I am fine today. Never paid a penny. How could anyone argue and say that was "bad"?

My sister has worked her whole life and paid into medical insurance just like everyone else. She lives in San Fransisco. She developed melenoma from a mole and had to have surgery. She was then dropped by her insurance company and she couldn't afford the premium to go private again. No one will have her. I find that disgusting.

I will say that the hospitals here do not look new, nor does the eqiuipment they use. The walls could use a good paint job and the seats are horrible but all in all I think the nurses and doctors do a pretty good job.

[Howard]

Just to add, Allen, that while Brits like Steve and me have an affection for the ideals of the NHS, we are in no way blind to faults in the way it is operated.  We had a chat about this back in April, and you might like to look at what we said there:


http://www.ukusforum.com/index.php/topic,2837.0.html

[ilyusha]

   The more medical attention you require, the likelier you are to wish for a good American PPO.

Not overly wishing to disagree with you right off the bat on our first interraction Ilya.....

I certainly don't view this as a disagreement, Steve.  As I said, my experience with NHS is rather cursory, my opinions are mostly inferences or hearsay-based.  It's true that experiences differ, both here and there, it is also worth noting that some would put a premium on having a no-cost service, while others would be willing to pay for a privilege of more expedient service...  As they say, you mileage may vary...   

[steveg]

Just to add, Allen, that while Brits like Steve and me have an affection for the ideals of the NHS, we are in no way blind to faults in the way it is operated.  We had a chat about this back in April, and you might like to look at what we said there:


http://www.ukusforum.com/index.php/topic,2837.0.html

Quite right Howard - but my arguments with the NHS are certainly not about the treatment and certainly not with the clinicians within the NHS - but with the over heavy management and micro management by the government. As I said earlier, I can certainly say that we have had good treatment from the NHS, sure it could be better, and as Cheryl said, it could use a lick of paint here and there - sack half the managers and management consultants (not medical consultants) and the funds will be there for better buildings and more clinical staff and treatment.

Steve

[Lotus Freak]

personally I haven't had any problems dealing with the NHS treatments, I suffer from high blood pressure and I've had to get loads of tests done including 24 hour blood pressure monitor. At the moment I'm using the NHS prescription prepay to pay for my medication. I'm currently on 4 types of meds and it costs me less than £100/year for this service. Even if I didn't have prescription prepay scripts here are about £7 per script. IIRC, old age pensioners get free scripts. It really is nice to be able to walk into a docs office and not worry about having to pay co-pay just for a brief consult. It was really weird going to the hospital and having tests done...blood tests, and sonogram...and not have to worry what the bill is going to be afterwards. Do I like the NHS? yes, do I think it's perfect, no. Much like US healthcare system, there are pros and cons. The big con for the US is the cost. I was lucky in the US because I had excellent healthcare but it came at a cost.

Having said that, I also have private insurance through my husband's company. The only reason why we've decided to have it is in case something were to happen to me and I have complications and I need some type of surgery. If I relied mainly on the NHS it would mean going on a waiting list and sometimes that list can be quite long. With private insurance I would get treated right away.

[Molly Mockford]

As far as I can see, the NHS is excellent in two particular areas:  emergency treatment (road traffic accidents etc.) and serious life-threatening illnesses (e.g. cancer).  One would have to be mad in this country to want to pay privately for cancer treatment, because it would cost a fortune;  but top quality treatment is provided absolutely free.

It's in the middle range that things could well be improved, and this is the range where some people do tend to take out health insurance.  Seeing somebody waste two years of their life, in pain and immobility, while they wait for a hip replacement is not an encouraging sight, and a lot of such operations are likely to be done privately, or paid for by personal medical insurance.  Other "elective" surgery, like having wisdom teeth out, or piles operated on, is likely to involve extensive waiting times, and those who can afford it are likely to pay.  (The morality of those with money jumping the queue, and therefore increasing the delays for those who cannot afford to pay for their treatment, is another matter.)

But where it's an emergency, or a matter of life and death, I reckon the NHS cannot be faulted.

[AllenRH]

Howard - cynical? Absolutely not. There is a theory called capitalism. Another called abuse. The reality of greed often over takes any decency some may have when dealing with their human kind. That is when capitalism turns into abuse. There is a glutinous amount of money to be made on the suffering of others through the medical system. Numerous methods as well. Equally, there are many with a more humane position with strength of character to not be over run by greed. Without becoming too philosophical, I agree that greed continues to shape the medical system to a great extent. Imagine all the money some would not receive if our system would change to something more like the NHS? The danger is as Steve accurately states - too many managers costs a good bit of money which could be used to improve the conditions under which the medical staff works. We have too many managers here where I work. They tend to gunk up the works a bit.

Lotus, you sound like another success story for the NHS in how your condition is properly managed and affordable. Nice for you that the convenience of private insurance is available to your family. I gather that most people must wait with their suffering if it is not life threatening. I have had to wait with suffering as well while having private insurance. The worst is continuing work during a time like that. It would be nice if the Dr could write you a note which your employer would be compelled to honor by reducing expectations during such a period. Some will out of humane understanding. Others will not. Some bosses even use it against their employees knowing that if they lose their job they will lose their health insurance and any hope of relief or cure. To me, that is criminal behavior which is very difficult for the oppressed to prove in a court of law.

Molly, I hear you completely. It is a moral question. Is it true, that a person with private insurance is granted preferred status in how soon they receive treatment while others who are less financially fortunate are bumped and have their treatment delayed? If so, is that because there are Doctors who take only patients with private insurance and therefore their backlog of patients is much lower than those of NHS Doctors?

[Molly Mockford]

Molly, I hear you completely. It is a moral question. Is it true, that a person with private insurance is granted preferred status in how soon they receive treatment while others who are less financially fortunate are bumped and have their treatment delayed? If so, is that because there are Doctors who take only patients with private insurance and therefore their backlog of patients is much lower than those of NHS Doctors?

There is a mixture, Allen.  Many doctors work only for the NHS (either out of moral commitment to fair and equal service provision, or because they aren't good enough to go private);  a few work only in the private sector (and those I would regard with deep suspicion as to whether they, by contrast, were not good enough to get work in the NHS);  and quite a number combine both.  We're talking doctors at consultant level here;  below that, it's purely NHS.

Similarly, there are private hospitals, where one has to pay for bed and board and nursing care;  and there are NHS hospitals, where all this is free.  And, very commonly now, there is private provision within NHS hospitals - private rooms which one can hire, private doctors who will treat one on NHS premises, and NHS nurses doing the important stuff.  It's a dreadful mish-mash, and there is no doubt that by taking advantage of such a set-up one may be jumping to the head of the queue;  while you're in a bed, somebody else can't be, and everyone in the queue drops down one place.

I'm not saying that all private treatment is immoral.  There is a place for everything, and I do think that there are various aspects of vanity surgery which should never be provided by the NHS, that it would be immoral to do so.  I differentiate here between life-enhancing cosmetic surgery, e.g. to repair damage after a fire or a traffic accident, and somebody who is simply unhappy with the size of their boobs or the length of their nose.  The former should be free, the latter should be paid for.  And yes, there's an area in the middle where it's hard to be dogmatic!  And in a case where the use of (a) the doctor and (b) the hospital resources by a private patient does not result in somebody else's treatment being delayed, I see absolutely nothing wrong with it.

I do, however, remember vividly Christmas Day 1991.  My then husband and I were Mayor and Mayoress of Lewes, and one of the traditional visits was to spend a couple of hours at the local hospital on Christmas morning (the local GPs always do the same, taking all their children along).  There were patients too ill (or too alone) to be sent home;  there were nurses who could not spend the day with their own families because they had to be there for the patients.  The nurses, out of their own pockets, had bought in some boxes of cheap wine, plastic glasses and sausage rolls;  they had put up decorations, and were playing tapes of carols, and they did their level best to make the occasion as bearable as possible for the patients.  We were proud to join them in their efforts.  But then we were invited to go upstairs ... and there was the private patients' area, which I had never seen before.  And there were private and well-paid doctors and surgeons, and top-quality bottles of wine, and delicious canapes, and a mere handful of private patients to be the recipients of all this bounty.

I asked why the private patients could not have been taken down to the regular wards to join in the party there, and they all stared at me as though I was mad.

[steveg]

  We're talking doctors at consultant level here;  below that, it's purely NHS.

I'm sorry Molly, but this is way off the mark - certainly as far as primary care is concerned

you would be staggered at the number of ordinary GP's (for instance) who have set up or are setting up private practices either on leaving the NHS or to run alongside their NHS practice - I speak to doctors doing this on a daily basis and pretty much none of them are or ever will be, of consultant level - though you may be correct in the secondary care (hospital) environment.

Also the latest government way to waste money - Darzi clinics, or polyclinics as they are Most likely to be known - almost all will be privately owned but run through and funded by the NHS - Virgin are a leader in bidding for these - many will have very few doctors at all and will be mostly Nurse led (or Health care professional as the government likes to call them) Polyclinics will be a disaster for community medicine as you are very unlikely to be able to see the same doctor on 2 consecutive visits - so continuity of care will go out of the window - as these clinics are privately owned (many by ex NHS doctors) they will be very cost conscious and there to make a profit - which is not the NHS I pay my taxes for

The sooner this (or any) government stops meddling with what was and is working the better

Steve

[Lotus Freak]

I'm not saying that all private treatment is immoral.  There is a place for everything, and I do think that there are various aspects of vanity surgery which should never be provided by the NHS, that it would be immoral to do so.  I differentiate here between life-enhancing cosmetic surgery, e.g. to repair damage after a fire or a traffic accident, and somebody who is simply unhappy with the size of their boobs or the length of their nose.  The former should be free, the latter should be paid for.  And yes, there's an area in the middle where it's hard to be dogmatic!  And in a case where the use of (a) the doctor and (b) the hospital resources by a private patient does not result in somebody else's treatment being delayed, I see absolutely nothing wrong with it.


I asked why the private patients could not have been taken down to the regular wards to join in the party there, and they all stared at me as though I was mad.

funny you should mention plastic surgery and NHS...it appears you can have plastic surgery on NHS. There's a woman working in my firm that brags about how the NHS paid for her boob job...WHY??? Because she went to her regular doctor and was whinging about how miserable her life was and how she suffered from depression because of her breast size and how she wanted to end her torment. After several months of ''happy pills'' and some counseling sessions the dovtor believed her only cure was to get plastic surgery....WTF???

Molly, if you think your Christmas holiday experience was something, I think you would be in major shock if you were ever to visit the hospital I worked in in the US. It was a private hospital and when you walked in, you felt like you were walking into a lobby of a 5 star hotel. Everything was immaculate and obscenely extravagant. Then you had the state hospital next door and honestly, it reminds me of the hospitals I've been to here...I've only been to 2. Compared to the hospital I worked in, the state hospital seemed depressing and dirty. I know North Staffs Hospital suffers a lot from infections like MRSA and problems with cleanliness. There's no way on this green earth will I let anyone admit me there if I should fall ill. I know too many people who have had complications from infections and mistreatment.

to me moral healthcare is an oxymoron much like business ethics, There is no morality when the bottom line is money and these days healthcare is all about money.

[brinapost]

If everyone really wants to get an understanding of American health care, I would suggest watching the documentary Sicko.  It goes into deph about our system and how flawed and costly it is.  It will open your eyes about a lot of things dealing with Healthcare. 

[Howard]

infections like MRSA

The Wiki article ( ) suggests it is just as much a problem in the States:  http://en.wikipedia.org/wiki/Methicillin-resistant_Staphylococcus_aureus

[Lotus Freak]

infections like MRSA

The Wiki article ( ) suggests it is just as much a problem in the States:  http://en.wikipedia.org/wiki/Methicillin-resistant_Staphylococcus_aureus

totally agree that the US has similar problems as far as infections go. One of my biggests gripes about the hospitals I've been to is the way staff go about universal precautions. I've had numerous blood tests done and there were 2 occassions where I never saw the phlebotomist wash their hands (granted they could have washed them before they entered the room) and they were about to take my blood without wearing gloves Maybe I'm used to the sanitised proceedures in the US where you have to be gloved when you do anything that has to do with body fluids and washing hands before and after treatments. I'm just a massage therapist and I always washed my hands before and after I treat someone.

The way MRSA is treated here also different from the US. When I worked in a nursing home here we had 2 residents who contracted MRSA from the hospital. I was in total shock that they were released from hospital care without having the infection cleared. In the US when a patient contracts MRSA, they are placed in the reverse isolation ward where anyone who entered had to wear shoe protectors, full cover gown, gloves and mask. The patients were never released until the infection was clear. This of course is the proceedure for the hospital I worked for and it's a safe bet the same proceedure for the other local hospitals.

[AllenRH]

Howard, you are correct. MRSA is quite the problem in the U.S. hospitals. Vancomiacyn (sp?) is the preferred antibiotic; through the IV. My Nana came down with it while in hospital a few years ago.

Lotus, sounds as though the good Doctor categorized her plastic surgery to be same as gastric bypass. I have heard some argue that surgery which forces someone to reduce food intake is as elective as some one who has their breasts enlarged since the former requires only a bit of self discipline as a remedy and the latter a boost of self confidence. Personally I have not experienced weight issues, so I would not be arrogant enough to say how difficult or easy it must be to resist eating. I have experienced extreme dietary restrictions for other reasons and can attest how difficult it is to eat a rice cake during Christmas dinner while surrounded by the usual holiday spread.

Molly, I can see that a fair solution would be difficult to find for such a dynamic set of human tendencies. Is there legislation to prevent someone with private insurance from jumping ahead of someone without? If someone wants to pay out of pocket for something private, they should be permitted to do so as long as it does not then put others to a disadvantage with their access to care. Then you have the added situation where Doctors who take only private insurance could make out like bandits compared to their NHS counterparts. To counter that, more legislation would be required which then caps the fees a Doctor can charge and receive from private insurance so that they are equal with NHS Doctor and office fees etc. Otherwise, if private insurance gains better and faster care, those who can afford it would be hard pressed to not do so from the position of Love for their family and the desire to see the best for them. Health care is truly one of those areas where favoritism should not exist if we truly want to say that we value all people's lives the same. To do otherwise is a statement that some people are more human than others, and each person can evaluate their own opinion on that. Perhaps I am mad.

[steveg]

My daughter had unequal boobs - one bigger than the other, but noticably so - and she had the "boob job" on the NHS

However I tend to agree with it in this case - a teenage girl who may already feel embarrassed and concientious about her somewhat ample bosum, but to have different sizes would be cruel not to get NHS treatment.

Steve

[Lotus Freak]

I can see where cosmetic surgery should be done on NHS but this isn't a teenage girl we're talking about. This is a grown woman who you would think would have a high enough self esteem to just live with it...this said person was in their mid 30's when they got breast implants. Hey Steve, it just dawned on me that someone we both know has had plastic surgery on NHS...my dear sweet husband had his ears pinned back when he was a teenager. He showed me before and after pics and he looked so different.

[Molly Mockford]

The way MRSA is treated here also different from the US. When I worked in a nursing home here we had 2 residents who contracted MRSA from the hospital. I was in total shock that they were released from hospital care without having the infection cleared. In the US when a patient contracts MRSA, they are placed in the reverse isolation ward where anyone who entered had to wear shoe protectors, full cover gown, gloves and mask. The patients were never released until the infection was clear. This of course is the proceedure for the hospital I worked for and it's a safe bet the same proceedure for the other local hospitals.

Well, that's a good way to boost the hospital's profits - ensure the patients contract an horrendous bacterial infection, and then make them stay in the hospital until they throw it off - at how many thousands of dollars a day, I wonder, to cover all those ET-style precautions the staff have to take?

[Lotus Freak]

I suppose they view those precautions as something that's necessary. Personally, I'm glad they take such precautions because at least I know that infections won't be readily transmitted to others. My mom's aunt contracted MRSA while she was in hospital and everyone who visited her had to gown up. Universal precautions can be very expensive but I would rather have it in play because it can help prevent or lessen contact with infections. The only reason why universal precautions don't work is because not everybody practices it.

why would you say that hospitals would keep patients in to make money? In my eyes it makes more sense to keep them in if they have MRSA. Outside the hospital those people are more prone to contract all the various viruses that are flying out there. So by staying in the hospital you're giving them a better chance of fighting the infection in a shorter period of time. Over here it seems like they give you your antibiotics and send you home. Of the 2 residents I had to work with in the nursing home, one passed away because he contracted flu and it's almost like his body gave up trying to fight the MRSA virus plus the flu. The other one is still alive and still carries the MRSA virus and it's been 4 years since I've worked at the nursing home.

maybe it's the culture I grew up in or it's my experiences with hospitals but I don't understand why having precautions is seen as throwing money away. The reality is, healthcare comes at a cost.

[Molly Mockford]

why would you say that hospitals would keep patients in to make money? In my eyes it makes more sense to keep them in if they have MRSA.

In my eyes, it makes more sense to ensure that they do not catch MRSA in the first place! - or at the very least, if they do catch it while in the hospital's care, to provide free bed and board and treatment until it is cured.  If the hospital insists that the patient stays until cured, they will still be charging them by the day, or by the minute of staff time, or by the dose of drug, however it's done - and all for something which the patient would never have contracted if they had not been in the hospital!  Don't you see the unfairness of it?  I can imagine that a poor family might just be able to pull in enough by way of loans to afford some uninsured treatment for a family member - and then they are stuck with weeks' worth of bills for something which the hospital should have prevented in the first place, which they will have no option but to find the money for if their relation is to be treated at all, but which will mean they lose everything they own as they struggle to pay back the loans - and the poorer one is, the higher the interest rate that loan sharks charge!

No, to my mind the UK system is far superior.  We may not all get treated instantly, we may not have palatial hospitals that could be mistaken for hotels, our doctors may not become millionaires - but our families do not have to bankrupt themselves in order to afford treatment.

[Lotus Freak]

I totally agree with you that the US system is flawed. Heck, I was extremely glad when I came here and found out what costs were for healthcare. In the uS I was paying well over $100/month for the meds I was taking and that's with insurance. Over here it costs me less than £100/year....there's no contest. For the longest time, people have been fighting to bring the cost of healthcare in the US but it's not working because personally, I think hospitals are being ruled by the drug companies...bottom line, it's all about money.

the reality is that life isn't fair and it will never be fair, the reality is that money is what drives everything and the world we live in will never be a socialist utopia where everyone is treated the same. I would love to live in a world where everyone had respect for one another and everyone got the same care but they don't. It's like the grocery prices increasing, there are people who can afford to be picky about the food they give to their families and people who can only afford the cheapest, non organic-free range stuff....where's the fairness in that?