Wednesday, February 4, 2009

Universal Health Care in the UK

If we get single payer healthcare in the US, this kind of scene will become much more common:

A BRITISH Gulf War veteran pulled out 13 of his teeth with pliers when he could not find an NHS dentist.

TA soldier Ian Boynton could not afford to go private for treatment after suffering with excruciating toothache since 2006.

So instead he took drastic action and removed them himself.

The 42-year-old, from Beverley, East Yorks, had not had his teeth looked at since seeing the army dentist in 2003.

And he has not registered with a dentist of his own since 2001.

He said: “I’ve tried to get in at 30 dentists over the last eight years but have never been able to find one to take on NHS patients.

“I started having pain in a front tooth, which protruded slightly more than the others. I was constantly fiddling with it and wiggling it because it hurt so much.

“In the end I knew it had to come out and had to use the pliers to pull it.

“Amazingly, it did not hurt as much as you might think. I think I’d been prising it that much in the meantime that I’d been killing the nerve.”


redhawk888 said...

The U.K. has made numerous improvements to the nhs system.
The British have made a number of good decisions that are transferable to other systems. Some of these are mentioned in the text and others come from a more comprehensive list.27
1. Health care should be “free at the point of service,” a founding principle of the NHS. Although this is precisely opposite the principle of American employers and politicians as they increase co-payments, the evidence from the United States and abroad supports the British position. Co-payments create inequities, raise barriers to access, and usually do not achieve their goals.28,29 They are not very effective in containing costs, because patients have discretion over just a small percentage of ambulatory and elective choices. Most “cost containment” efforts focus on minor, front-end costs rather than addressing major, back-end costs.30 Moreover, co-payments undermine the goals of appropriate and effective care and discriminate against the working and lower classes. Such evidence seems ignored by advocates of co-payments in Congress and the business community.
2. Fund health care from income taxes. Whenever the British have reviewed the option of using health insurance instead of income tax financing, they have found evidence that an insurance-based health care system costs more to operate, is more inequitable, controls costs less effectively, and provides no basis for population-oriented prevention or public health gains. By sharp contrast, US employers are moving the other way, from large group insurance toward individuals buying their own policies on a voluntary basis, long known as the most costly and inequitable way to structure health insurance, with few means to contain costs, raise quality, or improve the health status of the population.
3. Establish a strong primary care base for a health care system.Every UK resident chooses a personal physician or practice. The system provides incentives to practice in underserved areas and prevents new GPs from setting up in saturated, affluent areas. The primary care base of the NHS is widely celebrated 31 and has been consistently strengthened over the decades. For example, as recruitment into general practice and morale waned and sub-specialty medicine grew in the postwar years, the British raised GP lifetime incomes to equal those of subspecialists. Other changes were made to strengthen primary care by providing more practice staff and nurses in order to encourage solo practitioners to come together into teams. More recently, these teams have been further enlarged by bringing together geographic clusters of GP practices into large Primary Care Trusts that include all community health care services and many social services as well.
4. Pay GPs extra for treating patients with deprivations and from deprived areas. Almost 20 years ago, Brian Jarman developed a deprivation scale based on factors that affect clinical care, so that living alone is a factor as well as low income. The British have long paid GPs considerably more for taking care of patients who are more likely to have more problems and whose care is more demanding. American health policy researchers are still debating whether it can be done.
5. Reduce inequalities in historic funding that usually favor the affluent. Regional inequities in the United Kingdom are much smaller now than 20 to 30 years ago, and all major budgets are risk adjusted, in sharp contrast to the United States. Reductions have been achieved through national planning, building up hospitals and resources in underserved areas, and giving disproportionately more new funds to less well-funded areas.
6. Devise a set of bonuses for GP practices that reach population-based targets for prevention. Starting in 1990, the government added a new element to the GP contract—lump sums or bonuses for carrying out preventive measures on a high percentage of the patient panel (enrollees). For example, a practice could receive about $1250 if it completed the childhood immunization series for 70% to 89% of all eligible children registered and $3700 if it completed the series for 90% or more. The result has been high levels of immunizations and other preventive measures. Another incentive rewards GPs for using generic drugs for 70% of their prescriptions. Why don’t US health plans follow suit?
7. Pay all subspecialists on the same salary scale. This policy conveys the sense that psychiatry is as important and complicated as cardiology and pediatrics as challenging as orthopedics. On what defensible grounds should one specialty (cardiology) be paid more than another (psychiatry)? Equal pay signals to young doctors that they should specialize in what they do best and enjoy. Yet in many systems pay differs greatly by specialty. This decision has many cultural, organizational, and clinical benefits, even though some subspecialties have more opportunities to supplement their incomes than others.
8. Control prescription drug prices while rewarding basic research for breakthrough drugs. Like most other countries, the British have a national board that negotiates with the industry. Pharmaceutical companies like to portray this approach, which is nearly universal outside the United States, as “price controls” that can “never work.” In fact, nationally negotiated price schedules have worked well for years and saved billions. The British approach goes further, by rewarding breakthrough research and discouraging “me too” research or patent manipulation. It regulates profits, not prices, by having companies submit financial records and by determining set proportions for expenditures (e.g., a limit of 7% of sales for spending on marketing) on in-patent branded drugs. If prices result in higher profits than allowed, the excess profits are paid back. The British approach both ensures and limits profits. Meanwhile, providers are given drug budgets within which they have to live. Any other nation or large buyer can learn from this system.
*It's comical how far particular people must reach and extrapolate data to inhibit innovation and prolong oppression. Is that the best you can do to illustrate an illusion that U.K.'s system is less efficient than ours? Who's payroll are you on? I am an active Libertarian and refuse to negate the commonwealth's progression with useless contradictions.Unfortunately for those in accordance with the deceivers-> the information era is at hand and the truth will always dominate the lies. Progression, not regression. Mission, not margin.

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