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American using Britain’s NHS (2015)

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Re: American using Britain’s NHS (2015)

#71

Post by pjc50 »

chrisseaton wrote: post #65
cjrp wrote: post #60

Earlier quoted context omitted.

> If they tell you to go home that’s it and there’s no other option. Not even remotely true, if you don't mind paying. You can see a GP privately, there are already lots of apps which let you book appointments. A colleague had an ear problem, couldn't get an appointment with his local GP and so used one of these app-based services and got a same-day appointment with a doctor near the office.

I think there’s only one private A&E in the UK. Most people wouldn’t be able to get to it. If you go private and something happens during treatment they have to put you in an ambulance and take you to an NHS A&E. For most ordinary people if the NHS tells you to go home that’s it you have to accept it. And people die because of this!

Sure, and if the private system in the US tells you to home because you're not covered, you're just as stuffed. e.g. https://www.snopes.com/shane-patrick-boyle-died-after-starti...

This is not to say that the NHS could not be better, but its problems would generally be made worse not better by introducing market or pseudo-market mechanisms. Unless universality can be guaranteed.

Re: American using Britain’s NHS (2015)

#72

Post by pjc50 »

dageshi wrote: post #18
oldcynic wrote: post #9

Earlier quoted context omitted.

Who's suggesting it be set in aspic? That would be idiotic. I'd trust an independent body, with cross-party oversight, rather more to make changes, and choices, most suited to the service and populace than most politicians. There might even be some opportunity to think long term rather than just having the next election in mind.

I wouldn't. Any time that independent body fucked up or did a bad job, they'd simply claim they didn't get enough money from the government to do the job. Whether that was the truth or not. The "cross party" oversight would then take positions according to their party priorities, if in power blame the independent body for doing a bad job, if not in power blame the government for not giving them enough money. Unless o…

I suppose the TV license system is very close to an independent body with "tax" raising powers (including the ability to jail people for non-payment). No longer quite so popular.

Re: American using Britain’s NHS (2015)

#73

Post by CasaDeTony »

As I'm also an American using Britain's NHS, I was pleasantly surprised to see the article mostly matches up with my experiences using local services (though as others have called out, NHS GPs and Specialists still have regular 15-30 minute delays for pre-scheduled appointments, IME)

The only downside I would call out is that I pay slightly higher taxes in the UK than I would in the US, and I imagine that part of it goes to fund NHS programs.

That said, the small increase is a relative bargain, given the the excellent level of care provided by NHS staff and the avoidance of insurance nightmares I was used to dealing with back in the states.

Re: American using Britain’s NHS (2015)

#74

Post by Scoundreller »

lucideer wrote: post #46
Scoundreller wrote: post #44

Earlier quoted context omitted.

> I'm living in Ireland and would love to have a system as good as the NHS over here Why? Ireland has longer lifespans and better health-adjusted life expectancies than the UK.

Only marginally. The difference is negligible and even if it weren't, there's certainly far more contributing factors than the quality of healthcare provision. Playing devil's advocate, I guess one could speculatively argue that Ireland's private system* brings up the overall average while the public system only caters to the poor and deprived, but I don't think this would be enough to bring the averages up on its ow…

Granted it's from wiki, but 79% of 2010 Irish health care spending was by government. And part of that 21% will be from public system co-pays and levies that have nothing to do with private-run hospital visits.

Sounds like the public system provides the majority of care.

Any "public" system still has a private-tier available to anyone that can afford a plane ticket.

Re: American using Britain’s NHS (2015)

#75

Post by cstross »

jdietrich wrote: post #45
simonbarker87 wrote: post #38

By comparative metrics to the rest of the world the NHS comes out either top or pretty damn good. By comparison to whatever the metrics of whatever government is in power at the time the NHS always looks terrible. Budgets can be set arbitrarily by the government so it’s easy to make the NHS look like it is over budget (in fact all you need to do is increase the budget by less than inflation and talk about absolute nu…

>By comparative metrics to the rest of the world the NHS comes out either top or pretty damn good. Ish. The NHS is remarkably cost-effective, but has relatively poor survival rates for cancer, stroke and myocardial infarction. International comparisons seem to damn the NHS with faint praise - it's cheap and the patients are happy, but it's not very good at keeping people alive. http://www.qualitywatch.org.uk/sites/fi…

A chunk of the poor cancer survival is down to cultural issues — British men in particular being socialized to not complain, so they don't go to their primary point of care until it's too late to do anything beyond palliative care.

This is slowly changing, but it's generational. National-level screening initiatives also help: for example the Scottish NHS's national bowel cancer screening program. But when NHS England is facing real-terms cuts in spending, new long-term preventative stuff doesn't get rolled out.

Re: American using Britain’s NHS (2015)

#76

Post by cstross »

oldcynic wrote: post #5

As a Brit using the NHS I can only add that I trust, and expect, every government to make the NHS worse whilst they talk of how marvellous it is. I would really like it given to an independent cross-party body, or the civil service, to try distance it from politics and The Treasury. I'd like to see legislation to heavily penalise drug companies seeking 20,000% price increases and the like. Both sides fiddle with it,…

I'd like to see a long-term outcomes-based comparison between NHS England and the Scottish NHS, frankly.

The Scottish NHS is a fully devolved issue and has been diverging from the English system for most of a decade now, with a greater emphasis on preventative healthcare and screening programs (not to mention free prescriptions for all).

In another couple of years we may even have some hard statistical data on what practices work best!

Re: American using Britain’s NHS (2015)

#77

Post by nugget »

gaius wrote: post #37
nugget wrote: post #32

Earlier quoted context omitted.

I don't see how public health can dramatically improve until we start to have radically different conversations about diet across all levels of society. If you follow the money spent in health care it leads directly to obesity and related lifestyle diseases.

The NHS spends £11Bn/year on type-2 diabetes, 80% of which according to Diabetes UK is caused by or could be addressed by lifestyle choices. Not just diabetes of course, I don't mean to pick on one subset, I mean the NHS has to spend an awful lot of money on things that really shouldn't be things in the first place. People who really love "our NHS" eat right, exercise, and get enough sleep... The rest are just trying…

>eat right, exercise, and get enough sleep

Of these three, diet has by far the most impact on t2 diabetes. The focus on casual exercise ("10k steps per day") is relatively useless compared to a low-inflammation diet. But there seem to be a lot of perverse incentives and special interests who keep the conversation muddled or focused elsewhere.

Re: American using Britain’s NHS (2015)

#78

Post by alyandon »

Here in the US I had to take my son (he was 5 years old at the time) to the emergency room when he had slipped in the bathtub and hit his head which caused a huge gash right above his eye. We sat in the emergency room for 5 hours before any of the staff bothered to look at his open wound and then another 4 hours after that before they actually treated him.

The most infuriating part of the experience was the not-so-subtle attempt by the staff to see whether or not I had told them the truth about how he had sustained his injury by constantly asking him to recount how he had sustained his injury instead of actually treating his injury. On top of that, the staff were rude and generally dismissive when I asked how long they thought it would be before my son would receive treatment.

And then of course the billing nightmare that ensued was just extra icing on the cake. The hospital was in network for my insurance (which I verified before I went and again while I was there) but the staff neglected to tell me that they were contracted through a completely different company that turns out was not in network so I ended up having to pay almost $2000 for what amounted to a few stitches for my son.

Re: American using Britain’s NHS (2015)

#79

Post by lucideer »

Scoundreller wrote: post #74
lucideer wrote: post #46

Earlier quoted context omitted.

Only marginally. The difference is negligible and even if it weren't, there's certainly far more contributing factors than the quality of healthcare provision. Playing devil's advocate, I guess one could speculatively argue that Ireland's private system* brings up the overall average while the public system only caters to the poor and deprived, but I don't think this would be enough to bring the averages up on its ow…

Granted it's from wiki, but 79% of 2010 Irish health care spending was by government. And part of that 21% will be from public system co-pays and levies that have nothing to do with private-run hospital visits. Sounds like the public system provides the majority of care. Any "public" system still has a private-tier available to anyone that can afford a plane ticket.

Yeah, this is what I would've expected (hence the devil's advocate qualifier), which is why I think our life expectancy has other causal factors.

Although, one thing to note is the the government does invest in private hospitals as well, so that 79% figure won't be exclusively public healthcare. This is due to public-private-partnerships whereby a single site will accommodate both a public and private hospital with the entire project being funded by a combination of public and private funds, usually with an extremely favourable arrangement for the private side.

Re: American using Britain’s NHS (2015)

#80

Post by Marazan »

jdietrich wrote: post #45
simonbarker87 wrote: post #38

By comparative metrics to the rest of the world the NHS comes out either top or pretty damn good. By comparison to whatever the metrics of whatever government is in power at the time the NHS always looks terrible. Budgets can be set arbitrarily by the government so it’s easy to make the NHS look like it is over budget (in fact all you need to do is increase the budget by less than inflation and talk about absolute nu…

>By comparative metrics to the rest of the world the NHS comes out either top or pretty damn good. Ish. The NHS is remarkably cost-effective, but has relatively poor survival rates for cancer, stroke and myocardial infarction. International comparisons seem to damn the NHS with faint praise - it's cheap and the patients are happy, but it's not very good at keeping people alive. http://www.qualitywatch.org.uk/sites/fi…

Cancer survival rates are suprisingly tricky to measure. If I'm diagnosed with an incurable cancer 5 years before it kills me Vs diagnosed 3 months before hand then scenario 1 looks better in the cancer stats but scenario 2 is better for my peace of mind and probably avoid me having to have a bunch of superfluous medical procedures over the 5 years.
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