Visiting the UK. Health Coverage ?

[Castiel]

1) A poorly performing NHS.

Compared to who and by what definition?

http://www.commonwealthfund.org/~/m...1400_Davis_Mirror_Mirror_on_the_wall_2010.pdf

http://www.commonwealthfund.org/~/m...DF_Schoen_2013_IHP_survey_chartpack_final.pdf

http://www.commonwealthfund.org/~/m...homson_intl_profiles_hlt_care_sys_2013_v2.pdf

These statistics puts the NHS second overall to only the Netherlands, far above the United States and top by survey of 11 National Health Systems. Perhaps my perception and subjective experience is not so far off the reality afterall.

http://www.kingsfund.org.uk/topics/nhs-reform/mythbusters/nhs-performance

The evidence shows that the NHS is performing well compared to other countries' health systems, although there is still room for improvement in some areas.

 

[Xordium]

Compared to who and by what definition?

Err, Castiel these are the exact same links I used to demonstrate to Dolph (years and years ago) why he was wrong. But that's the problem - it was years and years ago - if you read what I have posted in this thread I have said a) currently poorly performing b) worsening since the recession:

So to counter that you present evidence from:

4 Years ago ...

http://www.commonwealthfund.org/~/m...1400_Davis_Mirror_Mirror_on_the_wall_2010.pdf

Access to services - not quality of services ...

http://www.commonwealthfund.org/~/m...DF_Schoen_2013_IHP_survey_chartpack_final.pdf

And a cost and coverage comparison ....

http://www.commonwealthfund.org/~/m...homson_intl_profiles_hlt_care_sys_2013_v2.pdf

And again a report from that's most recent data is 2010 ...

http://www.kingsfund.org.uk/topics/nhs-reform/mythbusters/nhs-performance

These statistics puts the NHS second overall to only the Netherlands, far above the United States and top by survey of 11 National Health Systems. Perhaps my perception and subjective experience is not so far off the reality afterall.

No, they don't challenge what I said at all. Your subjective experience is that and in contrast to what the patient outcomes show across the specialities.

I've used those figures in the past to demonstrate to Dolph access and efficiency - again note from the figures you provide the underfunding - but just because things work just mean they impart quality.

You have just linked a load of outdated data showing people have access to services. You have not linked anything to demonstrate the actual care quality. That is what is being challenged by people. And this goes back to what I was saying the layperson does not know how to measure quality in healthcare. Even a learned chap such as yourself has shown a very poor application of their understanding there. Try looking at actual outcomes for say cancer care and you will see that you are very wrong here. The NHS fails people. We may still be able to offer value for money but then we could could get pay everyone on the forum here 1p per year to provide NHS coverage for the whole country and I would wager for effectiveness of treatment that for you few quid a year we would be the most effective on results per cost. Wouldn't say much about the quality of outcome though would it.

 

[Castiel]

Lol, you have just repeated the same links I gave . The links included data from last year showing that the NHS compares favourably overall with 11 other comparable nations. You also said that it was bad since the recession, so before 2010, again this is not supported by the statistics from 2010-2013.

As I said, there are always improvements needed, like cancer care, but to say the NHS is shocking is simply BS as all those links demonstrate, supporting my so called subjective position while contradicting your subjective opinion. Picking and choosing statistics to suit whichever position you feel like arguing this week is disingenuous.

You still haven't answered the question about who you are comparing the NHS to, it can't be those nations in the links, as by that comparison the NHS is anything but shocking, as supported by the figures in the last 3 years.

 

[thedoc46]

So, i spoke to my insurance who told me, that i would need to pay, then to expect 'some' reimbursement upon returning to the USA.

Probably very much the same as if i went into a doctors or hospital here in the USA, that was out of plan. You'd get back 60% of what the insurance would have expected you to pay, but that doesn't help if the healthcare provider is charging 5x what is expected. you could very well end up with a HUGE bill.

I think I'm almost better off, just giving my old UK address, get the 'free' A&E coverage and then coming home. Rather than offering to pay up front and getting screwed at the end.

Besides I've paid my dues ! 15 or so yrs into the tax system. I'm sure Blighty can return the favor by fixing up a broken bone here or there for free !

 

[Castiel]

Alternatively just get some travel insurance with decent medical coverage, it's hardly expensive, particularly where your families health is concerned.

 

[thedoc46]

Alternatively just get some travel insurance with decent medical coverage, it's hardly expensive, particularly where your families health is concerned.

Expect it is expensive. For $387 you get this.


Medical Expenses
If, while on a Trip, an Insured suffers an Injury or Sickness that requires him or her to be treated by a Physician, the Insurer will pay the Reasonable and Customary Charges, up to the Maximum Limit(s) shown on the Schedule of Benefits or Declarations. The Insurer will reimburse the Insured for Medically Necessary Covered Expenses incurred to treat such Injury or Sickness within one year of the date of the accident that caused the Injury or the onset of the Sickness provided the initial treatment was received during the Trip. The Injury or the Sickness must begin while on a Trip, while covered under the policy.
Covered Expenses:
The Insurer will pay for:
* services of a Physician or Registered Nurse (R.N.);
* Hospital charges;
* X-ray(s);
* local ambulance services to or from a Hospital;
* artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
* the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist; * physical therapy up to 90 days after the Insured reaches his/her Return Destination.

Available coverage may vary based on time of purchase and/or state of residence. Please note that medical coverage may be excess. Refer to the full Description of Coverage for complete details.

 

[Castiel]

I paid under £100 for my family on a two week trip to the US last year, with up to £15m medical coverage, £50 excess.

I would shop around if I were you, either that or travel insurance is hugely expensive in the US compared to here, a quick comparison site check shows plenty of cover available under £100, some are as low as £30.

 

[Xordium]

Lol, you have just repeated the same links I gave . The links included data from last year showing that the NHS compares favourably overall with 11 other comparable nations. You also said that it was bad since the recession, so before 2010, again this is not supported by the statistics from 2010-2013.

As I said, there are always improvements needed, like cancer care, but to say the NHS is shocking is simply BS as all those links demonstrate, supporting my so called subjective position while contradicting your subjective opinion. Picking and choosing statistics to suit whichever position you feel like arguing this week is disingenuous.

You still haven't answered the question about who you are comparing the NHS to, it can't be those nations in the links, as by that comparison the NHS is anything but shocking, as supported by the figures in the last 3 years.

Whoosh, right over you head there didn't it. This is what happens when you move out of things you actually know about and just google stuff ...

Shall we try again?

1) The links were repeated to show that the data sets were over 4 years old in some cases and therefore not relevant
2) The links containing more recent data compared a) coverage b) amount spent - these are in no way shape or form indicative of quality.
3) Cost effectiveness can be achieved by offering very little very cheaply. It is a false metric unless it is applied along side a quality of outcome indicator.
4) If we look at how the quality of outcome for cancer care it sucks, heart disease it sucks, mental health it sucks, etc

Maybe you should read what I post, read the links you post and actually think about what you right when arguing outside areas you know very little about.

 

[Castiel]

Whoosh, right over you head there didn't it.

No it didn't...you simply cannot understand a simple sentence...the data doesn't support your claim that the NHS is in a shocking state compared to other comparable health systems. You are cherry picking depending on your argument, thus why you've used the same data to argue two opposite evaluations with two different people. Things like universal access, low specialist waiting times, and the most important one given the context of what I said, The overall view of the system from the standpoint of the patient all contradict what you stated and therefore while it is accepted that the NHS can and should improve in various areas, such as patient-centric care, it doesn't imply or suggest the the NHS is the shocking state compared to other relative systems that you have stated categorically is the case.

Perhaps you should read what people are actually saying instead of trying to defend a hastily put together argument you can only support by cherry picking or dismissing from others supplied data rather than taking the overall comparable position.

You have yet to answer or supply anything resembling proof other than your subjective opinion, especially as you have not been in the profession for some time if I'm not mistaken your opinion is no more objective than mine, at least mine has the benefit of being in the system throughout the period you are referencing from a grass roots position, but hey, continue in your ipse dixit position all you want, until you can actually show me some actual proof you are hardly going to convince me that your opinion is more than that of someone disillusioned with a system he used to work in and therefore operating under a negative bias.

 

[Xordium]

No it doesn't support it. I wouldn't use that data to support a position of the NHS has good results in the timescale we are talking about - it shows it had wide coverage and cost effectiveness prior to what we are talking about. You chose to use that data to use your argument and wrongly. Now, you can't even see that simple thing. And therefore are going off on a tangent.

I don't need to offer any proof anybody can look up the infant mortality rate in this country compared to the rest of Europe. Anyone can look up the cancer survival rates. Anyone can look up the problems of obesity and heart disease. Type 2 diabetes. I wondering why when you normally are happy to google things you overlooked these things. Maybe it's because you are googling and not really sure what the quality indicators are and therefore are stumbling around blindly and presenting something that does not support your argument. And then backtracking and saying it doesn't support my argument. Well that's funny because if it did maybe, just maybe, I would have used it but I discounted it as irrelevant.

And you subjective opinion itself is an opinion of your experience not an indicator of quality. You would not recognise whether the care you had was any good. Just the experience.

Strange how you think it's all ok and yet the RCN don't, the GMC don't, the NHS trusts don't, the general population don't, infant mortality rates don't, oncology survival rates don't, need I go on?!?

Let's go over your post for your clarification;

...the data doesn't support your claim that the NHS is in a shocking state compared to other comparable health systems.

That is because it is unrelated to my claim ...

thus why you've used the same data to argue two opposite evaluations with two different people.

I've not used the same data twice - you entered it into this debate not me. Moreover, with Dolph it was used to demonstrate underfunding (which is shows) and access (which it shows) but this was years ago when the data was relevant ...

Things like universal access, low specialist waiting times, and the most important one given the context of what I said,

Universal access is pointless without good results.
Good waiting times are pointless without good results.
All current indicators show waiting times are going up.

The overall view of the system from the standpoint of the patient all contradict what you stated and therefore while it is accepted that the NHS can and should improve in various areas, such as patient-centric care, it doesn't imply or suggest the the NHS is the shocking state compared to other relative systems that you have stated categorically is the case.

Outdated information shows nothing about the past. Do you say Man Utd are the best football team in the world because they won a lot with Alex Ferguson?

Perhaps you should read what people are actually saying instead of trying to defend a hastily put together argument you can only support by cherry picking or dismissing from others supplied data rather than taking the overall comparable position.

I did read what you said and I recognised a hastily put together argument with data that wasn't relevant ...

You have yet to answer or supply anything resembling proof other than your subjective opinion, especially as you have not been in the profession for some time if I'm not mistaken your opinion is no more objective than mine, at least mine has the benefit of being in the system throughout the period you are referencing from a grass roots position, but hey, continue in your ipse dixit position all you want, until you can actually show me some actual proof you are hardly going to convince me that your opinion is more than that of someone disillusioned with a system he used to work in and therefore operating under a negative bias.

Oh right so because I've stopped working in direct patient care then everything I learned is now redundant. So I would never recognise good ANTT, correct measurement, etc. That's an interesting one. I tell you what I think - I think you have had what you consider to be a good experience in middle England. You have extrapolated that as being a good experience, at an apparently cheap price, for everyone else. However, that I'm alright jack attitude flies in the face of other people's experiences and what we are hearing from the professions, the trusts, everyone else on this forum it seems.

 

[jas72]

I live in Belgium and have had to use A&E and doctor's surgery in the UK. I have proper medical insurance but everytime they simply wanted a UK address as they can't be bothered with the paperwork.

I just gave my dad's address and they were happy with that.

Both times I told them I had insurance and was willing to pay.

 

[jas72]

Expect it is expensive. For $387 you get this.


Medical Expenses
If, while on a Trip, an Insured suffers an Injury or Sickness that requires him or her to be treated by a Physician, the Insurer will pay the Reasonable and Customary Charges, up to the Maximum Limit(s) shown on the Schedule of Benefits or Declarations. The Insurer will reimburse the Insured for Medically Necessary Covered Expenses incurred to treat such Injury or Sickness within one year of the date of the accident that caused the Injury or the onset of the Sickness provided the initial treatment was received during the Trip. The Injury or the Sickness must begin while on a Trip, while covered under the policy.
Covered Expenses:
The Insurer will pay for:
* services of a Physician or Registered Nurse (R.N.);
* Hospital charges;
* X-ray(s);
* local ambulance services to or from a Hospital;
* artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
* the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist; * physical therapy up to 90 days after the Insured reaches his/her Return Destination.

Available coverage may vary based on time of purchase and/or state of residence. Please note that medical coverage may be excess. Refer to the full Description of Coverage for complete details.

I pay about the same as that for travel assistance for my family.

Doesn't seem extreme to me at all.

I presume that is an annual price and not per trip?


Also why aren't your sons British Citizen's (birth right) if you are both British?

I don't know your personal plans but if you don't register them as British their kids cannot have British passports and will lose out on any opportunities to live and work in Europe.

It only costs around £160 quid to get the birth cert.

 

[Castiel]

Xordium, basically what you are saying is that the figures quoted are wrong and that the general population all agree with you that the NHS is the now worst health system out of those quoted, falling from 2nd overall to worst in just 3 years! Paying particular attention to the US as that was the argument from my expense of both systems and even though the most recent figures quoted from 2013 state that the general populace don't agree with you as regard that position and the most recent figures anyone has posted all show that the NHS is performing well in some areas, average in others and poorly in others...as you would expect in a large universal health care system. Hardly shocking though. And what you've learned isn't redundant, only just like those figures you poopoo, out of date, just like you say diabetes is up, infant morality and so on, how does that compare to other systems however? That's what you have yet to demonstrate. Also great care is also pointless without access etc, so again what is the overall comparison with other systems currently? Again you gave failed to demonstrate this. In fact the only comparison this far demonstrates the opposite and you simply dismiss that as irrelevant. Fine, then prove it.

Professor Brian Jarman (in a comparison to the US and others, only the US was named and was the best for HMR) for example points out much like you do that there is poorer cancer survival, longer waiting lists lower number of acute beds per patients and so on..while also showing that the US has worse infant mortality rates, lower life expectancy and poorer access to care. He also notes that with around a third of people in the US having no or inadequate health insurance, many of the figures are skewed because the statistics only show Hospital figures, not those that are not admitted, he also shows that in England the hospital mortality rate has a greater downward trend than the US, although they are lower overall, again with the aforementioned access caveat as well as other caveats including how the data is regulated and how various countries health systems differ in the collating and dissemination of that data.

“The US system is very different from the UK and the US spends more than twice as much per person on healthcare as the UK and still has lower life expectancy and higher infant mortality rates.”

Other reviews (such as Keogh and more limited ones such as Francis) also show areas that need tackling, but what they do not show is an NHS in a shocking state compared to other nations health care systems. They show that the NHS needs and must improve in some key areas, they show where we do well, where we do poorly and where we should be investing and changing the culture towards a more patient centric system, but again they do not show that the NHS is in a shocking state...I cannot find any objective, reputable source that supports that position, and not for want of trying.

You sound pretty bitter about it all, and I'm sure that is affecting your objectivity, to the point that you still refuse to accept that you have yet to actually support the argument that the NHS is shocking compared to all other comparable systems. But what do I know, I'm just a privileged Middle Englander who is the exception and doesn't know anything about anything.

 

[D.P.]

It can be very misleading comparing mortality rates, life expectancy and access to health care. Is the american diet and lifestyle identical to the UK? No, there are many obese dietetic Americans who have easier access to cheaper, unhealthier faster food than the UK and healthy eating is relatively more expensive for an American than a Brit. Let alone any other genetic or socioeconomic factors. Britian may be healthier on average and that has little to do with the NHS who treat the sick and injured but do little to prevent sickness and injury. What matters is the quality of health care when revised to make a fair comparison.

Likewise access to health care - some Americans don't have health insurance and so have no easy access due to financial constraints. This is a real problem, but a separate one than comparisons of quality of service. Physical access will also be much harder for many Amricans - the population density is much lower, sometimes far lower. You could be living in the sticks of Alaska requiring a 5hr waterplane ride to the nearest town which could then transport you to the Anchorage to get full medical care in a big hospital. That is just a natural side effect of lower population density.


With hospital mortality rates, the US has a lower rate overall, so it is natural to expect that it is harder to reduce this rate to lower levels than in the UK where the rate is higher. There is rapidly diminishing returns in these kinds of circumstances. there is likely some base mortality rate simply related t serious injuries, RTA, terminal cancer rates etc. You can't lower the hospital morality rate below that with current technology. Perhaps the US is closer to that base rate?

 

[Castiel]

It can be very misleading comparing mortality rates, life expectancy and access to health care.

Indeed, the report states as much. It also pointed out that lower HMR would be affected significantly by the fact that it doesn't account for lower access in the US particularly amongst the poorest and therefore more likely to be the least healthy and death rates outside of the US hospital system that would be more likely within the UK system. The report also states similar caveats regarding other indicators such as cancer survival rates and so on, across a range of countries.

What it doesn't say, and no respectable source this far I can find, is that the NHS is shocking compared to those others...most say the opposite, that the NHS is indeed comparable and in some cases is worse, others better, others the same.

No one is suggesting there are not significant issues that need addressing, particularly in patient care (and some of those reports I linked are dealing with that specifically) but then so do all the other systems have areas that need addressing, including the US.

 

[holymonk]

I think its extremely dangerous to compare health care systems by looking at HSMR and SHMIs

There is a review that is ongoing on currently by Prof Nick Black, who has basically already poopoo'd mortality rates.

 

[D.P.]

Indeed, the report states as much. It also pointed out that lower HMR would be affected significantly by the fact that it doesn't account for lower access in the US particularly amongst the poorest and therefore more likely to be the least healthy and death rates outside of the US hospital system that would be more likely within the UK system. The report also states similar caveats regarding other indicators such as cancer survival rates and so on, across a range of countries.

What it doesn't say, and no respectable source this far I can find, is that the NHS is shocking compared to those others...most say the opposite, that the NHS is indeed comparable and in some cases is worse, others better, others the same.

No one is suggesting there are not significant issues that need addressing, particularly in patient care (and some of those reports I linked are dealing with that specifically) but then so do all the other systems have areas that need addressing, including the US.

I was just trying to point out that it is fairly meaningless to compare gross mortality or life expectancies because their are so many confounding factors.

I don't think the NHS is shocking, I do strongly believe the quality is a long way behind what the average American with health insurance receives. I do find that some people are too poor to have health insurance and have no state provided substitution to be shocking.

 

[Castiel]

I was just trying to point out that it is fairly meaningless to compare gross mortality or life expectancies because their are so many confounding factors.

I don't think the NHS is shocking, I do strongly believe the quality is a long way behind what the average American with health insurance receives. I do find that some people are too poor to have health insurance and have no state provided substitution to be shocking.

Then we are in broad agreement.

 

[Xordium]

Xordium, basically what you are saying is that the figures quoted are wrong and that the general population all agree with you that the NHS is the now worst health system out of those quoted,

Hmm, nice strawman there. I didn't say that at all care to show where I did.

But what do I know, I'm just a privileged Middle Englander who is the exception and doesn't know anything about anything.

Again I never said you didn't know anything about anything. What I said was that you lacked the knowledge or skills to recognise good care and would therefore judge the experience not the actual quality. Nice strawman again ...

Oh and those two links there. One was old data ... again ... and the second measured a scant few trusts and found glaring weaknesses even when just assessing on these:

mortality
patient experience
safety
workforce
clinical and operational effectiveness
leadership and governance

Oh, look we have missed off the actual outcomes again ... strange how no-one is really that willing in the NHS presented links you keep providing to actually talk about outcomes. I wonder why that is.

 

[Xordium]

It can be very misleading comparing mortality rates, life expectancy and access to health care.

When you have a health service that is supposed to provide from primary to tertiary care and also the health promotion then it is not so misleading. Many things can be compared quite easily across countries without the bias you state: neonatal mortality rate, rate of hospital acquired infection, etc. Strange these are the figures the NHS doesn't compare so well at. And it's interesting why Castiel doesn't use the data from these or cancer care to substantiate his claim instead focusing on how much is spent per patient and how many people get to see a practitioner ... from old data.

You can't just say well circumstances are different across countries when the NHS actually is responsible for ensuring that the message has got across to people that they shouldn't drink so much, get overweight, marry their second cousin (well they don't say this but they should!), etc and therefore is control of those variables.