Random musing

I think the NHS would do well to spend more wisely. The mark up on some of the drugs and products they use is ridiculous. Even some of the basic items we use on patients in hospital (soap, razors, shaving foam etc), we could buy cheaper on the high street. It seems to be a symptom of the general malaise surrounding the NHS at the moment that they don't even appear to shop around.

Perhaps the Foundation Trusts will do better knowing any money left over will come back to them. But what about the non Foundation trusts?

But not necessarily. Some people are stoic (sp?) and try and cope with their problems as they didn't want to bother us, even though it is free; whilst others come to a hospital with an insect bite that they've had for less than a day, rather than take antihistamines (for example, just because that was a previous pt today). I'm not sure the cost would make a difference

I think I was generalising, but do you not think that there would be higher instances of hospitalisations (for all conditions) if everyone had to pay for their prescriptions?

I don't know

If you look at the funding models widely touted as excellent, they all contain an element of government-funded (via taxation) health care, usually for "catastrophic" illnesses where people cannot possibly be expected to stump up the huge cost of treatments (cancer etc). In Singapore, people are required to save a proportion of their wages with a health care scheme (which I think is matched by the government) and they then use this account to pay for the health care they wish to access (money is transferable among families and any excess in your pot is inheritable upon your death).

The advantage of this system is that people don't usually choose what they view as wasteful or unnecessary treatments. If you have to pay the market cost of your indigestion cure, you might be more tempted to simply cut down on the spicy food. If you have to pay to see your doctor about that little sniffle, you might think twice.

This is interesting, so do you pay more if you have got a medical condition or does everyone pay the same in case they need treatment if you see what I mean?

Flora can you not pay for the pre-payment certificate at £11 a month or would that not cover this?

Another question, hypothtical, I live in America. I have a condition that requires medication or becomes life threatening. I have no job or way to pay for regular meds, what happens? Or need a life saving operation, cant afford it. Do they leave me to die?

Reminds me, one of the nurses from the Philippines telling me how she would be called upon by her neighbours to deliver babies because they couldn't afford to go to hospital. She'd have to row out in a little boat to a neighbouring village, deliver the baby for cash in hand and row back...then start her shift at the hospital.

When her Dad was admitted into hospital there was a computer on the wall tallying up everything that was used on him right down to IV administration tubing, cannulas and swabs

Don't worry Holey - it didn't come across that way at all!

My asthma is (or at least, was) worse than the average. It's still pretty bad, especially for my age, but hospital stays aren't the norm anymore like they used to be.

Footlong I think this says my inhaler costs £6.92. Not sure if that's what it means though!

https://bnf.nice.org.uk/?utm_source=evidence_bnf_redirect&utm_medium=(other)&utm_campaign=old_site_redirect

I don't know much about this (or anything worthwhile) but I read a book a while ago about a woman who had a serious form of cancer, the insurance no where near covered the medical bills and had it not been for her hubbys nest egg, she would have been left untreated. It left me feeling very fortunate indeed for the NHS.

Yup just checked the bnf (medicines guide) and that's what it says ?

randomly as I was thinking about antibiotics for my last patient, I looked up flucloxacillin. The price for an adult's course is £1.77; and infant's course is £13.12; and a child's course is £30.03! I never realised!

It may not be run the best but I'm a huge fan of the NHS.

In Ireland despite all wage earners paying a 1% health levy people still pay €50 for every drs visit and up to about €130 a year for prescriptions (over that amount you can claim back). Most people pay for private health insurance which is generally about €600 a year for an adult. The NHS is amazing in my eyes!

I also spent two summers working in an American hospital phoning insurance companies to see if patients were covered for surgery, regularly for serious conditions like cancer. If they didn't pay for the sufficient level of coverage the surgery would not be performed. End of. It is utterly horrible and Obama's healthcare reforms will do amazing things for that country if the Republicans aren't elected and overturn them.

I *think* they have a very very basic level of healthcare coverage for some of those situations. You would have to be quite poor and quite ill though I think?

When my grandad had his heart problems in India and was treated there, he had to pay for all his drugs, operations, pacemaker etc. He got a choice of a cheaper or more expensive pacemaker too. For those people like him who can pay, there is a bit of a premium added on and that money is used to fund treatment for poor people who can't afford it. There's also a massive culture of giving money to hospitals (and getting a wing named after you or whatever) as well as schools etc; the hospital he was treated in was set up almost entirely due to donated funds from one man. But then there is a huge disparity of wealth there.

One of the out of hours GPs (who is from India) said that if people were ill there then they would come to his emergency clinic (like A+E) and the waiting room would be full. They would work hard, do all the surgery in the emergency clinic (rather than referring to theatres or specialities as we do here), and if they didn't get through all the patients then they would come back the next day.

People might spend days just waiting to be seen!

You will be cared for in an emergency (no hospital leave you to die, I don't think). But probably billed afterwards, mind.

There is a welfare programme for medical treatment (MedicAid?), which provides costs for low-earners etc.

You've got me searching now... Prednisolone, a common steroid used to treat inflammation in lots of conditions including breathing difficulties costs £9.65 for a 30 tablet pack. I never realised!

Sicko is a good film if you want to learn more about the American health system, although you have to take it with a large pinch of salt as it's a Michael Moore film. The interesting point he makes is that although there are millions of people in America struggling without health insurance and that's bad enough, there are millions more with health insurance who are still struggling due to insurance companies screwing them over. I remember them talking to one girl in the film who was hit by a car (I think) and was taken to hospital in an ambulance unconscious. The insurance company charged her for the ambulance trip as it had not been pre-approved, although how she was supposed to ring the insurance company to let them know she was unconscious and needed an ambulance I don't know.

I think the NHS is poorly run, with huge amounts of money wasted on people they don't need, but at the same time is incredible. The NHS treated me at my lowest and thanks to all of you, me, and people we know, your taxes kept me alive.

That said, when it came to something I was 'entitled to' on the NHS (removal of eggs with a view to aiding fertility after chemo), I chose to pay privately as I didn't want to take a resource from where it was needed. Perhaps that was the right thing to do and I was in the minority for a)wanting to pay and b)being able to pay or perhaps it was simply c)I was a tw@t and should have let all of us pay for it. Who knows, but either way, I'm tremendously grateful for the service on offer to us all. I only wish more people used it sensibly - yes, you with the cold, I'm looking at you.

Having studied the more academic theories and history surrounding the NHS, as well as a module of Health Economics at university, i am finding this thread incredibly interesting.

If I have time later, I'll try to come back to this thread and contribute when I'm not on a nosy, busy train.

Agreed Cricks, some people have a massive sense of entitlement. In my job I provide equipment to people with disabilities who are being discharged from hospital to help them manage at home, and the response I get varies massively. Some people are suprised to find out it's free and are extremely grateful, some people demand everything under the sun that they don't need or we are unable to provide. I remember one woman who refused to go home from hospital because she wanted the NHS to provide her with a new bed. It's not that she was disabled to the point of needing a hospital bed at home, she just didn't like her bed and wanted the NHS to pay for a new one.

Also! Just as a quick add on, I theorised in my dissertation that the NHS would perform better if the government stopped constantly changing the systems/structures.

Major reform, staff and systems go through period of change, start adapting and overcoming any teething problems, and then rather than being allowed to perform, another government is elected and/or another reform introduced. The cycle starts again.

Singapore is a very unique model and there is a consensus that its health care system couldn't easily transfer to another country. Singapore is very small geographically and has only 4m or so people, skewed towards the younger age range. Also, the government is, um, slightly controlling (it has been described as a benevolent dictatorship).

The size/population/nature of governance means that there are actually only a handful of hospitals, each one part of a very tightly-controlled health system. Remember when the government here tried to introduce that nationwide computer system for patient notes etc? That actually works in Singapore. As such, there aren't really different standards available (unless, of course, you pay out of your own pocket) - every hospital is part of the same system.

People pay a proportion of their income into their savings account - same proportions for all but, obviously, higher earners put more in and will have more to spend. However, people on different incomes will qualify for different subsidies for treatment - a high earner might only get a 10% discount, a low-earner 90%. In this sense, the richer are paying for the poorer (just like the welfare system here). In this model, the ratio of paying in:taking out should be the same for all.

The key difference is the provision of patient choice, as they control their own spending. It allows the government to see what people truly value in terms of their healthcare. So, let's say we pay to screen all under-25s for cervical cancer, sending out reminders for appointments. In Singapore, it's up to the 24-year old "consumer" to decide if they view the risk of cervical cancer as high enough to be willing to pay for a smear test.

All of this means that the government has all the information they need to become ruthlessly efficient. People not spending cash on cervical smears when they are 24 years old? Well, we don't need to train quite so many nurses in that area.

I would be interested to learn more about this CB...I started reading a book a while ago about the slow privitisation of the NHS that's been happening (and it was published before the current government was even elected), I had to stop as I found it too depressing!

Edit: Just seen your second post, I definitely agree with you about the ridiculous amounts of constant change.

Gah, typed out a really long response to you, peanuts and then I got the shitty 404 error message. It reminded me why I rarely come here anymore!

So when I'm on 40mg a day, which happens a fair bit, I'm getting a good deal for my £7.40 or whatever it is now.

Im a bit of a hypocrit, I think we are very lucky to have the NHS. But I have health insurance ?

Boo Cricks, I'm curious to know what you were going to say. I was thinking earlier that the 404 monster hadn't struck in a while, and then it popped up for me out of nowhere.

I always mean to copy and paste and then remember just as I'm clicking "post"!

This is my personal rant. I dont begrudge diabetics the medication they need to regulate their condition and keep them alive, it's the free medication for anything else they may have that's not related (and I know a lot of conditions tie into diabetes) if they didn't get everything free then perhaps I wouldn't have to pay for my prescriptions for my inhalers and my twice yearly bout of steroids? I will gladly pay for my non asthma related prescriptions, my diazepam for flying, my steroid cream for my scar treatment, but the drugs that keep me alive I have to pay for? No fair, *stamps foot*

Not sure if this is what you meant but my H gets a free NHS eye test at the opticians every year?

We get free prescriptions up here in Scotland but we now get all the really cheap drugs which seem to have more side effects. I would much rather pay the prescription charge and get the decent stuff.

My daughter is asthmatic so gets regular inhalers - Salbutamol does not cost the NHS £75, one inhaler costs £3.19.

I suppose if you have the point of not paying for other people then would this apply if you were out of work and we had to pay for you to get benefits?

You could also throw in a point for discussion that should the mega rich have to pay for treatment??

Not with you...

Some of the antibiotics. For example the Clarithromycin used to be Klaricid but now is some cheaper version and i have found that i get more stomach problems with the different brand. The drugs were well know names but less so now. I didn't have a problem paying the prescription charge. I also find it odd that parts of the UK still have to pay. Surely it should all be the same?