You cannot just pay for these on top of your NHS basic ... you do not get the NHS basic, as you are deemed to have gone down the private route and hence pay for that in whole.
Choice. Eg of obstetrician, or cancer specialist, or cancer drugs.
HMO and Telemed models don't have free choice (almost by definition!), and these are the models used by the majority of Swiss residents, I believe.
Of course, you can pay more to not be bound by that restriction, but you can do that in the UK too.
Again ... I've not problem with NHS providing basic cover if you can pay for additional cover.
But that's not how the system is designed, and despite some blind eyes being turned to mixing NHS and private care, that's often not how it works out.
If I want private cover, I have to pay additionally for this in whole ON TOP OF the taxes I've paid for NHS cover. AND if I do get treated privately for one part of say cancer treatment, then THE WHOLE OF my cancer treatment has to be private.
I don't know anyone who uses those.
But it's a free choice, so if that's what you chose, you shouldn't complain about lack of choice.
Tom
Good point.
I'm going to exit since I'm going on hols .. and I'm not going to spend them debating the NHS!
Thanks to all for the interesting responses. Any discussion involving the NHS does tend to elicit an emotional response given it's a bit of a religion in Britain, but despite some defensiveness the argument here have been civil and informative.
Not as informative though as the US versus Swiss thread which featured a great deal of thoughtful discussion about relative strengths and weaknesses of both systems.
I have to say I'm sticking with my view that NHS is cheap but cheerless and that we could do better. I've also found the insight into Swiss healthcare very useful.
Cheers, laters ...
I don't have a link to the study, nor do I remember it's name and I'm not a fan of the US medical system, but I've read that study had been done between the US and UK, it came to the conclusion that you were %40 more likely to survive a serious trauma if you were taken to a trauma centre in the US versus the UK, despite the sometimes wide distances between location of the injured person and the trauma centre in parts of the US (eg. farmer badly injured in farm accident in central North Dakota being airlifted in a trauma centre in Minneapolis, MN)
I like the Canadian system - sure, you have to wait a long time for non-life threatening surgery but the system works much better than the Swiss system. I find the Swiss doctors are not that good compared to the ones I have had while I was in Canada. In the USA, you get a cold, and they give you an MRI....so it really is ridiculous.
We don't have enough level 1 and level 2 trauma centres (neurosurgery capable) in Ontario, sometimes we airlift people to New York State or Michigan for lifesaving care.
This 100% private or 100% NHS statement is not true. Part of cancer treatment can be private and part NHS. (e.g. surgery private, chemo NHS). And it was clarified either 2011 or 2010 that a patient can pay for a drug not available on the NHS and have it adminstered free alongside NHS available chemo on the NHS.
(If the drug is not available on NHS, and the patient is not anyway having other chemo, then the administration of the non-NHS drug has to be paid for)
From my experience in the UK and CH
- UK treatment can be restricted based on cost & availability of resources (doctors, theatres, ICU/HDU/general beds). Because there is less resource overall in the system, more complicated cases don't always get the specialised attention needed and doctors don't have so much time to learn, practice, consult with others.
- CH basic insurance will give the same (and more) than NHS. Good level of resources, allowing time for patient focussed nursing (not just being under constant pressure, running from one task to the next), and for doctors to take time to learn, train, consult. Care is far more joined up between hospital, rehab, home care, GP. No issue for the GP to call up the hospital and get information if needed. Tests are processed fast and results given promptly....anyone who has had to wait 3 weeks for the report on a cancer CT scan on the NHS can appreciate the luxury of a same-day answer.
- both systems: you will see a junior doctor initially, but get seen by a more senior / experienced one if appropriate. (talking about basic in CH remember)
- both systems: you can get referred to another kanton / healthcare trust if you need specialist care not available locally.
- UK: no out-of-pocket expenses. Prescriptions are known cost
- CH: never sure what is going to hit the pocket. We've had all sorts of small odd charges for medically necessary items, but stated as "not covered by basic insurance". For example, 1 of the blood tests done pre-surgery. Part of treatment to prevent allergic reaction to CT contrast. None of the costs have been huge, and we are fortunate to not have to worry about a couple of CHF 50-100 invoices. But I don't like the worry of not knowing if some other bigger bill might be on its way.
You live in Ticino, are you saying that if you want you can be transferred to a hospital in Geneva if you felt like it?
We also don't have HMO, but I don't think the choice is as you say it is. When my wife was pregnant ahe was told Triemli or Universpital, no other choices, and she pays a premium much higher than I do.
True, but in the Netherlands children enjoy free healthcare.
Yes, but why would I want to?
The choice of the hospital is tied to the choice of the obstetrician. Clearly, they only normally work with one hospital.
Same applies to surgeons.
Tom
There are two things you can do with telemed. One is ask for advice. The other is to announce appointments. Even if you have telmed, you can choose your own physicians, GP, gyn, and specialists. You have to call telmed to announce any appointments, and if it's a "new" episode, you may have to talk to a doctor there. So for example, if you have a high fever, you can call telemed for advice. But if you have to see your doctor for a "control", you just make the appointment and call telemed to let them know. For chronic stuff, they'll open a window for you regarding visits and you may not have to call them for 6 months or a year.
In 2011, I had chemo and rads, and called telmed at the start of the year to tell them that I'd need these appointments and I didn't have to call them again till 2012.
As for the care in different kantons, we moved to Kt Zurich in 2012, but I wanted to keep my gyn and oncologist in Bern at the Lindenhofspital. So I did. If I need a scan or radiology, I go to Bern as well. If I have to have a special scan, I can get that in Bern as long as my doctor prescribes it. And, because I have specific doctors, if I end up in the hospital, I see those doctors, not an assistant. I did switch GPs, to one near where I live.
And we do have just the basic insurance. For me at least, the care has been excellent.
Fair enough point, but it is a recent development, and only an exceptional arrangement. Ie it was done to accommodate a few awkward NHS cancer patients who wanted to pay for extra drugs, and when not allowed to complained to the press.
For most trying to juggle NHS vs private, the system works poorly. The NHS is often just too basic, but it's difficult to mix in the advantages of private without going wholly private.
The great advantage of the NHS is no out-of-pocket expenses (except maybe hospital parking). However, I highlighted above some of examples of what look like serious problems!
On the test issue, in my experience not only do you often need to wait, but the level of screw-ups is very high. Eg I've known many many times the need to redo blood tests because they lost it or because a typo on the label.
One other major problem with using private in Britain is that it is so poorly regulated. I've seen a lot of abusive practice, plus extraordinarily high costs, basically ripping off sick and worried people.
Bizarrely this is cited by NHS defenders as an argument in favour of state-rationed medicine. It isn't ... it's actually a nasty side-effect of the NHS because it causes the lack of political will to regulate private medicine properly, as it is in Switzerland.
Try breaking a bone and have to go back to the pharmacy every other day to get a 16-pack of ibuprofen when you go through 8 everyday, or recovering from a concussion and have to do the same with paracetamol. I would love to avoid the doctor, but I have to go in now just to avoid going to the damned pharmacy every other day. I wonder if the law-makers thought I could get high from these drugs?
That doesn't really happen on a regular basis. This happens when hospital are closed due to a suspected contaminant.. I remember this happening a lot during SARS, a lot of babies were born in the US.