Pay Your Own

stack-of-GBP-cashA lot of talk at the moment about cash and the NHS. This is not a particularly productive debate because no one wants to be the first to talk about murdering the sacred cow called ‘free at the point of delivery’. Should we now be having a more nuanced debate about what we pay from our taxes and what we might chose to pay for with what is left to us after paying said taxes? Do we need to try for a national consensus about an essential and high quality “core” NHS (taxation funded) and “additional” (insurance option) services. We need a “Beveridge for the 21stC”,  since the ability to “top up” was the principle he advocated but which is now forgotten.

One of the MAC partners does some work with patients who have used private health services and tells us  that these patients sometimes get indignant about the quality of service and care they get (in particular the hotel elements – the rooms, the food, the bathrooms) because they have paid for what they believe is a lot for the service. The reality is that the private healthcare providers have costs that are much the same as they are in the NHS and the standard private policy payments do not stretch to the Ritz-level service some people believe comes with the golden label ‘private’.

Just out of interest, I have used a Swiss price comparison website to find out what the current costs are for health insurance in the country with one of the highest healthcare costs in the world. The (US) Commonwealth Fund report in November 2014 showed that average spend per head on healthcare in Switzerland was about £4000 and in the UK £2125. The US leads with £5500.

I put in the usual personal details using a postcode on outskirts of Geneva, dob and various other personal bits and pieces and then chose from the service level options offered. I chose what was called the HMO level of care – the second cheapest with the first port of call a health centre using their doctors ie covering both primary and hospital care. This is about 25% cheaper than the Standard level which pays for the doctor of your choice. The cheapest was the one offering a phone call as the initial contact. You get a choice of the level of deductibles or excess – 300 Swiss francs (CHF) as the minimum and 2500chf as the max. I chose 500chf and my monthly premium would be 413.20chf (£280) a month. The most expensive would cost £465 a month. The median gross salary in Switzerland is around £4000 a month with a poverty level defined as £1550 per month.

You can get UK private cover from £200 a month – hospital care only and often with various excess payments for access to specialists etc.

We seem to be getting a lot for our money from the NHS but do we need to pay more to keep the show on the road? What elements of that road show should we get for our taxes? Is it time for a debate that at least acknowledges the possibility of ‘core services’ (a term used in NHS England documents but which they have shown complete disinterest in discussing) and then a top-up service for whatever we define as ‘non-core’? Is the focus on acute illness correct when it is the cost of social care which is the one to watch? What would it take to break the silence and start talking about lucre or is that too filthy?

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