Post No.: 0975
Fluffystealthkitten says:
Countries like the UK have a predominantly publicly funded healthcare system, as examined in Post No.: 0932.
Most other high-income countries have a different system of topping up a basic level of healthcare funded by taxes for those who cannot pay (e.g. Medicaid and Medicare in the USA) with a mix of private insurance cover and an array of fee-for-service options.
In the USA – where healthcare is largely provided by the private sector – doctors routinely overcharge for services and consumables. Many patients go bankrupt over medical costs there. It’s about generating profits, thus a hip replacement might cost $10k or $100k, or getting an appendix out could cost anything from $2k to $180k, and cotton swabs and routine x-rays are often marked up by as much as 400%! If the market were competitive and transparent then prices for similar (no differentiation) products should be competitive wherever you go. This has led to the need for price transparency legislation in the US.
In 2017, on average, £7,736 was spent per person in the USA on healthcare, compared to £2,989 per person in the UK. The USA spends more on healthcare as a proportion of their GDP per capita. This would all be fine if health outcomes were greater but (although there are other factors like contrasting firearms laws) the USA has the lowest average life expectancy of the G7 countries. So where’s the efficiency and value for money for US citizens?
Wealthy, insured Americans end up visiting their doctors too often for unnecessary things. Although they must pay any co-pay/deductibles, relying on healthcare insurance means one won’t care about searching for the best deals because one’s insurance company will essentially foot the bill. (Yet how easy is it to ‘shop around for the best deal’ when we’re seriously ill or injured anyway?!) This behaviour raises everybody’s insurance premiums. Some young adults get a bunch of half-unnecessary procedures done just before they turn 26, like having their wisdom teeth taken out, because they’re about to come off their parents’ health insurance plans.
Meanwhile, poor, uninsured Americans die younger than they should. They might delay seeing a doctor – but this may mean their health problems worsen and they end up with more expensive bills at the end of it all.
Another thing about insurance cover is that the more you truly need it – perhaps because you have pre-existing health conditions – the more expensive it’ll be for you. And the poorest tend to have the most health problems precisely because of their poverty. They’re hit the hardest during disasters too. It’s not like your home or motor insurance premiums rising the larger or more luxurious your house or car is – in which case you should be able to afford those premiums if you’ve got such a big house or fancy car. (In general, charging premiums based on demographic group patterns is against individual rights too – according to libertarians, people should be treated as individuals.) And when insurance firms are effectively the ones to greenlight or override a life-saving organ transplant instead of doctors who are actually present with the patients – something’s gone wrong! Meow.
Private healthcare providers are more incentivised to say you need this or that scan, treatment or procedure simply because they profit from every one they sell, even if you don’t truly need something, hence a higher rate of false positive diagnoses. Quantity is prioritised over quality of care. One’s earnings being tied to how many healthcare products one prescribes or administers presents a conflict of interest for doctors – to fully heal a patient as rapidly as possible or to expand their ‘customer lifetime value’ by keeping them mildly sick so they continue needing to rely on one’s services? Where’s the incentive to prevent people from getting ill in the first place if this reduces one’s customer base? (It’s a similar case for private arms manufacturers that profit from war or the threat of wars – they want war or fear more than peace.)
To cut costs, less-qualified physician associates may be used instead of primary care physicians, which maximises profits. Patients are taken in then sometimes literally shoved out onto the streets as quickly as possible because profits maximise when the total number of patients seen maximises – ‘patient dumping’ at nights is a problem in America. Patients with complex health problems are also eagerly transferred if requested because this absolves the hospital of liability for the patient.
A higher proportion of health spending goes into marketing, management and administration. UK NHS doctors should meanwhile be able to concentrate fully on serving their patients instead of on accounting spreadsheets and generating profits. The NHS, as a massive buyer, can directly negotiate with the pharmaceutical industry to procure a better deal for patients too.
The private healthcare sector in the UK may appear efficient but what private contractors do is only bid for the profitable services, not the complex and unprofitable ones, which a lot of healthcare needs are. The latter are thus left for the public healthcare sector to provide. In fact, even those with private health insurance, if they develop a complex health issue – what the private health provider will do is push the client onto accident and emergency (A&E) i.e. onto the public sector to deal with and pay for(!)
Due to under-funded NHS dentistry services, many UK dentists find it more lucrative going private, thus many poor people currently struggle to see a dentist. Public spending cuts and austerity measures hit the poorest the hardest i.e. spending cuts are regressive.
From a narrow perspective, the NHS isn’t profitable and just takes from taxpayers – but from a broader perspective, it keeps the nation’s present and future workforce healthy and in turn productive, which means that it indirectly positively contributes to the economy.
As a publicly funded service, there’s a strong public interest in ensuring the NHS delivers a high quality of accessible care and that its finances are sustainable. So it is ceaselessly publicly scrutinised and criticised (e.g. regarding a ‘postcode lottery’ for treatment access and waiting times due to how NHS spending is most commonly decided at a local level). But plenty is asked of the system and it performs well overall.
The Department of Health and Social Care (DHSC) is typically the government department with the largest budget. The NHS is the largest public sector employer in the UK too.
Doctors, nurses, midwives and allied health professionals all need to be registered with the relevant professional bodies before they can work in these professions. There are also regulators responsible for ensuring the NHS itself is providing safe and high-quality care, and is performing and spending its finances sustainably – primarily the independent Care Quality Commission (CQC), and NHS England, respectively, in England.
General practice is presently in crisis though because of difficulties in recruiting and retaining GPs. 84% of patients surveyed in 2022 required a GP appointment but of these, 55% avoided making one, mainly because they found it too difficult. The UK has one of the lowest numbers of practising doctors per capita in Europe, which makes it harder for people to get appointments. 21st century medicine is vast thus sometimes it’s ridiculous to expect a 10-minute appointment to cover sufficient ground. Effective preventative public heath initiatives and effective primary care would save taxpayers’ money. (It costs ~£40 for a patient to be seen by a GP but ~£200 to be seen in A&E and ~£400 for an ambulance call-out.) Improving the rate of early cancer diagnosis is one way to prevent costs downstream.
And although the number of nurses is around the European average, it’s lower than comparable countries like France, Germany and the Netherlands. Supply hasn’t met growing demand (e.g. due to increasing obesity-related health problems and people with complex health needs). Many staff feel overworked, underpaid and leave due to work-related stress. The UK’s withdrawal from the EU impacted upon the fact that 6% of the NHS workforce were EU nationals too.
The performance of the NHS is measured to assess whether patients can access care when and where they need it; health equities; and whether it runs on a balanced budget.
Two of the most high-profile targets regard waiting times for elective treatment and waiting times in A&E. Waiting times consistently rank as one of the public’s main concerns. But the NHS hasn’t met its own targets here for years, and the pandemic only made things worse. Reasons may be a growing population combined with staff shortages and insufficient hospital beds. The implications of the funding squeeze on the NHS and rising demand for care have been stark.
Now the NHS actually always balances its books – it doesn’t spend more than it receives or earns (via the government, private patient work or donations). What happens is that some parts of the system run into deficits while others make a surplus, and the latter subsidise the former. National bodies and local commissioners also hold some of their own budgets back to help cover any deficits.
Regulation ensures that NHS organisations are being responsible with their budgets. Bodies like NHS England will step in whenever financial performance becomes unacceptable.
We don’t let NHS organisations go bust though. The Department of Health and Social Care ensures staff will get paid. Yet balancing the books is still critical because if an NHS organisation fails to do so, it’ll make sacrifices somewhere like by not updating equipment, by reducing its services, by postponing hospital building redevelopment, or by not filling vacant staff positions immediately. (Citizens of local councils, even if their local governments run into deficits, similarly won’t be left without essential services. But cuts to less essential, yet still important, services will be made.)
The NHS primarily exists to improve the health of the population it serves, and one way to assess this is via measuring patient outcomes, like mortality rates for common conditions, how long people are surviving after receiving a cancer diagnosis, and patient reported experiences and feelings (bearing in mind that some of these outcomes, like survival from cancer, are affected by a wide range of factors that go beyond the NHS e.g. housing, support networks, diet and exercise). Did the healthcare intervention ultimately help improve the health status of the person receiving treatment?
The NHS is doing better here than historically but still lags behind comparable countries like Scandinavian countries, Australia and New Zealand when looking at things like lung cancer survival. The NHS delivers a largely high-quality service but there’s much room for improvement.
A typical pattern is that one’s opinion regarding the ‘satisfaction with the way the NHS is run’ depends on one’s political affiliation, along with which political party is currently in power i.e. we’re more pleased if the present political party in power is the party we personally prefer. Yet it’s worth noting that this political divide has narrowed in recent years and is no longer statistically significant, as general levels of satisfaction with the NHS fell across the board in 2021.
…Still, how does patriotism square with a largely private healthcare system? We should care about our fellow country folk. The ‘food bank’ model of pop-up free clinics indicates failures in providing needed services in society.
You have to keep a jar of money aside for doctors’ bills, and live in constant fear of getting ill. You’d think that mostly paying for your own healthcare would incentivise a population to care immensely about not getting ill – but the USA has a high proportion of individuals with obesity and drug addiction problems.
You can be punished twice, say, for getting injured from a robbery and then not being able to afford the costs to treat those injuries! Universal healthcare means no family needs to enter into debt for a child’s chronic or serious health problems.
Meow. Even just knowing there’s this safety net reduces stress and increases well-being for citizens… if we care.
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