1. This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies. Learn More.
  2. Get the Diabetes Forum App for your phone - available on iOS and Android.
    Dismiss Notice
  3. Guest, we'd love to know what you think about the forum! Take the Diabetes Forum Survey 2019 »
    Dismiss Notice
  4. Diabetes Forum should not be used in an emergency and does not replace your healthcare professional relationship. Posts can be seen by the public.
    Dismiss Notice
Dismiss Notice
Find support, ask questions and share your experiences. Join the community »

Can we have something good to say about our NHS?

Discussion in 'Diabetes Soapbox - Have Your Say' started by Kim Possible, Aug 31, 2017.

  1. dbr10

    dbr10 Type 2 · Well-Known Member

    Messages:
    2,274
    Likes Received:
    1,201
    Trophy Points:
    198
    There's a lot of merit in what you say, though I'm always concerned about taxing the sick, even if it is only a nominal charge. Whenever I go to the surgery I see the figures for 'wasted' appointments, and do wonder if that is exactly the way we should be looking at it. My surgery tends to be overbooked. People rarely even get a 10 minute consultation; and it's not as though the doctors are sitting there twiddling their thumbs waiting for the next patient because someone didn't bother to turn up. Just a thought.
    Edited to add:
    Of course, if people are not making use of booked appointments they are preventing other people from booking them.
     
    #121 dbr10, Oct 22, 2017 at 11:16 AM
    Last edited: Oct 23, 2017
  2. Ymdawd

    Ymdawd Type 2 · Well-Known Member

    Messages:
    363
    Likes Received:
    1,669
    Trophy Points:
    138
    Beg to difer. IF everybody paid a prescription charge what is the need for administration.

    Besides if some people had to pay a charge they might just ask themselves do i really need this prescription.?
     
    • Agree Agree x 1
  3. cott97

    cott97 Type 2 · Well-Known Member

    Messages:
    329
    Likes Received:
    1,099
    Trophy Points:
    138
    And if you kept the current prepayment discount system in place then the most anyone would be paying is around £12 per month if they had a regular prescription, those turning up for drugs they can buy over the counter or needing less than 2 items a month would pay standard charge.
     
    • Like Like x 1
  4. dbr10

    dbr10 Type 2 · Well-Known Member

    Messages:
    2,274
    Likes Received:
    1,201
    Trophy Points:
    198
    There will still be some administration in even the most basic system. If everybody paid a charge it would no longer be treatment according to need and not the ability to pay; and GPs should not be issuing unnecessary prescriptions in the first place.
     
    • Like Like x 1
  5. Ymdawd

    Ymdawd Type 2 · Well-Known Member

    Messages:
    363
    Likes Received:
    1,669
    Trophy Points:
    138
    Eco tourism is very much in the news today. What I cannot understand is why these people are not challenged at airports/ferryports.? If they cannot provide evidence that they have valid health insurance either give them the chance to buy it or refuse them entry to the UK. The UK is regarded as a soft touch but it is our taxes that are being abused in this way.
     
    • Like Like x 2
    • Agree Agree x 1
  6. Lally123

    Lally123 LADA · Well-Known Member

    Messages:
    232
    Likes Received:
    227
    Trophy Points:
    83
    BUT you could easily charge those who miss their appointments. My job is clinic based and I would estimate that approximately 10% of patients will routinely miss an appointment without bothering to ring in. If they got charged that would stop. My dentist, when he was still NHS, used to charge 30quid for a missed appt, now he's private that's gone up to 60 quid. I also agree that a nominal charge to see a gp would get rid of the time wasters and those who could self manage. It doesn't have to be a lot even a pound or two would do it. Think carrier bag tax and how we will go to any lengths to avoid it. Personally I would happily pay a couple of quid. Plus a service that you pay for is always treated with far greater respect than something you dont pay for.
     
    • Like Like x 1
  7. dbr10

    dbr10 Type 2 · Well-Known Member

    Messages:
    2,274
    Likes Received:
    1,201
    Trophy Points:
    198
    We certainly need to clamp down on "health tourism" for elective surgery - but should still be providing emergency cover. Given that I can travel all over Europe without hindrance and only have a problem getting back into my own country, I am sure that there could be stricter checks at the boarder. The sums are significant but tiny as a percentage of total NHS spending. We should remember that some of these stories, though undoubtedly true, are also intended to provide a distraction from NHS underfunding.
     
  8. dbr10

    dbr10 Type 2 · Well-Known Member

    Messages:
    2,274
    Likes Received:
    1,201
    Trophy Points:
    198
    Yes you could make a nominal charge for missed appointments. I'm not entirely sure it would be worth the problems in collecting it. But it is disgraceful that people don't show up for appointments and don't ring in to cancel. My surgery has a dedicated cancellation line which you can always get through on - unlike the appointments line - which you cannot.
    The worry must be that discouraging people from attending might have consequences. What about the patient with a persistent cough who does not want to pay a charge and just gets cough mixture from the supermarket. What if the cough is a symptom of a more serious condition?
     
  9. poshtotty

    poshtotty Type 2 · Well-Known Member

    Messages:
    1,015
    Likes Received:
    4,524
    Trophy Points:
    198
    There should be no problem collecting it. The missed appointment and the associated charge would show up on the booking system and the patient would be unable to book future appointments until the debt was cleared. Alternatively, paying in advance at the time of booking. Most places now ask for payment in advance - dry cleaners etc, to ensure we return to collect our items.
     
    • Like Like x 1
  10. dbr10

    dbr10 Type 2 · Well-Known Member

    Messages:
    2,274
    Likes Received:
    1,201
    Trophy Points:
    198
    This is completely unacceptable in a health care system.
     
  11. poshtotty

    poshtotty Type 2 · Well-Known Member

    Messages:
    1,015
    Likes Received:
    4,524
    Trophy Points:
    198
    Whether it is acceptable or not wasn't the issue. I am replying to your statement regarding the collection of payments and speak from a little experience of working in a private health care clinic where this system was used.
     
  12. dbr10

    dbr10 Type 2 · Well-Known Member

    Messages:
    2,274
    Likes Received:
    1,201
    Trophy Points:
    198
    How could it not be the issue? Access to health care is a basic Human Right. Anything which interferes with that is unacceptable.
    Your possible solution is to the narrower problem of missed appointments; but any solution cannot put people off accessing health care or prevent them from doing so.
     
    #132 dbr10, Oct 23, 2017 at 10:27 AM
    Last edited: Oct 23, 2017
  13. donnellysdogs

    donnellysdogs Type 1 · Master

    Messages:
    13,215
    Likes Received:
    12,468
    Trophy Points:
    298
    My old GP practice has recently done an analysis of DNA's did not attends.
    It actually turned out that the DNA's were far, far less than they thought.. ie people with double appointments showed up because the booking system actually recorded the 2nd half of that double appointment as a DNA and errors from staff (somehow) were high... instead of 100+ in a month it was actually below 10.

    So if a lot of Practices are doing the same as my old Practice then it is probably very likely that patients are getting blamed wrongly....
     
    • Informative Informative x 2
    • Agree Agree x 1
  14. Daibell

    Daibell LADA · Master

    Messages:
    10,835
    Likes Received:
    6,733
    Trophy Points:
    298
    When I lived in the USA you had to provide a credit card when checking in to the GP, consultant or hospital. No card meant no treatment - simples. This was for private provision. Where there is public provision (not that common) treatment is free as a tourist e.g. I was treated completely free when I had a kidney stone and treated at San Fran General.
     
    • Like Like x 1
  15. Biggles2

    Biggles2 · Well-Known Member

    Messages:
    327
    Likes Received:
    284
    Trophy Points:
    83
    Yes, but even if they do have health insurance, does the NHS have a mechanism in place to bill foreign tourists who need emergency treatment if they become ill or injured while on holiday in the UK?

    You might be interested in reading a US physician’s blog entry titled: “An American doctor experiences an NHS emergency room”. Here is a snippet:

    “So where do I pay?” I asked Dr. Williams. The answer: you don’t. Perhaps they might bill us, she just wasn’t sure. I was about as dumbfounded at her answer as she was at my asking."

    "I protested that it wasn’t fair. We had used services and I was very prepared to pay. I also have insurance that covers emergencies when out of network, so I was pretty sure I would be reimbursed at least some of the visit. However, we were just sent away. They do have my address so it is possible I will get a bill in the mail."​

    https://drjengunter.wordpress.com/2014/08/12/an-american-doctor-experiences-an-nhs-emergency-room/
     
    • Like Like x 1
    • Informative Informative x 1
  16. DCUKMod

    DCUKMod I reversed my Type 2 · Master
    Staff Member Administrator

    Messages:
    10,403
    Likes Received:
    6,102
    Trophy Points:
    298
    I'd also add that in some parts of the NHS, it is really difficult to cancel and appointment if you don't have a special code which allegedly was issued around the time a referral was made.

    It took me over half a day recently to cancel and appointment with a consultant, where test results sign-posted I actually needed to see someone from a different discipline.

    Many people would have given up before they achieved their objective.

    I still do value the NHS very highly indeed, and would hate to be without it.
     
    • Like Like x 2
  17. Biggles2

    Biggles2 · Well-Known Member

    Messages:
    327
    Likes Received:
    284
    Trophy Points:
    83
    I am familiar with both the US system and the NHS having worked in both. To be fair to the US system, there is a safety net of sorts, but treatment is never, ever free:

    All US hospitals receiving government funding (and all public and most not-for-profit hospitals do) must abide by the requirements of the 1986 Federal Law known as the Emergency Medical Treatment & Labor Act (EMTALA).
    EMTALA was passed to ensure public access to emergency services regardless of ability to pay’, and requires hospitals that receive government funding and offer emergency services to provide emergency care when a request is made for treatment for an emergency medical condition, regardless of an individual's ability to pay'. There are significant fines for hospitals that violate the provisions of EMTALA – $50K for the violation itself, and the potential loss of future CMS (government) revenue.

    However, the phrase ‘regardless of an individual’s ability to pay’ does not mean free. Health care is never free, even in a taxpayer-funded, centrally-controlled system like the NHS. In the US free-market system, a bill is always generated after a hospital visit, and, if it goes unpaid, it is eventually sent to a 'collections agency'. If the bill still remains unpaid the cost of care may eventually be written off as “charity care”. All not-for-profit hospitals must provide a certain percentage of charity care as a condition of their not-for-profit status. It is a quid pro quo arrangement as there are generous tax benefits to having not-for-profit status.

    However, long before any hospital bill gets written off, the patient will be contacted by a collections agency seeking to secure payment for the hospital. Here is a snippet from - and a link to - an informative (and profoundly sad) article titled: ‘Medical Debt Is Top Reason Consumers Hear From Collection Agencies’, which describes how grim the whole collections process is for patients:

    Hospitals must determine whether patients are eligible under their policies and provide charity care for those who are. Hospitals also must limit how much uninsured patients are charged and restrict aggressive billing and collections activities. Under those rules, nonprofit hospitals are barred from initiating "extraordinary collection actions," such as reporting to credit bureaus, garnishing wages or placing a lien on property or taking legal action, until 120 days after the first billing statement is sent.

    http://www.npr.org/sections/health-...eason-consumers-hear-from-collection-agencies
     
    • Like Like x 1
  18. dbr10

    dbr10 Type 2 · Well-Known Member

    Messages:
    2,274
    Likes Received:
    1,201
    Trophy Points:
    198
    Could well be a factor; but people who don't turn up have taken an available appointment from someone who might have needed it. Not really sure what the solution is which doesn't deter people from seeking help.
     
  19. dbr10

    dbr10 Type 2 · Well-Known Member

    Messages:
    2,274
    Likes Received:
    1,201
    Trophy Points:
    198
    Another story in the news today about health tourism in reverse - UK citizens travelling abroad for treatment because they can't get it, or can't wait for it, here.
     
  20. dbr10

    dbr10 Type 2 · Well-Known Member

    Messages:
    2,274
    Likes Received:
    1,201
    Trophy Points:
    198
    I think traditionally there is the NHS culture that treatment should be free according to need. I believe this is something we need to hang on to. So it's just a case of (probably) no proper systems in place. But the NHS obviously can't afford to turn down or lose money it could have.
     
    • Like Like x 1
  • Meet the Community

    Find support, connect with others, ask questions and share your experiences with people with diabetes, their carers and family.

    Did you know: 7 out of 10 people improve their understanding of diabetes within 6 months of being a Diabetes Forum member. Get the Diabetes Forum App and stay connected on iOS and Android

    Grab the app!
  • Tweet with us

  • Like us on Facebook