Originally Posted By SuperDry I was reading in the Economist (a UK-based conservative-leaning magazine) recently that healthcare costs in the UK over the past decade had increased on average 4% per year in real terms. That is, they increased 4% more quickly than inflation in general. I put "attn: davewasbaloo" in the topic header because I thought that he in particular would be well-placed to comment. I think that most people would agree that the US healthcare delivery system is dysfunctional, although people will disagree with what the specific problems are. But in the UK, where there's universal coverage, and healthcare provided primarily through the National Health Service rather than private providers, and where drug manufacturers don't have the crazy pricing structures that they do in the US, what exactly is accounting for the consistent greater-than-inflation increases in costs?
Originally Posted By Mr X I've nothing to add, but I too am curious to hear about Dave's take on this.
Originally Posted By davewasbaloo It is an interesting point. I think there are a number of factors here. Firstly, the Labour government have brought in a number of new targets for decreasing waiting lists, annual health checks for over 40's etc. coupled with increased budgets which get spent (or are lost forever). Mix in that until a couple of years ago, commissioning, front line provision and pharmacies were all part of one body. Now they have introduced a measure called World Class Commissioning, where the Primary Care Trusts were supposed to split between providers and commissioners (planners, strategy etc.). With this came additional costs for transformation coupled with the need to retender virtually all services provided by the NHS, also lead to a rise in expenditure. And then if you factor in that the UK is the size of California, and therefore still buys in products from Europe and the US, the value of the pound has worked against us, coupled with higher shipping costs due to green taxes. Also, year on year, providers do try it on in trying to squeeze contract values, although this year, all my contracts we have not added on an inflationary rise and are currently looking at budget cuts. You could also argue, that there has been a high turn over of staffing and use of interim or consultants like myself that can lead to increased spending as well. But I sleep well at night knowing I can contribute greatly to improving the situation without the politics, but it gives my clients the flexibility of getting rid of me within 5 working days without layoffs, pension issues, annual leave costs etc. Hopefully that helps explain the rationale, but we are also working to reduce as much as possible. E.g. free condoms used to cost the NHS 15 cents each, they now cost us 6 cents each in the space of 3 years. Chlamydia testing used to cost about $120 each test, now it is only $60. And HIV testing as a part of pregnancy terminations used to be $150 and now is $65. However, we also do research into new drugs, and tougher guidelines are leading to higher costs. Also, there is a big push on cancer screening and oncology improvements which has been a substantially increased area of expenditure. And in terms of governance, we are spending more than ever to work closely with local government and education on health initiative, bringing in a new nationalised IT system, and are trying to improve our work in public health diagnostics around epidemiology and social deprivation causations of health issues. In addition to all that, we are also piloting practice based commissioning (which may provide better outcomes but at a higher cost), and even more radically individualised patient budgets where individuals have more control over their care plans combining social services, health and benefits budgets into a holistic package that caters to their own needs. This does potentially increase unit costs dramatically, but if the long term conditions are better treated and provide less complexities later on, it should lead to an overall savings in the long term. No matter how you slice though, life is going to get very hard in the NHS as we slash budgets like never before. And last week's election will make life very interesting. I hope I have given an insight into some of the areas the Economist is ever likely to report on, given they have a much more conservative stance on life. But I ask conservative people to consider this. What is a better us of public funds? Giving out 6 cent condoms and free STI testing at $100 a time, or paying $750,000 per patient that becomes HIV positive? Fiscally, prevention is always better than cure (and in this case there is no cure).
Originally Posted By fkurucz FWIW my private American insurance went up 20% this year. I would LOVE to have insurance that only increased 4% + inflation every year. At my son's soccer match yesterday I learned that we are one of the few families on the team that isn't stuck with a high deductble ($2000+) health plan. Of course this means that most families on the team are now stuck paying the $100+ that it costs for an office visit to the familiy doctor (even more for a specialist). Now I know why I can get in to see my GP on the same day I call for an appointment. Just 5 years ago the wait could be as long as two weeks. Self rationed heathcare at its finest.
Originally Posted By fkurucz ^^Also, thereason most of the familes on the team have the high deductible insurance is because they are offered no other choice by their employers.
Originally Posted By davewasbaloo Yep, 10% of my income goes to pay for the NHS, Social Services and the rest, but I think it is totally worth it.
Originally Posted By SpokkerJones Whatever bad news you hear about health care in other nations, the situation remains ten times worse here.
Originally Posted By fkurucz "Yep, 10% of my income goes to pay for the NHS, Social Services and the rest, but I think it is totally worth it." Let's see: My family's health insurance is almost 20% of my income. Small wonder that my employer is breathing down my neck to switch to a cheaper high deductible plan. Luckily for me my employer picks up most of the tab, but I still have to pay $400 per month out of my paycheck and I know that the portion my employer is covering is becoming onerous, and I'm expecting that the "Cadillac" plan we have will be withdrawn next year. After a few more years I expect the deductibles to become higher and higher. There is one family on the soccer team that has a $10,000 deductible! And that doesn't cover "social services and the rest." I pay taxes to cover that as well.
Originally Posted By fkurucz >>Whatever bad news you hear about health care in other nations, the situation remains ten times worse here.<< Absolutely, and Americans are taking it very stoically. Its mind boggling how many people aren't going to the doctor when they need to. I can only imagine the number of people with hypertension who don't know it, or who do but don't receive treatment because they don't go see a doctor.
Originally Posted By tashajilek " but I still have to pay $400 per month . And that doesn't cover "social services and the rest." I pay taxes to cover that as well." So you pay $400 a month for medical and then even more money for taxes? Ouch. I dont have a medical plan as of now meaning my meds arent covered so i have to pay $40 a month and that covers dr's, hospital coverage whatever. I still get $300-$400 of each cheque for stupid taxes.
Originally Posted By fkurucz >>So you pay $400 a month for medical and then even more money for taxes? Ouch.<< And I'm one of the "lucky ones" who still has decent insurance and the fact that my employer pays another $800 a month on top of what I pay. Its only a matter of time until virtually everyone in the US has a high deductible plan. For those of you outside the USA a "high deductible" plan is one where each family member has a "high deductible" that has to be met before the insurance plan begins to pay for anything. Say you have a $2000 deductible, which is becoming quite common. That would mean that I would have to pay the first $2000 of my annual medical expenses out of my own pocket before the plan would begin cover my bills. My wife would also have another $2000 of her own as well. What does this mean? It means that Americans are not visiting the doctor as much as the used to because they cannot afford to pay for an office visit, which typically costs more than $100. I know folks who undergo minor surgery and their deductible is so large that they end up paying for the surgery entirely out of their own pocket, which often means they charge it to their Visa card.
Originally Posted By ecdc >>I know folks who undergo minor surgery and their deductible is so large that they end up paying for the surgery entirely out of their own pocket, which often means they charge it to their Visa card.<< My children were both born when I worked for a small, non-profit organization that offered bare bones insurance, sans maternity. Both boys were charged to my credit card. God bless America.
Originally Posted By Mr X If you don't mind my asking, how much was it (or perhaps to keep it more in general terms, how much is the cost of an average, no-complications birthing stay in your area?)?
Originally Posted By tashajilek It's really a shame that the US does not yet have universal medical coverage.
Originally Posted By fkurucz >>It's really a shame that the US does not yet have universal medical coverage.<< We have been brainwashed into believing that our super expensive, byzantine system is "the best in the world", and that any attempt to change it is tantamount to communism. When they passed the incredibly watered down health care bare recently one of my neighbors flew an old Soviet Union flag from his front porch in protest. Go figure.
Originally Posted By Dabob2 <a "high deductible" plan> Out of college before I got my first full-time job, I called it the "God forbid plan." Meaning, "God forbid" I was hit by a bus, I had some insurance so the hospital bills wouldn't wipe me out. But the deductible was so high that anything short of that was basically my expense. It was the sort of thing that people without full-time jobs got as a stop-gap measure, just to prevent against catastrophic injury or illness. Now, it's becoming more and more the norm even for people who have full-time jobs that provide insurance (and by no means do all full-time jobs do so any more to begin with).
Originally Posted By fkurucz >>If you don't mind my asking, how much was it (or perhaps to keep it more in general terms, how much is the cost of an average, no-complications birthing stay in your area?)?<< If you are talking about a tradition birth in a hospital, I recall it cost over $6000 over 15 years ago, so I'm guessing it's over 10K now. A lot of the uninsure that show up at the ER when labor begins and never pay of course. I've heard of a lot of uninsured women resorting to midwives and giving birth at home.
Originally Posted By ecdc My first son was 5,000. After I looked at it again after my post, we did have maternity, just with a $5,000 deductible My second son was two months premature and spent a month in the NICU. This was not covered under the maternity part of the plan; total bill was somewhere around $750,000. We were VERY fortunate to have our policy through Intermountain Healthcare, which is a local, non-profit HMO. They were cited as an example by President Obama as a good model for healthcare reform. They knew they'd never get the $750,000 from us, so they forgave the debt and encouraged us to make a donation to them sometime in the future. If we had been insured through Wellpoint or CIGNA, or another publicly traded company, we would have had to file bankruptcy. We had no idea how unique our situation was and how lucky we were at the time.
Originally Posted By tashajilek I couldnt imagine having to pay 75,000 for having a baby? or having to consider filing bankruptcy. Even here in Canada it's not all great. There are a lot of surgical centers here that will take people in willing to pay and then the others have to wait on a list for 6month or up. On the other hand if i got hit by a bus i would be taken to the hospital and not have to pay a dime. When i watched the movie Sicko it was amazing how many insurance companies found little loop holes in order to not cover. Its also disqusting to have seen people turned away and even die because the person didnt have insurance or the right insurance.
Originally Posted By davewasbaloo I will never forget we went from being affluent with 3 houses and some boats, to just hanging on to one house because I broke my leg and arm, had surgery and my mom got sick. This was in the space of 3 years due to loop holes. Yep, the NHS may not be perfect, but I am glad the UK has it.
