Understanding impact of private healthcare schemes on the NHS
August 30, 2017 8:04 AM Subscribe
What impact does the rise in private health insurance have on the NHS, in the short and medium term?
My employer is offering me heavily subsidised health insurance via one of the big UK providers. I believe strongly in the principles of the NHS -- taxpayer-funded healthcare for all, free at the point of delivery -- and want to understand whether joining a private health insurance plan can be reconciled with this.
Naively, it seems that as I'm still paying the same level of tax but using NHS services less (or alternatively, having the insurance company pay the NHS for services that I'd be using anyway) it seems like this would be a small net gain for the NHS.
However, presumably some of the faster service offered by the insurance companies is achieved by the insurance companies paying to, in effect, bump normal NHS patients down the waiting list for shared resources?
More nebulously, I worry that increasing numbers of people with employer-provided private health insurance will be used as support by politicians who want to (continue to) gut the NHS and move to a more US-style system.
Can you recommend any good articles, research papers, etc that will help me to understand the impact of rising numbers of privately insured patients on the NHS?
Obviously, the contribution of one person's insurance policy to any of the above will be negligible. I'm trying to understand the wider picture, across a complex system I know little detail about, to see whether I'm comfortable contributing to it.
My employer is offering me heavily subsidised health insurance via one of the big UK providers. I believe strongly in the principles of the NHS -- taxpayer-funded healthcare for all, free at the point of delivery -- and want to understand whether joining a private health insurance plan can be reconciled with this.
Naively, it seems that as I'm still paying the same level of tax but using NHS services less (or alternatively, having the insurance company pay the NHS for services that I'd be using anyway) it seems like this would be a small net gain for the NHS.
However, presumably some of the faster service offered by the insurance companies is achieved by the insurance companies paying to, in effect, bump normal NHS patients down the waiting list for shared resources?
More nebulously, I worry that increasing numbers of people with employer-provided private health insurance will be used as support by politicians who want to (continue to) gut the NHS and move to a more US-style system.
Can you recommend any good articles, research papers, etc that will help me to understand the impact of rising numbers of privately insured patients on the NHS?
Obviously, the contribution of one person's insurance policy to any of the above will be negligible. I'm trying to understand the wider picture, across a complex system I know little detail about, to see whether I'm comfortable contributing to it.
Best answer: I'd have pointed you at the Kings Fund, too. My personal feelings are most strongly about the fact that private hospitals don't have ICUs, so if surgery goes wrong, you'll still be treated by the NHS (out of the NHS's pocket), but you're likely to be in a different hospital.
The only resource that I know of that private hospitals use is consultant time (for which the consultant is paid the private hospital), plus the aforementioned risk of the NHS having to pick up the pieces.
I think there are things I'd consider paying for out of pocket if the NHS wasn't offering them quickly enough, but I can't imagine feeling comfortable leaving my NHS GP out of the loop totally. Just because the NHS is for everyone and gets its legitimacy to tax everyone from being a universal service.
posted by ambrosen at 10:31 AM on August 30, 2017 [1 favorite]
The only resource that I know of that private hospitals use is consultant time (for which the consultant is paid the private hospital), plus the aforementioned risk of the NHS having to pick up the pieces.
I think there are things I'd consider paying for out of pocket if the NHS wasn't offering them quickly enough, but I can't imagine feeling comfortable leaving my NHS GP out of the loop totally. Just because the NHS is for everyone and gets its legitimacy to tax everyone from being a universal service.
posted by ambrosen at 10:31 AM on August 30, 2017 [1 favorite]
Best answer: The big thing is no preexisting conditions coverage and extremely limited networks for some services. Mental health and midwifery most often are badly covered but there may be others. Many private insurers simply help you cut in line to see NHS doctors faster but don't actually provide you with any cost savings for doing so.
posted by parmanparman at 12:42 PM on August 30, 2017
posted by parmanparman at 12:42 PM on August 30, 2017
Best answer: I think private healthcare really comes into its own for things that the NHS doesn't cover - minor ops, sports physiotherapy, etc. The surroundings will be nicer, the waiting list non-existent and the consultation longer, with more time to ask questions. This is a good thing - it cuts the NHS waiting list for other people who can't afford to go private, and reduces NHS spending on fluff.
No way would I have anything serious treated in a private hospital - they just aren't set up to deal with sick patients (no ITU, no cardiac arrest team, OOH cover provided by one RMO rather than a full complement of registrars, nurses unused to spotting deteriorating patients, variable access to imaging, etc). To be fair they often won't accept anybody remotely ill anyway - I've had quite a few relatives being very vocal about transferring their 90yr old mother to a private hospital, then having to backtrack when they can't find anywhere to accept them.
The best teams are in the NHS - individual consultants may do private work, but you won't get the whole multidisciplinary service. Having said that, there are plenty of run-down depressing NHS services that I'd be ashamed to work in - you would probably know if you lived near a failing hospital, it's usually common knowledge.
In terms of taking resources from the NHS: NHS consultant work is timetabled, so if they are working in the private sector (most don't), it is in their own time. You aren't taking them away from NHS patients. You aren't using NHS resources, and on the very few occasions when you are (there are sometimes local contracts for stuff like MRIs), the NHS is charging like a rhino.
The dumping of sick patients in A&E after the private sector has fucked them up is definitely a real thing that happens though, so as I say I wouldn't have anything remotely major done privately.
A bigger problem is middle class flight - if only inarticulate poor people use the service, it is easier to for politicians to downgrade it. You need pushy middle class people complaining to hold the service to account. My husband opted out of his work's private cover for that very reason, but we live between King's College Hospital and St Thomas', so our local services are world-class anyway.
posted by tinkletown at 5:21 PM on August 30, 2017
No way would I have anything serious treated in a private hospital - they just aren't set up to deal with sick patients (no ITU, no cardiac arrest team, OOH cover provided by one RMO rather than a full complement of registrars, nurses unused to spotting deteriorating patients, variable access to imaging, etc). To be fair they often won't accept anybody remotely ill anyway - I've had quite a few relatives being very vocal about transferring their 90yr old mother to a private hospital, then having to backtrack when they can't find anywhere to accept them.
The best teams are in the NHS - individual consultants may do private work, but you won't get the whole multidisciplinary service. Having said that, there are plenty of run-down depressing NHS services that I'd be ashamed to work in - you would probably know if you lived near a failing hospital, it's usually common knowledge.
In terms of taking resources from the NHS: NHS consultant work is timetabled, so if they are working in the private sector (most don't), it is in their own time. You aren't taking them away from NHS patients. You aren't using NHS resources, and on the very few occasions when you are (there are sometimes local contracts for stuff like MRIs), the NHS is charging like a rhino.
The dumping of sick patients in A&E after the private sector has fucked them up is definitely a real thing that happens though, so as I say I wouldn't have anything remotely major done privately.
A bigger problem is middle class flight - if only inarticulate poor people use the service, it is easier to for politicians to downgrade it. You need pushy middle class people complaining to hold the service to account. My husband opted out of his work's private cover for that very reason, but we live between King's College Hospital and St Thomas', so our local services are world-class anyway.
posted by tinkletown at 5:21 PM on August 30, 2017
Best answer: I should say, Harley Street and the big London private hospitals which cater to overseas patients are slightly different - several of them have ITU beds, and some of the consultants work full-time in the private sector.
But in the rest of the country, private hospitals (Nuffields, Spires etc) are really for daycase or overnight stays only, not for medically unwell patients.
posted by tinkletown at 5:28 PM on August 30, 2017
But in the rest of the country, private hospitals (Nuffields, Spires etc) are really for daycase or overnight stays only, not for medically unwell patients.
posted by tinkletown at 5:28 PM on August 30, 2017
Best answer: Just popping in to disagree about having major ops privately. I had one yesterday and got to choose the best surgeon in the country for this procedure, and didn't have to join a waiting list. I feel in very safe hands at this hospital - it all feels very professional.
posted by Jacqulyn at 5:53 AM on August 31, 2017 [1 favorite]
posted by Jacqulyn at 5:53 AM on August 31, 2017 [1 favorite]
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posted by crocomancer at 8:35 AM on August 30, 2017