Top ups or Copays in NHS???

Perhaps this should be under News section, if so please feel free to move.

This morning I heard something on the news about "top-up" fees on the NHS.  Now this isn't even a proposal yet, just an idea batted around.  Since many of us have experienced another healthcare system (canada, US, etc first hand), what do you all think?

I personally am in favor of a small co-pay at the point of service (£5 or so).  I think this will greatly reduce waiting times for appointments.  Does anyone know if the copay many US HMO patients pay actually amounts to very much or are just used to make sure you'll show up?

I am against a top-up fee for the NHS.  I wouldn't mind a small increase in our taxes, but it should be all or nothing.  This may sound contricitory b/c I have supplemental insurance.  But very often with supplemental, I woudl be seen at private hospitals, thereby freeing up places for NHS patients.  The way the top-up has been described to be it appears to be cue jumping within the NHS system.

Thoughts? 

I wouldn't mind a small co-pay, but I agree that top up fees would enable people to jump the queue. I am against an increase in taxes though....I am (as a lot of folks are, taxed to the hilt). Like you, I also have supplemental and just don't understand why I even have to use the NHS at all. The way I look at it is folks that have private should go private and free up the NHS queues for those that don't have insurance. It seems like such a easy fix, I just don't understand why everyone is fed into the NHS when it can't support the population.

Bottom line the NHS needs major reform and I don't see anyone in the government doing anything about it...except to hear constantly on the news that yet another NHS Trust is being closed?   

there's a two tiered NHS in Canada.  my sister who lives in canada says that it works "ok"... but she's only been there a few years and never had to rely too heavily on healthcare.  does anyone have any first hand experience with the canadian socialized but two tiered system?

It would be interesting to hear about the Canadian system.

I just looked up the French NHS because I have heard good things about it. Here is an article.

http://www.civitas.org.uk/pubs/bb2France.php

One thing it says is "The French dislike GP gatekeepers." Couldn't agree more with that statement. 

I lived in New Zealand for 10 years where healthcare is heavily subsidised but not necessarily free.  Public hospitals are free but GPs and other treatment providers can charge what they like.  Some charge nothing, some charge a lot, most charge a modest fee.   You can also choose your GP, it doesn't matter where you live, as long as they're not overbooked they will take you.  For example, the GP I went to was in the central city and she charged around $40 (about £15) for a consultation, which I thought was a very reasonable amount.  It was very rare not to be able to see her at the time I wanted either, although her practice was a very busy one. 

I wouldn't mind paying a small fee to see the GP here if it meant I could see the doctor I wanted to see and not just a random person within a large practice.  Also, two of my friends in NZ have had babies in recent years, they both had an independent midwife. One friend paid nothing, the other had to pay a small amount to hers. It's not income related or anything like that, it is up to you to choose who you see, so if one doctor is too expensive, you just choose another.   It works pretty well, but there are still similar problems to the NHS with the public hospitals being overburdened.

Like you, I also have supplemental and just don't understand why I even have to use the NHS at all. The way I look at it is folks that have private should go private and free up the NHS queues for those that don't have insurance.

But why shouldn't you use NHS if you are paying for it?  I feel like I've paid plenty into this system and I better get something out of it for my money!

It is possible on private health insurance to have a private GP. I work for WPA (www.wpa.org.uk - the insurers for the royal family!) and we do accept private GPs, but people so rarely use them, I'm not even sure how it works. I think even then you'd need a referral to one from your NHS GP (though quite a few NHS GPs are also private GPs).

Many private insurers also encourage you to use the NHS for certain conditions because in some cases, the care from the NHS is first rate. For instance, some people bounce back and forth between private and NHS for cancer care but  wouldn't bother with the NHS at all for knee or hip problems.

I have always said from when I moved here and had to start using the NHS that I wouldn't mind paying a small co-pay if it meant better care and less waiting times.  I didn't see it as any difference than paying a copay with insurance in the states.

But why shouldn't you use NHS if you are paying for it?  I feel like I've paid plenty into this system and I better get something out of it for my money!

You do have a point but to be honest I would prefer to go private even though I pay for the NHS.

Its interesting my company just started offering another private healthcare plan aside from BUPA (which I have) so I thought I would look into it, its an enhanced private plan with full maternity and chronic illness coverage unlike BUPA which has either limited or no provision, so basically I felt it was overall a meatier plan. Anyway, the cost to me annually as the employee with a partner would be £6229, family coverage £9343, I even considered going single and getting coverage just for myself because my husband doesn't mind the NHS but that cost was £3114. All whoping amounts of money!    Needless to say I thought my employer was having a laugh....who can afford that unless you are on a big ex-pat package?

Balmerhon to your question - before I had learned about the cost of the health plan I called the company (Cigna) to inquire about private GPs and the woman I spoke with said that I would have to continue to go to my NHS GP first for a referral and that was not dictated by Cigna rather I was told "that is just how its done in the UK". Again, as we all know from our experiences with immigration and tax advise, the first person you speak with is not always correct so not sure if what she said was true or not?

Needless to say I am sticking with BUPA and pray that we remain healthy! 

The thing with private health insurance is that they often rely heavily on using NHS services. Most doctors in private medicine are also NHS doctors, and it is often the case that whenever something goes wrong in a private hospital they ship you round to the local NHS one as quickly as possible.

genevieve-
do you have personal experience of going to a private hospital and then being transferred to an NHS one?  i have "heard" the same thing as you but i don't know anyone who actually first hand has had this happen to them or a close friend/family member.

my mother-in-law (future) had the exact oposite experience.  went to NHS.  completely messed up.  sent to private hospital as soon as she was conscious enough to tell them that she had private cover.

meggles - yes, a close friend of our family underwent a procedure in a private hospital. Something in the procedure went wrong and the private hospital called 999 to take him to the NHS hospital. I mean, private hospitals aren't charities. It makes complete sense for them to cut their costs by using NHS services whenever possible.

Private hospitals have to pay when they refer to NHS hospitals in this way.

Vicky

Are you sure? If it was an actual referral to a specific NHS doctor/department maybe, but if it is a simple case of calling 999 would they still have to?

I am pretty sure they would be sent a bill.

Vicky