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Feb 9, 2021 09:15PM
1. What country are you from?
Currently in the UK; have used both NHS (public, universal care provider) and private services
2. Are you able to choose your doctor and hospital or are you assigned to one?
Under NHS - I was assigned to a hospital for my initial dx, and would have had surgery there had that been the proper route. I was not happy with the surgeon OR the hospital, which was miles from my house, and I felt it was of questionable cleanliness. I was then reassigned to a different hospital for oncology, and reassigned to a new oncologist who I only saw once, instead mostly seeing junior oncologists/researchers/registrars. Appointment times were down into the 8 to 5 minute range and every new oncologist meant they had no idea who I was or my concerns. It drove me nuts so I switched to private care, where I was able to choose my oncologist and hospital and I see JUST HER every month, so she know me as a person and I feel much more at ease opening up to her.
3. Are tests and results scheduled in a timely manner, like two weeks?
Depends - my scans were moved from 3 to 4 months right away, mostly due to Covid pressures. Results were hit or miss, I once waited almost a month for the outcome of some scans. At diagnostics it took two weeks to find out I had cancer (for sure), then another two weeks to find out it was terminal, and then another 8 weeks before I started treatment. Under private treatment I use the same facilities but am "bumped to the head of the line" - my scans are now scheduled when they are convenient for my schedule (end of day), I can make changes, and my results are done within 24 hours. The same doctors work in the NHS and private systems as I don't think they can have hospital privileges without agreeing to see a certain percentage of NHS patients.
4. Do people generally agree that the higher income tax rates are a fair trade for the medical benefits? (I only ask this because I can't see how it would be possible to provide it without raising taxes)
The NHS is essentially a state religion in the UK and the link between tax payments and affording the health service has been broken. There is very much a sense of entitlement to "our NHS" - you get a lot of stories of timewasters who are drunks in the ER at 3 am every Saturday, or people going to the GP because their toe hurt, that sort of thing. Similarly you get people who "don't want to waste the NHS time, its just a little thing" when it actually is something that SHOULD be checked out, but there is this perception that the all-holy NHS can't cope year after year after year so we must all support it by... not using it?!
It is free at point of access so people push that to the limit. I am in a high tax bracket and pay over 40% of my salary on taxes, a lot of which goes to supporting the NHS. That is before you account for the local services monthly tax and the 20% VAT tax on everything else. My workplace 100% funds my medical insurance and I have no other deductibles and maybe a small copay (I had to pay the difference for my genetic testing - a whole £14). As a cancer patient, any medicine prescribed for me is free - so my letrozole or amoxicillan or whatever the GP may prescribe is always free, as are my Ibrance and other drugs. You can access other drugs in the private system as there are certain equations used to determine if a drug is useful to offer to the wider population.
Is it a fair trade? I think a small form of personal contribution to access services (say £10 for a GP visit, or £100 if you are using the ER as a drunk tank on the weekend) would help encourage people to take care of themselves better, fund improved services and access, and get people to realize that health care isn't free and no, the NHS can't just always patch you up and off you go. Many people in this country don't pay any form of income/contributory tax, so if you are stuck in the higher tax bracket, but below the super rich, you are paying a lot of money in contributions to the health system for others who won't take care of themselves (not everyone is like this, but you see the disincentive).
A small fee could also help fund better preventative care - mammograms dont start here until 50 (even then is every 2 years), its every 3 years for a PAP (which doesn't include breast/pelvic exam). The GP system acts as a gatekeeper into the NHS services so if you are "too young" for cancer they are more likely to put you off rather than refer to get something checked out. It took me almost four weeks to get my initial appointment to be seen for my breast lump. GP offices are not great - usually somewhat shabby with older equipment and I have never EVER had a single GP actually touch me. I had one diagnose my back problem from sitting behind a desk. 5. What's the best/worst things about your healthcare system?
Best - it is good to know it is there in case of job loss or whatever. They are really good at acute care, but that is because that means someone else is getting shoved off or things have been allowed to deteriorate so far that a simple issue BECOMES acute care.
Worst - it is just as political as the US system, and above challenge. It is essentially run at this point on the goodwill of nurses and doctors to push themselves to the limit of their time and energy and conscience, without proper compensation. To me, that is unacceptable and hides the true cost of healthcare delivery. Ten years of under investment, many layers of bureaucracy, etc and there are tens of thousands of nursing roles open that you better believe won't be filled now. I make 4x what a junior doctor makes, and frankly I wouldn't be surprised if a lot of doctors and nurses leave the NHS and emigrate to Australia or NZ after this is all over. Why would you put up with this bs if you could leave, move to a country with sun and beaches, make enough for proper housing and a good life, and work in updated surroundings?
To sum - I think everyone should have access to a base standard of healthcare, and not be subject to bureaucratic accountancy whims (that is true for a state system or an insurance system), with some sort of small contribution at access and for there to be insurance that serves as a top up on the state system (I believe Germany has this system) in case of larger issues. Unfortunately to bridge the gap would require a significant increase in wages and living standards that I just don't think is possible.
9/27/2019, IDC, Right, 5cm, Stage IV, metastasized to bone, Grade 3, ER+/PR+, HER2-
11/28/2019 Ibrance (palbociclib)
11/28/2019 Femara (letrozole), Zoladex (goserelin)