In a quick (no time) nutshell
1) Everyone pays whatever they currently pay in tax for the NHS into a new "state backed medical insurance fund"
2) That fund has minimal headcount, circa 20 or 30 people max, less if they outsource more of the donkey work
3) All NHS providers of care are sold or given away to whoever wants them, else they get shut down, all hospitals etc are then forced to compete for patients directly with patients (and by implication with their GPs, but patient keeps the ultimate choice)
4) For most secondary care on diagnosis patient gets give a cheque by "state backed medical insurance fund" to take anywhere they dam well want, including abroad, including to BUPA etc with a top up of their own if they so choose
5) State stops funding cheap/infrequent stuff for the vast majority, so GP appointments are charged at full commercial rates, free market allows some innovation, and patients and doctors come to better compromises about what suits both sides
6) Central NHS IT is shut down, all senior bods involved sacked from where ever they are in government/public sector and never allowed to work again, lock them up, throw rotten fruit at them
7) To compensate for 5 above, SBMIF covers expensive stuff much better, much better funds for cancer treatments, heart treatments etc
8) Special dispensations to 5 for folk with long term life threatening conditions, diabetics etc, SBMIF picks up tab
9) Some subsidies for rare places, remote parts of Scotland etc, dished out directly to patients for them to spend locally as they see fit
10) Any patient is allowed to go to any doctor or consultant, no artificial barriers to access
11) All doctors are forced to work one year in four in an inner city
12) Task force sent round "best of rest of world" such as Europe, New Zealand, States, and brings back best practise from those areas and refines regulations with this in mind
13) Medical business becomes a state regulated not a state run business
14) NHS dentistry is abandoned, poorest patients given cheques to take to any dentist they choose
Needs a good transition plan, wouldn't want to do it overnight, but over the course of say 4 years this could be implemented easily
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6 comments:
1, Fair enough
2, 20-30 people to run a fund that will deal with every medical claim for 60 million people. Hmmm don't think so!
3,These new providers of care will be running their hospitals to make a profit. This would bring a multitude of problems such as. Patients would find themselves traveling huge distances for some treatments because it would be unprofitable to offer them at local level.
4, Fine but what about those who hadn't paid into the scheme? Also how would regulate the potential for fraud?
5, I am not a GP so don't know what a full commercial rate for an appointment would be, but I doubt it would be less than £100. This would have a huge negative effect on the health of our nation as people would delay seeking medical advice.This would lead to an increase in people presenting with advanced stages of disease which in turn would be more expensive to treat.
6, Yep can't disagree with that!
7, As number 3, People will have to travel much further for treatment to specialist centers. It would be uneconomic to offer them at local level.
8,Their care is likely to be poorer as profit is now involved. Look at Dialysis patients for example. In this country the vast majority of haemodialysis patients have AV fistula vascular access (by far the best option). In the USA it is less common as it is cheaper to put a central line or a graft in.
9, These places will suffer the worst because it will be unprofitable to offer much in the way of care for areas that have a sparse population and large geographical location.
Subsidies are of little use if you have nothing locally to spend them on.
10, Costs and workloads would spiral out of control if patients would allowed to self refer to consultants.
11, Apart from being grossly unfair. Would you also reimburse their increased living expenses for that year, in which case again your model is more expensive.
What about these GP's children who either live without a parent for a year or have their education disrupted every 4 years.
12, Best practice is already widely shared around the world.
13, For reasons given above following this model would certainly reduce the health of our nation as a whole and is unlikely to be any cheaper.
14, Depends a lot on your definition of poorest, but this would again either increase costs for your new scheme or increase personal costs for a lot of people.
1, Fair enough
Yep
2, 20-30 people to run a fund that will deal with every medical claim for 60 million people. Hmmm don't think so!
Easy, subcontract the donkey work, only need strategy folk on the actual payroll, force efficiency in the folk they subcontract donkey work to by using this technique
3,These new providers of care will be running their hospitals to make a profit.
Nothing wrong with that
This would bring a multitude of problems such as. Patients would find themselves traveling huge distances for some treatments because it would be unprofitable to offer them at local level.
They already do, even in NHS fantasy land, and often they currently don't get the treatment they would get in any other western nation
4, Fine but what about those who hadn't paid into the scheme?
Lots of people get treatment from the nhs now without having paid a penny in, it would be no different in that regard
Also how would regulate the potential for fraud?
lots of fraud currently in the nhs, its unlikely to be worse
5, I am not a GP so don't know what a full commercial rate for an appointment would be,
its circa 55 quid in medicentre in central London, I expect this sort of price, cheaper elsewhere in the country, and less as efficiencies are forced by free market which are not there now
but I doubt it would be less than £100.
its cheaper than 100 quid in many other western nations too when paying full commercial rate
This would have a huge negative effect on the health of our nation as people would delay seeking medical advice.
they already do, its called the nhs waiting list! and the 3/4 days routine to see a GP currently, waiting lists would disappear if the patients had money to spend, the providers would quickly self optimise to solve the supply side problems, and the artificial barriers to treatment such as waiting lists would disappear, rationing could then be more transparent and subject to public scrutiny as patients would know whether they had had their insurance cheque or not
This would lead to an increase in people presenting with advanced stages of disease which in turn would be more expensive to treat.
On balance I don't think the current system is working, and people who present early are often just left to die by the nhs, in the other model providers would be more honest, keener to help patients, and patients would have buying power to force change with their millions of small decisions
6, Yep can't disagree with that!
good
7, As number 3, People will have to travel much further for treatment to specialist centers. It would be uneconomic to offer them at local level.
it already happens, the patients having cheque will optimise the situation better than the current faceless wonders of the nhs do
8,Their care is likely to be poorer as profit is now involved. Look at Dialysis patients for example. In this country the vast majority of haemodialysis patients have AV fistula vascular access (by far the best option). In the USA it is less common as it is cheaper to put a central line or a graft in.
Patients genuinely with money to spend and choice would be able to force issues like this
9, These places will suffer the worst because it will be unprofitable to offer much in the way of care for areas that have a sparse population and large geographical location.
I agree they need subsidies, they currently are heavily subsidised by city folk, it would be no different
Subsidies are of little use if you have nothing locally to spend them on.
They often travel long distances now, it would be better optimised if the patients had money than current Stalinist central planning
10, Costs and workloads would spiral out of control if patients would allowed to self refer to consultants.
no they wouldn't, just look at the many European countries where this is the norm, actually more efficient than wasting a GP slot just to have an obvious referral
11, Apart from being grossly unfair. Would you also reimburse their increased living expenses for that year, in which case again your model is more expensive.
this point was a little tongue in cheek, but something radical needs doing to improve the GPs in inner cities, they tend to end up with the crapper GPs at the moment, this needs to change, ideas welcome
What about these GP's children who either live without a parent for a year or have their education disrupted every 4 years.
as above a little joke, don't take this one too seriously
12, Best practice is already widely shared around the world.
no its not, the nhs is fucking years behind, ill take your to a GP in Milan/Auckland/Chicago and we will compare and contrast with average UK, I'm afraid the UK has much to learn, but is too fucking arrogant to realise how behind the times it is
13, For reasons given above following this model would certainly reduce the health of our nation as a whole and is unlikely to be any cheaper.
disagree, status quo is the worst of all worlds, puts the wrong incentives in the system, and stops the natural processes of optimisation and improvement
14, Depends a lot on your definition of poorest, but this would again either increase costs for your new scheme or increase personal costs for a lot of people.
Most of us pay a lot for NHS dentistry but have zero access at the moment, so for the vast majority there would be little change, for the poorest their would be real help where they could shop around and not be stuck with the less desirable dentists
Going abroad for dental treatment is definitely the best option. Better prices than the NHS, cosmetic dental work can also be done, immediately appointments, access to leading doctors, easy to get do and have a holiday at the same time. What more could you ask for?
www.dentalholiday.co.uk
1) Yes
2) 20 or 30 people might need a larger workforce
3) Agree - patient keeps the ultimate choice
4) Agree
5) Agree
6) Agree +++
7) Agree
8) Agree
9) No problem
10) Agree
11) A bit Cambodian?
12) Yes
13) Yes
14) Yes
Good to see some solutions Great post!
I still worry that there might not be enough cash to go around...
Anyway; Merry Xmas (belatedly)
Slainte
S
yes there will never be enough money for all possible health interventions
but at least in the model of the patient seeing the cheque, and being directly responsible for where it is spent, the patient sees how much money is being spent, appreciates the value, and their countless small actions can change the biggest health providers, and the patients will see when no cheque is forthcoming and it will be immediate and honest and not the current wait to get on a waiting list to wait some more to wait to be sent to the beginning
i think the current nhs model of folk dying early from easily treatable conditions having never been put on a list is the worst of all models
at least in the model i propose also the consultants and docs would be under no pressure to keep someone off their lists
happy seasons greetings
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