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What's so special about the NHS?


miga

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The NHS seems to be close to many people's hearts (witness the Olympics opening ceremony, "Save our NHS" bumper stickers, general pre-election scaremongering, special budget protection etc. etc.). I don't by any means want to take anything away from the hard work and dedication of many healthcare professionals employed by the NHS. But I do wonder what separates the NHS from the myriad other first world universal or means tested health care systems. In my (albeit limited) experience of two others, the NHS is fine, if a little stretched and shambolic. It also seems like its structure is so Byzantine, that I'm not sure how anyone can really know where the money goes, and so layers of bureaucracy and consultancy have to be brought in to try and get a handle on where the money goes, further removing the money from the front line.


So, what's so special about the NHS?


ETA: its not it's , bloody auto complete.

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AM - glad you're with us, and that kind of personal experience of course explains some of the emotional attachment to the organisation. Do you doubt you would have received similar level of care on the continent, or elsewhere in the first world?


rahrahrah Wrote:

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> It's one of the best (and best value) healthcare

> systems in the world.

>

> http://www.theguardian.com/society/2014/jun/17/nhs

> -health

> http://www.telegraph.co.uk/news/health/news/887741

> 2/NHS-among-best-health-care-systems-in-the-world.

> html


Both those from a think tank/lobbying organisation for health care reform in the US AFAICT, but quick google reveals others where the UK comes 18th (2000 WHO rankings), 10th, 14th etc. To properly understand each, the ideological bent of the ranker and scoring system used should be understood, I guess. But the idea that NHS is "the best system" is far from unanimous it would seem.

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If you've been unfortunate enough to be sick or suffer as a result of an accident overseas, you wouldn't need to ask that question. But give it a few years and the Tories will make sure that we will all need private health insurance to protect ourselves as the NHS will be a thing of the past.
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My first child was born elsewhere (in the first world), and the care was superb, and also completely free.

So many variables in care though, so even if it was rubbish, I wouldn't rush to extrapolate from that personal experience to a general conclusion.

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miga Wrote:

-------------------------------------------------------

> AM - glad you're with us, and that kind of

> personal experience of course explains some of the

> emotional attachment to the organisation. Do you

> doubt you would have received similar level of

> care on the continent, or elsewhere in the first

> world?


>

TBH I haven't a clue. I don't know about healthcare anywhere else.

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My late father suffered a heart attack while in Turkey 12 years ago, luckily he had comprehensive travel insurance. The treatment he received in Turkey wasn't great by any stretch of the imagination, thankfully his insurers arranged for him to be airlifted by a privately chartered jet back to the UK where he was treated in Guys to get back to full health. That's my only experience of health care overseas. I find it strange that our NHS doesn't get much of a positive press but we seem to have fair numbers of so called health tourists that come over to reap the benefits.
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"If you've been unfortunate enough to be sick or suffer as a result of an accident overseas, you wouldn't need to ask that question."


This is just narrow minded rubbish. Public healthcare in most developed world countries is comparable to that in the UK overall, and certainly measured in terms of health outcomes e.g. cancer survival rates the NHS is nothing special:


http://www.theguardian.com/society/2015/mar/24/uk-cancer-survival-rates-trail-10-years-behind-those-in-european-countries


My real objection to the current NHS structure is that it means healthcare is inevitably politicised - sometimes it seems like every big decision generates a campaign against it and politicians get sucked in, for example arguing to keep local hospitals open when all the professionals agree that ultimately people will be better served if they close and services are concentrated. Similarly, any discussion of costs is held in an essentially political environment - people talk about 'cuts', whereas in most big organisations it is taken for granted that looking to save costs by being more efficient is an ongoing everyday task.


The NHS works pretty well in spite of that, and there's plenty of evidence that it actually provides good value, but even on that score it seems likely that at least part of the value gain derives from artificially holding down wages, hence British nurses etc going overseas.


The best short analysis of public healthcare I have read was by Tim Harford in his book, The Undercover Economist. You can get a flavour from these articles:


http://timharford.com/2009/10/a-brilliant-and-doomed-template-for-healthcare-reform/


http://timharford.com/2014/05/healthcare-the-final-reckoning/

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I'm basically in the "what's so special about the NHS?" camp. That isn't to say it's a bad system, but not convinced it's any better than comparable western European countries.


I was actually hospitalised for 10 days in Italy last year. Some of the gear seemed a bit retro compared to what they have in Kings, but standard of care was absolutely fine. Small wards with plenty of nurses. I stupidly didn't have an EHIC card (and stupidly still don't) but the hospital somehow sorted it out. Food was a bit grim though!

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The NHS is very good - indeed it is currently keeping me on my feet. But having seen other countries in action, then I agree with the premise that amongst first world nations (not, obviously, the USA) it isn't anything amazingly exceptional.


Which is why all this talk about privatisation is a load of scaremongering. Successful national health services all over the world have a wildly varying mix of private and public.


There is one and only one criteria that mush be kept, having seen Australia make this mistake. It must always remain free at the point of delivery. Anything else is irrelevant ideology.

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Parkdrive Wrote:

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> If you've been unfortunate enough to be sick or suffer as a result of an accident overseas, you

> wouldn't need to ask that question.


I had a mate go through the Austrian system when he tore his ACL skiing. Within two weeks of the injury he had the initial treatment by the local GP, his knee operated on and physio started, all for free as he was working (as I was) in Austria at the time.


He'd have been lucky to get all that done in four to six months under the NHS.

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Loz Wrote:

-------------------------------------------------------

> There is one and only one criteria that mush be

> kept, having seen Australia make this mistake. It

> must always remain free at the point of delivery.

> Anything else is irrelevant ideology.


Hang on - it is free (if you don't earn enough), and you get varying levels of rebate depending on your income.

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"If you've been unfortunate enough to be sick or suffer as a result of an accident overseas, you wouldn't need to ask that question."


This is just narrow minded rubbish. Public healthcare in most developed world countries is comparable to that in the UK overall, and certainly measured in terms of health outcomes e.g. cancer survival rates the NHS is nothing special


Narrow minded really? So rubbishing an alternate view to yours is not? I bow to your overwhelming and superior knowledge. You talk of cuts in industry being needed from time to time and that the health service is no different. Actually there is, unless of course human life is now to be treated as commodity. Good luck with that.

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miga Wrote:

-------------------------------------------------------

> Loz Wrote:

> --------------------------------------------------

> -----

> > There is one and only one criteria that mush be kept, having seen Australia make this mistake. It

> > must always remain free at the point of delivery.

> >

> > Anything else is irrelevant ideology.


> Hang on - it is free (if you don't earn enough), and you get varying levels of rebate depending on your income.


Precisely. It is not free at the point of delivery for all users. And even 'free depending on income' is becoming a little theoretical.


And, a bit like dentists in the UK, fewer and fewer GPs provide the necessary bulk billing service for the service to be free to even those who would qualify. Medicare defines standard rates, but doctor can set their own rates. But you only get the standard rate back. So if Medicare say a GP visit is $50, but your doctor charges $75, then you are left out of pocket. If the doctor bulk bills, then he/gets the standard rate directly from the government and you pay nothing, but as I said, few do that.


And now most states have started charging for ambulance calls, often a few hundred dollars.


Charging really is the thin edge of the wedge stuff.

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miga Wrote:

-------------------------------------------------------

> Jeremy Wrote:

> --------------------------------------------------

> > Food was a bit grim though!

> What, even compared to NHS food?


Yep! I'd take an NHS "microwave meal" over the super-bland Italian hospital food any day. And breakfast was just "biscottate" and coffee (although I accept that's just because Italians don't know what breakfast is).



Loz Wrote:

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> Jeremy!! Five minute of your time and it lasts for five years. Do it now!!!


I know I know. I will before I go to Euroland again...

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it has a brilliant 'brand' and narrative that makes reform pretty difficult (including needed reform) which CAN be extremely handy for entrenched interests - nearest thing the UK has to a religion etc.


Don't get me wrong I'd rather have the NHS than most alternatives but we're not even allowed to really debate how it's run without emotive or shouty stuff appearing

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Jeremy Wrote:

-------------------------------------------------------

> Loz Wrote:

> --------------------------------------------------

> -----

> > Jeremy!! Five minute of your time and it lasts for five years. Do it now!!!

>

> I know I know. I will before I go to Euroland again...


I'm gonna go for a nag, here: it lasts for five years and there is no time like the present. A good lunchtime task!

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Parkdrive Wrote:

-------------------------------------------------------


> Narrow minded really?


You've managed to rubbish every single heath system in the world, based (by your own admission) on one experience that occurred in a relatively poor country 12 years ago. That's pretty much dictionary definition stuff.

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Loz Wrote:

-------------------------------------------------------

> Parkdrive Wrote:

> --------------------------------------------------

> -----

>

> > Narrow minded really?

>

> You've managed to rubbish every single heath

> system in the world, based (by your own admission)

> on one experience that occurred in a relatively

> poor country 12 years ago. That's pretty much

> dictionary definition stuff.


One system was mentioned specifically and mentioned in my example, but never let a fact get in the way of your argument eh?

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Parkdrive Wrote:

-------------------------------------------------------

> One system was mentioned specifically and mentioned in my example, but never let a fact get

> in the way of your argument eh?


In your example, yes. But the context of your original comment spanned all non-NHS countries as it was in answer to the original question - "what's so special about the NHS?". It was only when challenged you admitted your opinion was based on one example a long time ago.


Are you actually admitting that there may actually be better health systems in other countries and that the NHS may not be special?

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