Non-political Save our NHS

As I said in another thread - here in France the insurance companies are not allowed to ask about pre existing conditions - here it is age related more than anything. Some conditions such as cancer are still state funded and if you have a condition which is classed as long standing by the GP a lot of medication etc is free- not sure exactly about this part as do not know anyone affected and having this classification.
Travel insurance is also much cheaper here as no medical conditions are considered and if you are really stuck and repatriation is needed your house insurance will pick up that tab! We had holiday insurance for seven weeks - five in USA with everything covered except the flight tickets -as paid for with credit card - for €100 each.
The UK insurance business needs to have more regulation if this is to become necessary. The French health authorities issue a list of prices for their area which is the price they will reimburse 70% of - this is referred to as 100% by the ins. Companies - if you are in an area where the consultants or hospitals charge more it will be classed as 200 or 300%. You can take the lower cover and pay the extra yourself or just have hospitalisation costs covered. We opted to have 200% which means if we are sent to Bordeaux which is one of the best five in France - our ins will cover the bill. It is a very complicated system and getting to grips with it is a gradual learning curve - we went to a very good broker who explained all to us and what he recommended.
As a point of reference the local clinic charges €100 for a room and food each night - you do get to see the bills and who has paid what afterwards. We fortunately do have the funds to pay up front where needed and wait for the money to appear in dribs and drabs in our bank account.
In USA many of the ins.co. do limit the overall amount they will pay out on your behalf - my son has told me this and says it can affect people who have serious conditions which need long and expensive treatment - when you reach the limit the financing does cease as far as I know.

A friend in South Africa desperately needs medication for mental health and physical illnesses but can't afford the doctor's fee let alone the cost of the medicines. It's gone so far that I have painkillers delivered to her from a local store in Cape Town but I can only send basic stuff because like here a lot of medications are prescription only.

Mine have been a complete mixture.
One was an accident at work in USA, so work paid it thorugh their work insurance.
One was an operation, not due to work. In Canada. The MSP was paid for through his work. He may pay a 1/4 of the insurance, but not sure.
One worked for 6 months in France. Hers went through EHIC and physio related. She paid half and EHIC paid half.
One only has experience of GP and presciptions in Republic of Ireland. But he is a student through Northern Ireland. So it is complicated. He pays some but it is not full whack.

This is all in the last 3 years.
Different scenarios, different countries, different payments. All care good.

GERMANY. Over 11% of GDP

Dual system. Based on the concept of the Welfare State.
1. Compulsory Health Insurance working out to approx 14.6% of net income. Half paid by employer. So earnings related - the more you earn the more you pay. About 300+ insurance companies approved by the government.
2 If you earn more than approx 50K euro or a few other exceptions than you can opt out and go private. However lately private insurance is being considered as more expensive than the Government scheme and less efficient.
3. Other schemes include a 2% yearly insurance for elderly care, and accident insurance paid by the employer covering commuting accidents and workplace accidents.

Patients can walk off the street to any medical establishment.
You have an insurance card which you present to the Dr. Or hospital and they bill the insurance company

PS whilst looking at this I read about the social system/pension etc. Blimey talk about us being the poor relations!!!!
They pay in total about 40% of their salary of which half is paid by the employer and the pensions, unemployment benefit etc is so generous.

ITALY 9%GDP
At one time ranked 2nd in the world. Not sure now.

Fully insured Health system paid for by employers.
Patient recieves a health care card and presents this to medical practitioner.
All citizens receive free healthcare. HoweveR as far as I can make out there is a nominal sum for visits to specialists. Not sure why and whether this is reimbursed.
Due to mismanagement by various governments however this is beginning to creak at the seams and there may be changes in the future.

I can see one problem here I.e. in times of high unemployment the government presumably picks up the tab?

Good analysis Anya
Teetime They may have listened to you. Some practices do have nurse practitioners who are able to prescribe from a limited formulary without the patient having to see the doctor, as well as triaging. The government is trying to introduce 'assistant physicians' to perform a similar role.

The NHS suffers from what is known as the Quality-Price-Time triangle.
What this means is that when you are providing a service, you cannot have good quality, plenty of time, and a low price all at the same time.

If a service is cheap, you have to sacrifice either quality or time to provide it.

If you want to have good quality, and plenty of time spent on patients, the cost goes up.

This is what the NHS struggles with.
The cost of providing a comprehensive service, when medicine has made such enormous strides over the last sixty years, have increased exponentially. Patient expectations have similarly changed, so that withing thge financial constraints of the NHS it is very difficult to provide the quality that patients expect, and that the professionals want to deliver.

SPAIN 10%GDP

Universal coverage paid for out of general revenues. Social security payments deducted from salary.
No upfront payment by patient except proportion of prescription charge.
Health very decentralised. Government giving each region a grant and they spend as they wish on healthcare.
Spanish women live longer than any other nationality except Japanese.

As whitewave is showing, the financial constraints on the NHS are political dogma, janea. There is no reason why the UK cannot put more into the NHS.

FRANCE. 11.6% GDP considered as the best in the world.

Universal coverage.
5.25% of income, capital and gambling. National Health Insurance.
3.25% for pensions and other benefits.
Various fees are charged and reimbursed at approx 70%. The rest is made up by the patient out of pocket or insurance.
So an example visit to GP 23euros eventual charge to patient 6.6 Euros.
Board and lodging is charged for hospital stays. Not reimbursable

One thing I think is important is to be able to identify exactly what is being paid for health.
In Germany and France this certainly seems to be the case. And as a user it would be good to know how much it is costing us all. All the countries so far seem to base it on how much you earn. So those with highest income pay the most.

Knackered off to bed to read

There is always some constraint, Jen, with whatever payment system is used.
In an insurance-based system, the insurers will dictate what fee is paid to the practitioner and very often which practitioners the patients can go to.
Even if someone is self-funding their own private care, there will be cost considerations. Not many people would go along to their private heart surgeon, or get a new hip, and say 'Fix this and I don't care what it costs.'

I thought this thread was supposed to be apolitical but since you introduced the p-word, I will just say that a government of any persuasion has a duty to spend and borrow money responsibly, and there will always have to be a balance between the demands of different departments - education, social security, infrastructure, defence, police as well as the NHS.

WW this is very interesting. Thank you.

Here in France you go to the specialist your GP recommends or the one you choose - the insurance companies have no input with this - neither do they have any say with what is charged. The equivalent of the NHS decides the rates as to the amount they will refund the 70% - most places abide by these prices or are only slightly more - Paris may be an exception but I have no idea on that. You do see the costs eventually as they are shown on the statement you receive. A friend recently needed radiotherapy treatment and the hospital he needed to go to is an hour away - he was taken on a daily basis by a car from the local Ambulance man - the cost for this all was about €20K! The govt picked up that tab totally.

The social charges here are very high - employers pay almost as much in charges and taxes for each employee as their salary! This means it is very difficult for entrepreneurs to set up and so many move to UK to do this.

If it is decided this is the way for the UK to go there are many ways of setting something up - there is not a one size fits all method - much depends on what the Govt decide to pay from taxes and what percentage the patients will contribute. There are a lot of means tested exceptions to the payments too. I will check our statements and see how much of the €23 we pay to see the GP is refunded by the state and the Ins. Mind you I remember my mother taking me to the GP and paying just after the war and before the NHS kicked in.

My grandfather died before the war because they could not afford medication for him. That's why it is difficult for it to not be political for me.
So are you saying I should not contribute to the thread, janea?

No, jen. <sigh>

I didn't do a proper job on France as too tired. So will finish off.

Individuals pay 21% of their income. The French see their system as quite distinct from the UK as they would argue that it is much more flexible. With regard to the top up payments mentioned above. The sicker you are the less you pay. In fact the government will pick up the entire tap.
With regards to things like cancer the Health system guarantees that every drug however expensive will be made available.
Board and lodging averages 18euro a day. Insurance will be taken out for this.France has the highest overall life expectancy in the world except Japan.

NETHERLAND 9% GDP Has one of the highest customer satisfaction.
It is entirely private insurance based.Paid for by employers at 6.5% of earnings. This makes up 50% of total cost. 45% is insurance which is compulsory by the individual and 5% from tax. Premiums are about 100 euro per month. There is a type of opt out for some Christian groups. Not sure why - some Christian grans may know?
Hospitals are private and not for profit.
Insurance companies are all not for profit and highly regulated..
Divided into 3 areas
1 common medical care
2 Long term nursing and care
3 Supplentery car e.g. dental.
Insurers can't choose who to insure, nor put conditions on certain illlness.

Oh! Meant to say that the Netherlands system was entirely overhauled in 2006. So something our government may be looking at.

Just to add to Bez's explanation. Our top-up insurance in France is about 150€ a month, so not insignificant.
We find that income tax is lower than in England but the equivalent of NI contributions are much much higher which, as Bez said, puts a huge constraint on businesses, especially small businesses who struggle to employ anyone (when we ran our gite business about 50% of our total income was taken.)
The service is excellent but the costs are quite high.

Yes It seems that most individuals in our countries so far pay quite a bit more than in the UK I will eventually return to compare.

I find it interesting that although they are using insurance based models the companies providing the service are not for profit. Where we are using private companies this is by no means always the case.

I do not know but I wonder if the Christian exemption is because they can support nun run hospitals (?)

Don't know gg. Rather surprising to myself I am beginning to see that other systems may well be OK ,although this is only an overview and not a thorough comparison.

I am also aware that some are under pressure like the French system, although others as far as I am aware are functioning without problems like I think the German and Netherlands.