What Ails the British Health Service
GELB, NORMAN
COPING WITH HIGH COSTS What Ails the British Health Service BY NORMAN GELB London Several years ago, an ambitious young American free-lance journalist recently settled in Britain heard there...
...Others pay a pre-set price for each medication, regardless of the actual cost to the health service...
...Everything else is free with a few minor exceptions, such as some vaccinations for foreign travel and certain notes patients may want from their doctors for nonmedical reasons...
...The NHS was introduced by a Labor government in 1948, on the principle that' 'everyone in Britain should be entitled to the best medical treatment available, irrespective of means...
...In the NHS' current troubled circumstances, insurance-based financing makes economic sense...
...Medicine in Britain would revert to being the business that the pioneers of the British National Health Service thought they had closed down for good...
...COPING WITH HIGH COSTS What Ails the British Health Service BY NORMAN GELB London Several years ago, an ambitious young American free-lance journalist recently settled in Britain heard there might be a job opportunity in India with the news operation of a major U.S...
...television network...
...some will die before their turn comes...
...Indeed, instead of being able to expand its services in response to criticisms, the NHS finds itself having to close hospitals of marginal use to save money, provoking howls of outrage from the people affected...
...So whether one has the flu or a heart attack, an "out-of-sorts" feeling or a need for chemotherapy, there are no bills to pay nor is there anything to sign...
...They chalked up a 13 per cent increase in 1979 alone, and probably did even better in the year just ended...
...Practically every man, woman and child in the country is registered with a neighborhood NHS general practitioner...
...The study stresses that nonmedical causes-poor housing, education and working conditions-are largely responsible for these inequities...
...The Tories are not alone, however, in their complaints...
...If the squandering of resources has been as uncontrollable as critics suggest-and there is no denying that private hospitals do get by with smaller staffs-an insurance system is likely to make the NHS more cost-conscious...
...About 6 per cent of the British population is currently paying for private health insurance, despite the availability of free services from the NHS...
...It had meant for him what it means for Britons-no need to face financial disaster because of serious illness...
...He was surprised, therefore, that the matter of payment was not mentioned upon his discharge...
...Norman Gelb reports from London for the Mutual Broadcasting System...
...All medicine prescribed by an NHS physician is free for children under 16, women over 60, men over 65, and low income earners...
...If surgery or out-patient treatment is necessary, they can quickly enter almost any private hospital (another growth industry in Britain...
...Similarly, a person requiring an emergency operation is treated immediately, but the waiting list for those needing nonemergency operations (say, repair of a hernia or a hip replacement) is huge-more than 650,000...
...Prime Minister Margaret Thatcher's Conservative government has made no bones about its belief that the NHS has been inefficiently run for a long time and now requires a major overhaul, or perhaps a fundamental change of direction...
...Some argue that even if individuals were fully reimbursed f or medical costs, many simply would not have the money to make the initial cash payments and would not seek medical care for fear of financial embarrassment...
...The situation is further complicated by the fact that every time a heart transplant operation takes place, a debate on medical priorities begins anew: Is it right to engage in costly medical adventures and help a few individuals at the expense of large preventive medicine programs that could help many people...
...Britons who are covered by private insurance see the specialists they prefer, usually within days of making their appointments...
...For the next six weeks he was kept under close medical scrutiny and given endless doses of medicine...
...An appointment with an NHS specialist can always be arranged once the general practitioner has recommended it, but except for acute cases a patient may have to wait several weeks...
...The one point of unanimous agreement is that the NHS desperately needs more funds...
...Recalling family medical experiences in the States as he lay in the hospital, the young man imagined himself being slowly and relentlessly wiped out financially...
...It notes, for example, that twice as many babies of unskilled manual workers still die at birth or during the first month of life than babies born into more comfortable families, and that chronic illness is twice as high among the unskilled as among professionals...
...The Health Service has been in trouble for years, plagued by an inevitable shortage of funds and by doubts as to whether it is fulfilling its fundamental purpose...
...to take a job in Minneapolis...
...He whizzed off to Delhi, realized after a while that no one was about to be hired, and returned to London not only disappointed but feverish and nauseated as well...
...It quickly became such an accepted part of British life that although the Conservatives have been in power on several occasions during the last three decades, no government minister has ever so much as hinted that medicine ought to be de-socialized...
...The cost of full insurance for a family of four is roughly 320 pounds (about $740) a year, but may soon rise by 20 per cent...
...According to its findings, the National Health Service has failed to narrow the difference in health between the poor and the affluent...
...These people pay their own bills, file claims with their insurance outfits and then are reimbursed by return mail...
...The consequence of all this has been a business boom for Britain's private health insurance plans...
...But the NHS, long touted as a model for an American national health program, is suffering hard times...
...The contrast between private and public health care has become so glaring that it has added to the burdens of the already hard-pressed NHS administrators...
...Others see the plan as designed to eventually undermine the NHS altogether, particularly in the light of constant reports about how the NHS costs are invariably higher than those in private hospitals-50 per cent higher for a kidney transplant or a body scan...
...On the advice of a colleague who had worked in South Asia, the journalist went to the highly regarded Hospital for Tropical Diseases, where he was admitted and diagnosed as having picked up an obscure, nasty Eastern bug...
...People would be less prone to visit their doctors for minor illnesses, or to ask for medicines for every ache and pain...
...But since he was eager to know the extent of the debt he had incurred, he phoned the following day to ask when the bill would be forthcoming and how much it was likely to be...
...Labor politicians have been quick to condemn the plan...
...Gerard Vaughn, Britain's minister of health, recently suggested that the money might soon be available, but not from traditional taxpayer sources...
...A Middle-Western Republican back home, the journalist became a devoted advocate of England's socialized medical system and remained so even after returning to the U.S...
...Last month that price more than doubled to one pound ($2.31), an increase that the reflects NHS' troubles...
...He is contemplating converting to nationwide publicly-operated insurance funding for the Health Service, a system used by several other European Community countries...
...After some confusion because the first two people he spoke to could not understand what he was talking about, it was finally explained to him that there would be no bill-he had been treated free of charge by the British National Health Service (NHS...
...A recent study issued here seems to confirm persistent claims that Britain is hardly a medical paradise...
...Though much Health Service care is excellent, it simply cannot compete with the private sector...
...If they have ailments calling for special attention, the doctor refers them to a specialist at a nearby NHS hospital...
...Some people on the list have waited for years to be summoned by the hospital...
...Yet the NHS cannot be absolved of all blame, for its medical shortcomings are well known...
...Nonetheless, the casu-alness of seekingadoctor'sadviceor reassurance, which has been a comforting part of British life, would be eliminated and sorely missed...
Vol. 64 • January 1981 • No. 1
