Should I just stick with NHS?

March 23, 2008 10:01 PM

UKFilter (again): What are the advantages of private medical insurance over just relying on NHS? I'm an American moving to London being offered private medical insurance. What are the advantages? Things to look for in a private medical plan? Any guidance/links appreciated.
posted by vacapinta to health (15 comments total)

Speed of access to elective treatment and procedures for which there's a waiting list. If you need specialist medical care, you will, for the most part, be treated by people who do NHS work the other half of the week. (There are fringe benefits, too: private rooms in NHS hospitals with flowers and TVs, etc.)

Additionally, in London and the south-east of England, you're likely to have problems finding a dentist who accepts new NHS patients. (If you've got a 'British teeth' joke, now's the time to use it.) Dental plans are offered separately. There's a rota system of emergency NHS dentistry, which doesn't require registration: the NHS site lists daytime clinics, and the NHS Direct phone service hooks you up to out-of-hours clinics.

With opticians, the days of Elvis Costello-style NHS specs are pretty much gone, and free eye tests are limited to children and OAPs; if you need contact lenses, a vision plan might be useful.

Employment based packages are designed, most of all, to reduce the potential for lost working time due to acute health issues and the timesink of scheduling appointments. They also tend to offer on-site assessments, screening, vaccination etc., again to ensure that you don't stray too far from your desk. BUPA's the classic private choice, AXA PPP's another long-established insurer, but the range is a lot wider than, say, ten years ago. You can evenbuy it from Boots these days.
posted by holgate at 10:57 PM on March 23

Here's the answer I gave to a similar question a while back The big, big advantage of private health care for me was not having to use my local NHS hospital.
posted by essexjan at 12:28 AM on March 24

It also depends somewhat on where you are. My local NHS hospital and doctors are excellent. In other areas, no so much. Clearly in the second case, it's handy to have private coverage.

Despite horror stories, being without medical insurance isn't a death sentence - many professionals in London rely purely on the NHS or figure that if something comes up, they'll just pay for it. So, in reference to your question, insurance is handy to have. But it's not essential.
posted by outlier at 2:54 AM on March 24

People who have private medical insurance in the UK fall into two groups: those to whom it is important to minimise time off work and those who are willing to pay a premium to get high quality care delivered quickly. The former group includes those who are self employed and the HR managers of many large companies who offer private health care as a free or subsidised part of a standard job package. The latter group comprises many reasonably wealthy older individuals.

Since you appear to be getting offered private insurance as part of your job one of the first steps I would take would be to see how much you will pay for this. Generally the premium will be much lower than you would face in the US since you are paying for a service that you will only be expected to use as a top up for the NHS (there are some areas where private medical insurance will usually not cover your: maternity care and emergency treatment for example). You might pay £250-£500 per year for example.

Should you become ill your first point of call will be your GP (see last week's thread on this) - should you need further specialist advice s/he will normally refer you to a specialist in the NHS. For anything non-urgent this could involve waiting for several weeks. If you get admitted to hospital then you may find yourself on a shared ward - food will not be very good, the hospital may have problems with infections and you might not get the attention you feel your case deserves. On the other hand your experience may be very good - it depends where you happen to end up. There has been quite a lot of recent investment to clean up and speed up NHS hospitals.

If you have private cover then your GP will recommend you to a specialist at your local hospital (often the same person who would have been treating you in the NHS). You will usually have some choice of which specialist to see. Whether you need to be admitted to hospital or seen for outpatient treatment this will normally be possible within a few days. The hospital will like a fairly luxurious hotel with good food, doctors will take time to listen to your problems, you will have your own room, etc. Specialists working in private hospitals tend to be those with an especially prestigious career record which may mean that that are very good at what they do and which may also mean they tend to be a bit arrogant. Private hospitals tend to be quite well equipped in terms of surgical facilities - but they may not have the money to buy some of the most expensive or specialist bits of hardware so you can end up back with the NHS for those elements of your treatment.
posted by rongorongo at 3:49 AM on March 24

Depends.

Will you be paying tax and National Insurance in the UK? If so, then the NHS will cover your needs admirably. Not perfectly and not to the best American standards (although my partner has been treated shockingly in a US hospitals - much worse than the NHS).

If you're not paying UK tax, then no, you shouldn't be using it. You should get medical insurance.
posted by alllowercase at 3:55 AM on March 24

"If you're not paying UK tax, then no, you shouldn't be using it. You should get medical insurance."

anyone in the UK on a visa of more than 6 months length is entitled to NHS care.
posted by wayward vagabond at 3:59 AM on March 24

to add: if paying taxes were a prerequisite for NHS coverage, many Brits would be SOL.
posted by wayward vagabond at 4:01 AM on March 24 [1 favorite]

wayward vagabond: I didn't say that paying taxes was a prerequisite for NHS care. Clearly many UK users of the NHS do not pay or tax. I said that the OP should get medical insurance if he/she isn't paying UK taxes.

Also, it is not the case that anyone here on a visa for more than 6 months is entitled to free care. The list of entitled persons is on the DH site.
posted by alllowercase at 4:16 AM on March 24

that should be "pay NI or tax"
posted by alllowercase at 4:17 AM on March 24

the OP will not be "visiting", she will be living and working here, and therefore contributing to the economy, whether paying UK taxes or not (presumably under the UK/US tax treaty which prevents double taxation of workers).

from your link:

Who does not have to pay?

People Entitled to Full NHS Hospital Treatment free of charge –

* Anyone who is working in the UK for an employer who is based in the UK or is registered in the UK as a branch of an overseas employer (this includes self employed people). You must be actually working, not just looking for work;
* Any unpaid worker with a voluntary organisation offering services similar to those of a Health Authority or Local Authority social services department;
* Any full time student on a course of at least 6 months duration, or, if less than 6 months, a course substantially funded by the UK government;
* Anyone who has come to live permanently in the UK. If you make an application for permanent residence after you get here you are chargeable until your application is approved;
* Anyone who has been lawfully living in the UK for twelve months immediately prior to treatment;
* Refugees and asylum seekers whose application is still being considered;
* Anyone employed on a ship or vessel registered in the UK or working offshore on the UK sector of the Continental Shelf;
* Anyone who receives a UK war disablement pension or war widows pension;
* Diplomatic staff working in embassies or Commonwealth High Commissions in the UK.
* Members of Her Majesty’s UK armed forces*;
* UK Civil Servants working abroad who were recruited in the UK and employed by Her Majesty’s Government*;
* Anyone recruited in the UK who works abroad for the British Council or the Commonwealth War Graves Commission*;
* Anyone who is working abroad in a job financed in part by the UK Government in agreement with the Government or a public body of some other country or territory*;
* Anyone working abroad for not more than 5 years as long as they have lived legally in the UK for ten continuous years at some point (including self employed people);
* Anyone working in an EEA country member state and contributing compulsory (not voluntary) UK national insurance contributions (class I or II);
* Anyone who is a national of an EEA member state, a refugee or stateless person or their dependant or survivor living in an EEA member state who is referred to the UK for specified treatment with an EC form E112 or E123;
* Anyone who is referred by their home country authorities for specified treatment in the UK under the terms of a bilateral agreement;
* Anyone who is detained in prison or by the Immigration Authorities in the UK;
* Serving NATO personnel, posted in the UK, who are not using their own or UK armed forces hospitals;
* UK state pensioners who have lived lawfully in the UK for 10 continuous years at some point, who now live for not more than 6 months each year in another EEA member state and not less than 6 months each year in the UK;
* Missionaries working overseas for an organisation principally based in the UK, regardless of whether they are receiving a wage or salary*;
* The spouse or civil partner and any dependent children of anyone who is exempt under the above criteria, if they are living permanently with the exempt person. Coming to visit the exempt person for a few weeks or months does not give exemption.




de facto, this includes everyone with a visa of six months or longer (work permit, finacee visa, spousal visa, unmarried partners visa, HSMP, student visa, etc.). the OP clearly falls under the first category.
posted by wayward vagabond at 4:36 AM on March 24

Just to give you an example - I needed a minor-ish operation on my leg. I had to wait 8 month for the NHS to do it, whereas, had I had private insurance, they would have done it in 2 weeks. Not that this was a problem in my case, but if it was something causing you pain, that could be a big difference.
posted by prentiz at 4:58 AM on March 24

* Anyone who is working in the UK for an employer who is based in the UK or is registered in the UK as a branch of an overseas employer (this includes self employed people). You must be actually working, not just looking for work;

Yep. That's me.

Thanks for the answers. I have the inverse problem of many people in these health-care threads. My health care here in the US is very, very good. My GP is a personal friend of mine. I get in same day. Had a minor-ish recommended operation scheduled and performed within a couple weeks at a great hospital, etc...

I read the brochures and everything but its hard to determine from here if private medical is something that say, most working professionals have or its more of an outlier. rongorongo's answer helps a lot as do the other personal experiences.
posted by vacapinta at 6:39 AM on March 24

I read the brochures and everything but its hard to determine from here if private medical is something that say, most working professionals have or its more of an outlier.

It depends on what you mean by 'working professional', as London itself is an outlier compared to the rest of the UK. Judging from my friends who live and work there, if you're in a 'City' job (whether or not you're actually based in the City) your employer either has a supplementary plan as part of the package, or encourages/subsidises you to get one. Otherwise, the NHS provides.

(The official numbers suggest that under a tenth of the population has any kind of private health insurance, and my guess is that most of those five million or so are clustered in and around London.)
posted by holgate at 8:00 AM on March 24

It may be difficult for a visitor from the US to realise the extent to which the British regard the NHS as their birthright, and free healthcare as part of the social contract between the individual and the state. (That's why horror stories about the NHS have such potency -- failings in the NHS seem to symbolise, in a very visible way, the breakdown of the social contract.) No government, not even the Thatcher government, has really been able to touch the NHS -- I remember the outcry when Edwina Currie (minister of health under Mrs T) declared that wealthy people had a moral obligation to take out private health insurance in order to 'take pressure off' the NHS. Until quite recently, private health insurance was a strong class indicator -- going private was a sign that you considered yourself too posh to use the NHS like everybody else -- and there was a certain stigma attached to 'opting out' of the national health system. Attitudes have changed a lot, and it would now be considered rather quaint to make a fuss about private health insurance (my public-sector employer certainly feels no shame about doing a deal with BUPA to sell us subsidized health insurance), but I still know a great many people who use NHS services on principle and would consider it immoral to go private. Old attitudes die hard. (Another reason for the popularity of NHS horror stories -- to assuage the guilt that many people still feel at the thought of going private.)

Barring major illness, your contact with the health system is likely to be mainly with your local GP. You say you're accustomed to very good GP service in the States, so it may be as well to warn you that you can't necessarily expect the same over here. GP surgeries vary enormously -- some are very good, some are not -- and it's worth asking around and (as far as the system allows you to do so) shopping around to find one of the better ones. Some surgeries are so overstretched that they will not accept new registrations. There are also some perverse incentives operating in the system -- e.g. GPs were set 'targets' for reducing the number of patients waiting more than 24 hours for an appointment; they met the targets by making it impossible for patients to book appointments more than 24 hours in advance. You may find this hard to believe, but my local surgery has no telephone booking system -- the only way to see a doctor is to turn up in person, join the queue and wait to be seen.
posted by verstegan at 3:00 AM on March 25

In my not-extensive encounters with private health providers in the UK, I'll offer the warning that while you may get in more quickly, there is no guarantee whatsoever that the standard of treatment won't be dramatically less competent than you'd get inside the NHS.

(The plural of anecdote is not data but) I don't know anybody hospitalised in a UK private facility who wasn't killed, or nearly killed, as a result of cack-handed surgery. I do, however, have three separate counterexamples.
posted by genghis at 6:48 AM on March 25