Non-political Save our NHS

Hmm not sure that is entirely correct whitewave. There are places where lots of specialists charge above the usual (conventionée) rate (maybe places like Paris, Nice) but I don't think that it is generally true in most of France that you can't find an alternative.
The state taking more control? Well maybe in the case of things like prescribing generic drugs, but I wonder if this is actually a reference to GPs preferring to continue with cash payments rather than automatic deductions from cards? This brought them out on strike for a week between Christmas and New Year.
The deficit bit is right, a lot of head burying in sand on that one, I think.
Like lots of things in France, the quality is very good but the need to modernise and streamline is not always seen as a priority.
I am not sure if this is good or bad tbh.

Problems with the FRENCH system.
1. When is was originally set up some practitioners were permitted to charge more than the regulated rate. This has now risen to in excess of 50% or more, resulting in it sometimes being difficult to find a Dr not charging this amount. The Insurance will not reimburse this fee.
2. When set up the Health fund was independent of the state. However the state is taking more and more control. Critics in France argue that this is moving towards the Beveridge model - something the French don't want.
3. Like us France's health system has a large deficit 11bn in 2010 with a total debt of 100bn. The government has been reasonably successful at reducing costs between 3-4%. However, it seems that the French are intending to ride the problem out until growth comes back into the economy.

Pros and considered of the ITALIAN SYSTEM

At its best the Italian healthcare is as good as anywhere in Europe, however the level and quality of healthcare varies considerably. The best is in the wealthy north and the poorest in Calabria and Sicily. The main reason being that the regional governments administrate the system. There is undoubtedly corruption, and how soon you advance up the surgery list for instance will depend on connection with the surgeon. Jobs in healthcare are also dependent on patronage and there is frequently no selection process.

As well as finishing with looking at some Commonwealth countries, I thought it is time now that we have an idea what is on offer, what the problems and criticism with each health system.

Pros and considered of German model.
This is the middle option between the UK and the USA model
So we know that the compulsory funding is not through taxes but by a sickness fund and wealthy individuals can opt out entirely.
Patients have a lot more choice than the UK, but the percapita spend is much higher.
One of the criticisms is the lack of central control of medical staff, with no behavioural guidelines in force.
The dual,/public system is encouraging the best Drs to practice in the wealthier more lucrative areas. Recently a poll suggests that 58% think the system should be entirely public.

I was just having a scan through University of York's Centre for Health Economics which pretty much has published papers on all aspects of the NHS and other healthcare systems - worth a look if you unfamiliar with it. I used it a lot when studying for my degrees in nursing and healthcare economics. Many government White Papers are based work from this centre of academic excellence.

There are probably some grans out there who have real knowledge of the different health systems on offer and it would be great if they could give us on overview and critique of the healthcare system they are familier with - if possible comparing it to the NHS.

INDIA

I will just mention India although it is not useful for our purposes. Almost all provision is out of pocket privatate care, so we can imagine how the poor fare. One thing to mention though. India has one of the cheapest private health provision in the world and people from the UK have taken advantage of this. I have no knowledge of the quality.

Thought that I would finish off looking at some Commonwealth countries before a brief look at our own NHS

eloethan this thread is in response - well on my part to the report that the government is actively looking at introducing an insurance system. I thought then that it would be useful to look at other systems to see how they deal with their healthcare system, and whether if forced on us an alternative was acceptable. I fully endorse your argument that the NHS is one of the best in the world , indeed after exploring other systems this will almost certainly be the conclusion. However there is one area that I think may well be useful to look at and that is a way of cutting out the political interference, and it seems possibly the Dutch have achieved that, although I am happy to stand corrected on that point.
I have tried not to introduce politics into this thread because I wanted to keep it a learning thread -well at least on my part and to avoid argument, although I would be more than happy to debate the subject on another.er thread.

I don't know why we are buying in to the notion that the NHS is inherently not fit for purpose in its present form.

As I've pointed out before, in June last year a very detailed study of 11 countries' health systems carried out by an international panel of experts appointed by a well respected Washington-based foundation declared the NHS to be the best of the systems studied:

"The United Kingdom ranks first overall, scoring highest on quality, access and efficiency," The study found that the NHS spends the second-lowest amount on healthcare among the 11 – just £2,008 per head, less than half the £5,017 in the US. Only New Zealand, with £1,876, spent less.

No healthcare system is perfect and there are certainly challenges to be be faced in terms of ther rise of certain illnesses - some of which relate to personal lifestyles or which are age-related. However, the NHS has in effect had its funding reduced, and its top-down re-organisation (which even some Conservatives have criticised) has created yet more expense and upheaval.

I'm sorry if this introduces a political element to this discussion but the fact is the situation in which the NHS now finds itself has been very much affected by political decisions.

margaret does everyone receive the same level of care? Is healthcare given to the poor,elderly,sick etc at the same. Quality as everyone else?
Is it affordable? Is the government at arms length so that it can't interfere?
Give a rundown. Also are health outcomes as good/better than the UK?

Look at the Dutch system when that looks a possibility. I will look more tomorrow only too tired now to make sense.
I would be very happy for someone to disagree with me though if they think I am wrong!!!!

Don't be afraid of a health system run by health insurancees. They can work very well indeed. There are usually several and they are in competition with each other to provide a good service. Of course basic care and treatment must be set down in law by the government

The doctors are then free to run their practices as they wish. After all they have studied for years and should be allowed professional freedom.
They will be paid by the different insurances according to which insurance company their patient belongs to. Sure, you have to carry a card but you will be treated in an emergency even if you don't have it with you or are not able to speak.
I can get an appointment with my GP in Germany in the next 24 hours if necessary and always within 2-3 days. being free to do as they wish, many doctors don't overburden themselves with patients. Appointments with specialists can take longer if not urgent.
The NHS will have to change somehow, sometime.

whitewave, you are playing a stormer here, and what a lot of work you have done. Thank you

I agree with you that less direct government control would be good, but I'm not quite clear who you would suggest should run the NHS. You mention the patient and the insurance companies, but if I'm going to be a patient, I want to have good care without having to run it! Also, I think, while some of the ideas that other countries, particularly France and Germany, have about health insurance have great possibilities for us too, I'm not sure that the companies should be in charge of the system. Perhaps I just haven't understood you properly (Saturday evening = ) but I would be interested to know what you think. The state does seem to have a role in France and Germany, so is there an alternative?

This is what the NHS says about the availability of cosmetic procedures

"Cosmetic surgery is rarely available through the NHS. There must be a major physical or psychological reason for needing the surgery. For example, in rare cases it may be required for health reasons."
Sounds fair and sensible to me.

I doubt very much that 15-year old girls would get breast implants on the NHS ethel.
As for breast reductions, these are usually done for valid clinical reasons (putting strain on back/shoulder) as much as cosmetic ones.

what is taking a lot money from the nhs is cosmetic surgery, these women who want free breast implants /reductions. These ops should be private apart from surgery such as to repair bad scarring or breast cancer repairs.
the nhs was intended to treat sick people not vain people. I read about a 15 year old who 'needed' a breast implant. She probably was not yet developed and in a few years might have had the bust she desired.

I also saw many examples of 'waste' during my recent stay in hospital, light left on, food waste etc.

It takes some getting used to actually. We are so used to the NHS.

I too dont know enough about possible pitfalls.
I only know that in some cases, outcomes in other countries are not that bad, and sometimes very good. Better than the NHS.

soon Honestly I am now at the stage of trying to make up my mind so am not sure. But yes I am now aware that there are workable systems that I think I could live with. Need someone to outline the pitfalls, and of course I haven,'t looked at the Health outcomes of the different systems, but none of them seem dreadful

I agree with you whitewave.

You seem to have done a bit of a turnaround from the start of this thread. Is that a correct assessment?

Up to about 10 years ago, I think that the NHS, as it stood, was coping. But no longer.

I am beginning to know what I would like to see for our NHS.
First I want government interference taken out of it entirely except as I mentioned strict regulatory powers.
Funding therefore has to be at arms length from government or they would interfere Not sure how that would work.
I want to see care from the cradle to the grave, and no nonsense about it being unaffordable. If I want it I am prepared to pay for it.

Our Canadian friends think the NHS is wonderful and wish their health care was as good. I just think that it could be managed better and would then be able to fund itself.

Bloody hell I typed the following all out then managed to zap it
Healthcare provided by a wide variety of organisations.
Most private health insurance is paid for by the employer.
However 25 million are underinsured
50 million have no health insurance.
There are 48 million unnecessary deaths each year through lack of insurance.
The take up of private health insurance has been dropping over the past few years because of the rocketing costs.
Medicare - for the over 65s paid for during their working life. It covers 50% of cost of Health care the rest must be made up from the individuals own resources.
Medicaid for the poor with children, disabled. Jointly funded by federal state and government. 80million in 2014.
The childless poor have no insurance.
Hospitals are however legally bound to stabalize uninsured patients - probably enough to send them tottering ou of A&E!!!!
Each state can decide on what level of provision of Medicaid and so there is a vast diffe4ence of cover.
700K are bankrupted each year as a result of being unable to cover their healthcare. As an aside my DH has a friend who had to sell his house this spring to cover costs even though he had Medicare.
Comparing the US with other similar counties the US has the worse child and maternal mortality and life expectancy at 78. But the best cancer outcome and other outcome because Americans present earlier and have more checks.
Sounds likehell

The elephant in the room!
AMERICA 18% GDP

Our top up insurance is €150 a month for the two of us - Allianz and 200% cover. The system seems to work well with the paying system that is in place. With the need to pay €23 when you go to the GP I think people may think twice and only go for their check up or when they really need it - I wonder if that situation will change when your Carte Vitale will be all you need in the surgery and payment go the GP automatically from CPAM.

I think it would be a great mistake to take the NHS out of the State's hands - just look at the shambles some of the denationalised services have got into. The use of outside agencies is part of the problem with the NHS now. Once out of the States hands - however badly run we think it is - would be the short sharp slide into complete Private Health care and no guaranteed safety net for people who, for whatever reason, cannot afford to pay for treatment or insurance - and then we would have no control at all on prices charged or hours of operation.