NHS breaking point?

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Herainestold
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Re: NHS breaking point?

Post by Herainestold » Thu Apr 07, 2022 3:35 am

Millennie Al wrote:
Thu Apr 07, 2022 1:37 am
nekomatic wrote:
Wed Apr 06, 2022 10:47 pm
That being the case, if we accept the premise that the current funding model is irreparably broken, then any alternative model needs to either a) convince people to accept less from the NHS for the same or less money, or b) persuade people that paying more than they currently do is worth it in order to get the level of healthcare they consider adequate.
Persuade rich people that using the NHS shows that you're poor so many will pay for private treatment that they could have received on the NHS. Private hospitals could provide better food (emplying skilled chefs etc), nicer decor, and other things that make no difference ot the treatment but attact business. Just like happens in other parts of life - people spend more on clothes, cars, flights etc than actually necessary - that's why we have first class seats on planes and trains. Make it socially unacceptable for someone to use the NHS when they could have easily afforded to pay for private treatment. It's no different to people running their own car or taking a taxi when there's a bus service.
Yes. Free, timely, excellent but un pretentious health care for the poor and expensive, upscale, bespoke health care for the rich.
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Re: NHS breaking point?

Post by lpm » Thu Apr 07, 2022 5:54 am

Yes, but you all realise that the expensive version is paid for via insurance, right? Few pay private hospitals directly.

And so the "INSURANCE = USA = TERRIBLE" shouting begins. Even though some European countries make extensive use of insurance proceeds.
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Re: NHS breaking point?

Post by jimbob » Thu Apr 07, 2022 7:05 am

dyqik wrote:
Wed Apr 06, 2022 11:50 pm
monkey wrote:
Wed Apr 06, 2022 11:14 pm
lpm wrote:
Wed Apr 06, 2022 10:56 pm
Two tier healthcare

- Basic survival NHS
- Paid for healthcare, with people/employers taking out insurance

In other words, a reversal of the current NHS/BUPA ratio.
So a bit like the US then? It works really well and it's not at all expensive.

I also really hate that my healthcare is decided by who I work for.


(The US has Medicare for the poor, Medicaid for the old, and the VA system for veterans. Everyone else gets insurance through their employer, by themselves, or through charity.)
And it costs the US government more per capita than the UK government spends on the NHS.

And requires far more labour to administer and to deliver healthcare.
. indeed.

Data in graph form from 1990 Before the ACA, this was simply "public" not "public/compulsory" spending

https://data.oecd.org/chart/60Tt
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Re: NHS breaking point?

Post by lpm » Thu Apr 07, 2022 7:29 am

Now do France, Netherlands, Germany.

Always reaching for US comparisons is Fake Debate.
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Re: NHS breaking point?

Post by Little waster » Thu Apr 07, 2022 7:44 am

Millennie Al wrote:
Thu Apr 07, 2022 1:37 am
It's no different to people running their own car or taking a taxi when there's a bus service.
Although I imagine those've who bought a bus pass might get a bit annoyed if their bus kept turning up weeks late because the bus driver was prioritising his side-hustle as an Uber driver.

Or that when they finally did get on the bus the nicer half of the seats were already reserved for queue-jumpers who had slipped the driver a couple of quid.
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Re: NHS breaking point?

Post by Woodchopper » Thu Apr 07, 2022 8:13 am

I think some of you are being a bit myopic in assuming that mass use of private health insurance would lead to the clusterf.ck that is found in the US.

Private health insurance is normal across Europe. In the UK about 78 per cent of healthcare is provided by the government. You can compare that to six percent in Germany and the Netherlands, five percent in France, or 20 percent in Belgium. We don’t read about German or French or Belgian people being bankrupted by a road accident because the system is highly regulated. To simplify enormously they have compulsory insurance payments and state financing of private providers so the financial burden is spread across society and isn’t excessive for individuals. Source: https://www.oecd-ilibrary.org/sites/0a5 ... e-d1e22586

IMHO the danger for the UK isn’t so much the use of private healthcare but drifting into a situation in which there is a two tier system in which people who can’t afford it rely solely on the NHS and get very poor standards of care and everyone else uses voluntary private insurance that isn’t state subsidised to get an acceptable level of care. That would be a way to move toward the US system.

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Re: NHS breaking point?

Post by IvanV » Thu Apr 07, 2022 8:42 am

Woodchopper wrote:
Thu Apr 07, 2022 8:13 am
Private health insurance is normal across Europe. In the UK about 78 per cent of healthcare is provided by the government. You can compare that to six percent in Germany and the Netherlands, five percent in France, or 20 percent in Belgium. We don’t read about German or French or Belgian people being bankrupted by a road accident because the system is highly regulated. To simplify enormously they have compulsory insurance payments and state financing of private providers so the financial burden is spread across society and isn’t excessive for individuals. Source: https://www.oecd-ilibrary.org/sites/0a5 ... e-d1e22586

IMHO the danger for the UK isn’t so much the use of private healthcare but drifting into a situation in which there is a two tier system in which people who can’t afford it rely solely on the NHS and get very poor standards of care and everyone else uses voluntary private insurance that isn’t state subsidised to get an acceptable level of care. That would be a way to move toward the US system.
This use of health insurance, to be clear, is about funding, not provision. One difficulty in the US is the competitive provision of health services, not forming an integrated public heath service. Since users get to choose their provider, within what their insurer will fund. We all know that "insurance job" on our car or house means it is going to cost more than if we were procuring it and paying it out of our own pocket. And so inevitably it is in private provision of privately funded health services in the US. And there's a massive army of accountants writing out every sundry you incurred into a detailed bill for the insurer to pay.

But European countries on the whole do have integrated public health systems. For example, my wife is Czech and they have a compulsory health insurance system - on that OECD chart only 13% public funding. But the health system itself is largely publicly provided. You attend your local public clinic, or hospital, just as here. The difference is that there is an adequate quantity of service, you can directly access many specialist services without asking a GP, because the size of it is more adequate. You give your health insurance details and it is sorted out behind your back, with standardardised payments, not some huge itemised bill as in the US.

So a different funding system does not militate against a largely unified and integrated public health system on the supply side, which is what drives efficiency on the supply side. The insurance part of it in many continental countries, we see, is largely about the funding.

Thanks for the link to the graphics. We were discussing Norway earlier. Direct public funding of health care is actually a higher proportion of total spend in Norway than Britain, for all that they have these small direct charges as a contribution to the cost of service. Sweden is the one that has an almost entirely publicly funded health service.

Interestingly, I always thought that Ireland was a country where you have to pay for health care. The Irish have often told me that the NHS is a reason that many Northern Irish might vote against unification whatever community they come from. Yet the proportion of health care spending from public funds in Ireland isn't very much lower than in the UK - 73% vs 78%.

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Re: NHS breaking point?

Post by Ben B » Thu Apr 07, 2022 9:51 am

IvanV wrote:
Wed Apr 06, 2022 4:33 pm
Ben B wrote:
Wed Apr 06, 2022 4:05 pm
This is deliberate Tory policy
  1. Underfund the NHS for decades
  2. Talk up its failings and downplay the pressure it is under
  3. Present privatisation as a solution to "fix" it
  4. Profit
Someone else wrote:I just wonder if all this is a prelude to Johnson's plan to sell/privatize the NHS, as predicted by Corbyn.
As I mentioned upthread, there are many - especially on the left - who use "privatisation" as a generic insult for many kinds of potential NHS reform they wish to disparage, whether they are reasonably described as such or not. And it is an effective form of insult, that appeals to the voter, fake news that it often is. It tends to result in preventing any kind of effective reform that might result in something nearer to the better health services of our peer nations on the continent.

I don't really see how we get past that taboo until the NHS is in such a mess that a consensus around the need to do something sensible arises. So I think it happens deliberately or otherwise.

I think even the Tories understand that true privatisation - as they have in the US - is non-runner. Everyone can see how disastrous the US health service is. Anyone going that way will be out of office before they finish it. I think the Tories' real instinct is for increased contracting out. That can be abused to dob money the way of their friends, and we have seen recently how it has been abused in that way. But it doesn't have to be abused. The GP service has always been contracted out, and no one says that is what is wrong with it.

But actually contracting out is beside the point. It is incapable of addressing the main point, which is that funding is grossly insufficient for the demand placed on the service. It is the funding of the health service that needs addressing, not details in the way the service is delivered. There is no reason to believe there is so much inefficiency in it that if that could somehow be rooted out the money would now go far enough.
It's hardly fake news to conclude that the Tories hate the idea of the NHS (as they can't line their pockets or those of their rich mates) and want to see it dismantled. Quite a few senior Tories are on record saying they want it gone. It's also demonstrably the case that they have seriously underfunded it during their time in Government.

More often than not, healthcare that has been contracted out to private providers ends up being more expensive and with worse outcomes than if the NHS had done it. An example being that fairly high profile case to do with privatised eye operations where the contract had to be terminated early due to the substandard level of care. This is obvious. A private provider has to do the work and also pay their shareholders. They cannot possibly deliver the same level of care without costing more money.

I agree that the public need to accept that they need to pay more to properly fund the NHS, but not wasting £billions on inadequate PPE and useless Test and Trace would go a long way.
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Re: NHS breaking point?

Post by lpm » Thu Apr 07, 2022 10:31 am

Ben B wrote:
Thu Apr 07, 2022 9:51 am
More often than not, healthcare that has been contracted out to private providers ends up being more expensive and with worse outcomes than if the NHS had done it. An example being that fairly high profile case to do with privatised eye operations where the contract had to be terminated early due to the substandard level of care. This is obvious. A private provider has to do the work and also pay their shareholders. They cannot possibly deliver the same level of care without costing more money.
This is incorrect.

There's no reason why private healthcare needs more resources than NHS. Sure, there's admin costs for private hospitals and insurance. But there's admin cost for the NHS too. No particular reason why the admin resources are higher in one vs the other, it could be either way.

Likewise, a region's privatised eye operations might be substandard. But a region's NHS eye operations might be substandard. Is there anything inherent that makes one more likely to be substandard than the other?

Ultimately substandard healthcare is now a reality in the UK, because healthcare is under resourced. So anything that increases resourcing, from training nurses with taxpayer funding to building hospitals with insurance funding, can be expected to raise standards. This under resourcing effect is vastly bigger than any public vs private effect.
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Re: NHS breaking point?

Post by EACLucifer » Thu Apr 07, 2022 11:02 am

lpm wrote:
Thu Apr 07, 2022 10:31 am
Ben B wrote:
Thu Apr 07, 2022 9:51 am
More often than not, healthcare that has been contracted out to private providers ends up being more expensive and with worse outcomes than if the NHS had done it. An example being that fairly high profile case to do with privatised eye operations where the contract had to be terminated early due to the substandard level of care. This is obvious. A private provider has to do the work and also pay their shareholders. They cannot possibly deliver the same level of care without costing more money.
This is incorrect.

There's no reason why private healthcare needs more resources than NHS. Sure, there's admin costs for private hospitals and insurance. But there's admin cost for the NHS too. No particular reason why the admin resources are higher in one vs the other, it could be either way.

Likewise, a region's privatised eye operations might be substandard. But a region's NHS eye operations might be substandard. Is there anything inherent that makes one more likely to be substandard than the other?

Ultimately substandard healthcare is now a reality in the UK, because healthcare is under resourced. So anything that increases resourcing, from training nurses with taxpayer funding to building hospitals with insurance funding, can be expected to raise standards. This under resourcing effect is vastly bigger than any public vs private effect.
The inherent difference is that the private organisation - unless it is a non-profit trust - is taking some of the money out to stick in shareholders pockets.

The usual argument is that private sector for profit stuff is more efficient, and there are some areas where that is true, but that isn't likely to be the case for health. Private sector efficiency relies on efficiency pressures caused by competition and price signals - which in turn requires consumer information that is very difficult to achieve with health. Market efficiency usually also allows for some people to just do without - not a moral option when it comes to health.

In turn, any system with multiple providers subcontracting to each other generates enormous amounbts of bureaucracy over who pays for what, and when everyone is trying to weasel out of responsibilities, gaps open up - one example I've had personal experience with is in wheelchair provision*, where the body coontracted to provide wheelchairs came up with thresholds based on who needs what that weren't closely attatched to care needs, and couldn't be overridden by medical professionals - specifically they were only obliged to provide electric wheelchairs to people who needed to be hoisted in and out of them, other patients were expected to get by with manual ones. There was no flexibility to allow people who were recognised as needing wheelchairs but unable to operate a manual one - in my case it was a joint condition that affects every joint in my body, but I was told that it would still apply to someone with no arms - to be provided with an electric.


*Perhaps a blessing in disguise, as being able to modify chairs has radically improved my ability to get around compared to stock designs.

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Re: NHS breaking point?

Post by Gfamily » Thu Apr 07, 2022 11:09 am

In addition, the cost of failure in the private health sector falls back on the NHS.
Private hospitals tend not to have fully functional ICU facilities, so an emergency in a Bupa hospital will go to the local NHS hospital for treatment.
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Re: NHS breaking point?

Post by JQH » Thu Apr 07, 2022 11:12 am

IvanV wrote:
Wed Apr 06, 2022 4:33 pm
But it doesn't have to be abused. The GP service has always been contracted out, and no one says that is what is wrong with it.
In fact salaried staff (as opposed to partners) think that is exactly what is wrong with it.
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Re: NHS breaking point?

Post by dyqik » Thu Apr 07, 2022 11:27 am

lpm wrote:
Thu Apr 07, 2022 7:29 am
Now do France, Netherlands, Germany.

Always reaching for US comparisons is Fake Debate.
You think the UK (Tory) government would follow the European model over the US model, where their political and ideological ideas, strategists, and a chunk of their donations are sourced?

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Re: NHS breaking point?

Post by dyqik » Thu Apr 07, 2022 11:30 am

JQH wrote:
Thu Apr 07, 2022 11:12 am
IvanV wrote:
Wed Apr 06, 2022 4:33 pm
But it doesn't have to be abused. The GP service has always been contracted out, and no one says that is what is wrong with it.
In fact salaried staff (as opposed to partners) think that is exactly what is wrong with it.
Yeah, that's pretty clear. It's where the clusterf.ck that is GP targets came from.

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Re: NHS breaking point?

Post by Little waster » Thu Apr 07, 2022 11:47 am

Even "efficiency savings" (whether public or private) when they are present are often misnomers.

Sure if a game-changing technology comes online or new medical technique is developed or a radically better administration system is implemented you can have a win-win with improved care at less cost but most often "efficiencies" are incremental refinements.

Sadly those "refinements" are either:-

paying the same person to do more for less money (when low pay, demoralised and burnt-out staff driving poor staff recruitment and retention are causing many the issues in the first place

getting less/un-qualified people to do the role instead (as we've seen in the care homes)

relying on agency staff to paper-over the cracks long-term (with the associated loss of in-house expertise and team-work, a short-term fix that is is currently costing nearly £0.5bn a year)

cutting corners

or cherry-picking the profitable, easy stuff leaving the expensive hard stuff for someone else (typically the public sector)

All of which are things the private sector are more prone to do than the public.

Add in executive pay, advertising, administration, legal costs and profits even if there are nominal efficiencies to be squeezed out of existing SOPs the additional overheads of the private health care system always going to swamp these.

For all the free market dogma it is unlikely in the health sector a Henry Ford character is ever going to come along and introduce the production line equivalent for emptying bed-pans and wiping arses. Short of a big jump in robotics healthcare is always going to be labour-intensive with little opportunity for automation. And that costs.

Whether private or public in the end as a society, when faced with an ageing population, we no other choice but to simply divert more people from whatever they are currently doing* and yeet them at healthcare or accept declining standards.


*Raiding the Third World/Eastern Europe has worked for a while but Brexit seems to have knackered that while the EU, US ,Japan etc. are all doing the same. Perhaps the roll-out of automation elsewhere in the economy will up free up people?
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Re: NHS breaking point?

Post by lpm » Thu Apr 07, 2022 11:48 am

EACLucifer wrote:
Thu Apr 07, 2022 11:02 am
The inherent difference is that the private organisation - unless it is a non-profit trust - is taking some of the money out to stick in shareholders pockets.
I know this feels like it's true, but it's not actually relevant to the nation as an entire entity.

What matters is resources, namely the lack of resources. Profit going round in a circle doesn't absorb the economy's resources. It doesn't reduce the number of nurses in existence.

For a nation what matters is resources being drained away by inefficiency. Private healthcare is inefficient. It's very hard to achieve efficiencies in healthcare as you say. But NHS healthcare is inefficient. Pointing at things and saying inefficient isn't enough.
In turn, any system with multiple providers subcontracting to each other generates enormous amounts of bureaucracy over who pays for what.
This is of course true but it applies to the NHS as well. Nobody thinks it possible for a vast single corporation to employ 1.2 million people and provide healthcare as a single entity. Communist states have attempted to run vast entities as single entities and they have been hopelessly inefficient. The management reality is that the NHS has to be broken down into sub units to make the bureaucracy possible, even if all those multiple NHS providers subcontracting to each other simultaneously adds to bureaucracy.
Gfamily wrote:
Thu Apr 07, 2022 11:09 am
Private hospitals tend not to have fully functional ICU facilities, so an emergency in a Bupa hospital will go to the local NHS hospital for treatment.
Again, this does not absorb any additional healthcare resources. The emergency happens whether it occurs in an NHS or private hospital, the emergency treatment resources are required both times. Is there a risk that private hospitals would take more risks because it can free ride on the consequences? No, if the structures are established properly.

Many European countries show you can get more resources into healthcare by using private/insurance/employer funding. This isn't anything new to build from a blank piece of paper.

Would I prefer socialised healthcare funded by far higher tax rates on all UK citizens? Of course I would. But that's not going to happen. Look at all the moaning from an insufficient 1.25% tax rise. So let's get extra resourcing by pressuring employers to give their staff health insurance and getting richer people to pay even more for extra insurance.
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Re: NHS breaking point?

Post by dyqik » Thu Apr 07, 2022 11:59 am

lpm wrote:
Thu Apr 07, 2022 11:48 am
Gfamily wrote:
Thu Apr 07, 2022 11:09 am
Private hospitals tend not to have fully functional ICU facilities, so an emergency in a Bupa hospital will go to the local NHS hospital for treatment.
Again, this does not absorb any additional healthcare resources. The emergency happens whether it occurs in an NHS or private hospital, the emergency treatment resources are required both times. Is there a risk that private hospitals would take more risks because it can free ride on the consequences? No, if the structures are established properly.
This causes large amounts of additional work - the patient has to be transported, there are immediate communication issues (hampered by liability concerns), the records have to be transferred, consent to be treated by an additional hospital has to be obtained, the patient's emergency contacts have to be informed about where to find them, much other paperwork has to be done, the private hospital has to be billed for the work, the patient's insurance has to be billed.

Much of that is true of transfers within the NHS as well, but it's usually much easier to do that within organizations than between them. I have direct experience of the hassles this causes, by the way.

Establishing and maintaining those structures requires large amounts of additional work.
Last edited by dyqik on Thu Apr 07, 2022 12:14 pm, edited 1 time in total.

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Re: NHS breaking point?

Post by IvanV » Thu Apr 07, 2022 12:04 pm

EACLucifer wrote:
Thu Apr 07, 2022 11:02 am
The inherent difference is that the private organisation - unless it is a non-profit trust - is taking some of the money out to stick in shareholders pockets.

The usual argument is that private sector for profit stuff is more efficient, and there are some areas where that is true, but that isn't likely to be the case for health. Private sector efficiency relies on efficiency pressures caused by competition and price signals - which in turn requires consumer information that is very difficult to achieve with health. Market efficiency usually also allows for some people to just do without - not a moral option when it comes to health.

In turn, any system with multiple providers subcontracting to each other generates enormous amounbts of bureaucracy over who pays for what, and when everyone is trying to weasel out of responsibilities, gaps open up - one example I've had personal experience with is in wheelchair provision*, where the body coontracted to provide wheelchairs came up with thresholds based on who needs what that weren't closely attatched to care needs, and couldn't be overridden by medical professionals - specifically they were only obliged to provide electric wheelchairs to people who needed to be hoisted in and out of them, other patients were expected to get by with manual ones. There was no flexibility to allow people who were recognised as needing wheelchairs but unable to operate a manual one - in my case it was a joint condition that affects every joint in my body, but I was told that it would still apply to someone with no arms - to be provided with an electric.
"Money to shareholders" is money to pay for capital provision and for taking risk. The public sector also requires capital, and has risks, and has to pay costs. They just have a different name. So "money to shareholders" is often used pejoratively, as though it is something you can save entirely when you nationalise. But that is not true. It might indeed cost far too much privately provided, but that is something to be analysed, not asserted in every case.

And clearly a lot of our economy works very well with private capital, and would be disaster if it was all running with public capital.

Even in China they make considerable use of private capital to provide public services. But they tend to do it more intelligently than we do. So, for example, the Chinese will build a toll highway with public money, and get it up and running, and only then bring private capital in. In this way, they take the construction risk in the public sector, and get an idea of what the traffic is likely to be, and so reduce the demand risk. Getting the private sector to accept these risks would be a poor use of public money. Only at this point do they bring in private capital, to take over the toll concession and maintenance of the highway. This then gives them a big pile of capital to build the next highway with. It's a very good model which has enabled the rapid expansion of highways across China - understanding that such major roads are toll highways, something which is perhaps less plausible in UK geography.

But the reason certain things are commonly in the public sector, is that for some things, public capital can be cheaper. As we just saw with the Chinese highways, certain risks are not good value for money if you get the private sector to take them. Just about the very worst use of private capital is to fund the building of a costly and specific public building, to be occupied by a public sector tenant, which will have no private income stream, and with limited alternative use for the building. PFI for schools and hospitals, in other words.

As you say, there is a lot of stupid bollox over bureaucracy, and we seem to be increasingly foolish at creating lots of stupid bollox bureaucracy in this country. Currently the stupid bollox bureacracy in the NHS is mainly internal, patients don't see a lot of forms. On the continent, patients see more forms, but have less waiting around and being pushed from pillar to post.

As I said previously, contracting out can be done badly and/or corruptly. But it doesn't have to be. Some things work well when a sensible contracting out method is devised. I will repeat, the GP service in Britain is entirely contracted out, and it isn't a problem. But there are things which are hard to contract out effectively, and care needs to be taken. Maybe more contracting out can make parts of our health service better, while containing the costs of provision of those particular services, I really don't know.

But I really don't think that contracting out is particulary relevant to solving the problems with the health service, it's a secondary issue. If we are going to suffer Tory government for an extended period, and more contracting out will make the Tories feel better about it as they actually address the real problems, then maybe we can live with that. But unfortunately I don't have a great deal of faith in them doing that.

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Re: NHS breaking point?

Post by monkey » Thu Apr 07, 2022 12:50 pm

lpm wrote:
Thu Apr 07, 2022 7:29 am
Now do France, Netherlands, Germany.

Always reaching for US comparisons is Fake Debate.
Those countries use insurance, but none of those have a system like you described. The closest country I could think of was the USA, which is why I reached for it. Those countries have a Bupa/NHS ratio closer to the UK, but instead have statutory insurance instead of the NHS.

I am not against an insurance based system, it seems to work in other countries who regulate it sufficiently and ensure that everyone has it. But I am unsure that the UK moving to such a system would bring much benefit.

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Re: NHS breaking point?

Post by lpm » Thu Apr 07, 2022 12:58 pm

dyqik wrote:
Thu Apr 07, 2022 11:59 am
lpm wrote:
Thu Apr 07, 2022 11:48 am
Gfamily wrote:
Thu Apr 07, 2022 11:09 am
Private hospitals tend not to have fully functional ICU facilities, so an emergency in a Bupa hospital will go to the local NHS hospital for treatment.
Again, this does not absorb any additional healthcare resources. The emergency happens whether it occurs in an NHS or private hospital, the emergency treatment resources are required both times. Is there a risk that private hospitals would take more risks because it can free ride on the consequences? No, if the structures are established properly.
This causes large amounts of additional work - the patient has to be transported, there are immediate communication issues (hampered by liability concerns), the records have to be transferred, consent to be treated by an additional hospital has to be obtained, the patient's emergency contacts have to be informed about where to find them, much other paperwork has to be done, the private hospital has to be billed for the work, the patient's insurance has to be billed.

Much of that is true of transfers within the NHS as well, but it's usually much easier to do that within organizations than between them. I have direct experience of the hassles this causes, by the way.

Establishing and maintaining those structures requires large amounts of additional work.
Yes, but on the other hand there's advantages to be had from having extra hospitals that do hip replacements, or cataract operations, or whatever.

What doesn't cause any extra bureaucracy for anyone is not doing the hip replacement. Leave it neglected for years and the paperwork's a breeze. Which is what happens at the moment. The 18 week target is long gone, people are waiting in pain for a couple of years. The queue for this group of operations is half a million people.

It's not right morally if you take the 500,000 queue down to 100,000, but all those left are poor people and the richer people keep jumping the queue. But in utilitarian terms that's 400,000 people who are out of pain and have a better quality of life.
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Woodchopper
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Re: NHS breaking point?

Post by Woodchopper » Thu Apr 07, 2022 1:02 pm

lpm wrote:
Thu Apr 07, 2022 12:58 pm

What doesn't cause any extra bureaucracy for anyone is not doing the hip replacement. Leave it neglected for years and the paperwork's a breeze. Which is what happens at the moment. The 18 week target is long gone, people are waiting in pain for a couple of years. The queue for this group of operations is half a million people.
Which is an important point. Its easy to point to inequalities and other problems with other means of financing. But they need to be balanced against the current inequalities in which people with chronic conditions can receive very poor quality of care.

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Re: NHS breaking point?

Post by dyqik » Thu Apr 07, 2022 1:29 pm

Woodchopper wrote:
Thu Apr 07, 2022 1:02 pm
lpm wrote:
Thu Apr 07, 2022 12:58 pm

What doesn't cause any extra bureaucracy for anyone is not doing the hip replacement. Leave it neglected for years and the paperwork's a breeze. Which is what happens at the moment. The 18 week target is long gone, people are waiting in pain for a couple of years. The queue for this group of operations is half a million people.
Which is an important point. Its easy to point to inequalities and other problems with other means of financing. But they need to be balanced against the current inequalities in which people with chronic conditions can receive very poor quality of care.
I'm already taking that into account. I'm very aware of the problems of access to healthcare. Under your system, people without health insurance or with the wrong health insurance (if the UK was stupid enough to go down the route of multiple providers with separate contracts with providers, and thus preferred provider networks) won't have access to the hip operations.

And the access to healthcare issues are worse under the US system than the UK system. Even the wait times with full health insurance aren't really any better (remember, I have extended family in both countries, and both sides have some complex health issues that they are dealing with now). Of course, other systems exist, but they also exist in a different legal and social environment to either the UK or US, and they have arrived at that set up by a different route than the UK would.

There's also substantial external issues caused by private insurance and access to it. In the US, one of the biggest problems is that private health insurance is inevitably tied to employment as a benefit (as BUPA is now in most cases in the UK), and this leads to labour mobility issues and subsequent low productivity and increased inequality.

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Re: NHS breaking point?

Post by Ben B » Thu Apr 07, 2022 2:26 pm

lpm wrote:
Thu Apr 07, 2022 10:31 am
Ben B wrote:
Thu Apr 07, 2022 9:51 am
More often than not, healthcare that has been contracted out to private providers ends up being more expensive and with worse outcomes than if the NHS had done it. An example being that fairly high profile case to do with privatised eye operations where the contract had to be terminated early due to the substandard level of care. This is obvious. A private provider has to do the work and also pay their shareholders. They cannot possibly deliver the same level of care without costing more money.
This is incorrect.

There's no reason why private healthcare needs more resources than NHS. Sure, there's admin costs for private hospitals and insurance. But there's admin cost for the NHS too. No particular reason why the admin resources are higher in one vs the other, it could be either way.

Likewise, a region's privatised eye operations might be substandard. But a region's NHS eye operations might be substandard. Is there anything inherent that makes one more likely to be substandard than the other?

Ultimately substandard healthcare is now a reality in the UK, because healthcare is under resourced. So anything that increases resourcing, from training nurses with taxpayer funding to building hospitals with insurance funding, can be expected to raise standards. This under resourcing effect is vastly bigger than any public vs private effect.
I am correct. A private provider has the same overheads as the NHS, and also has to return value to shareholders, so it cannot supply the service more cheaply than the NHS; it's impossible. And that's exactly what we see in practice.
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Re: NHS breaking point?

Post by lpm » Thu Apr 07, 2022 3:16 pm

Ben B wrote:
Thu Apr 07, 2022 2:26 pm
I am correct. A private provider has the same overheads as the NHS, and also has to return value to shareholders, so it cannot supply the service more cheaply than the NHS; it's impossible. And that's exactly what we see in practice.
Wrong.

"Return value to shareholders" is not returning resources to shareholders. It's merely money going round in a circle. It comes back into the economy through taxes, investment and consumption.
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Re: NHS breaking point?

Post by nekomatic » Thu Apr 07, 2022 3:44 pm

monkey wrote:
Thu Apr 07, 2022 12:50 pm
I am not against an insurance based system, it seems to work in other countries who regulate it sufficiently and ensure that everyone has it. But I am unsure that the UK moving to such a system would bring much benefit.
This being my earlier point: it would only bring a benefit if it either persuaded people to spend more on their healthcare than they do now, or persuaded people to accept less healthcare than they get now. People seem to assume that the former would somehow automatically happen, but it’s not obvious to me.
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