NHS Hot Topics: Private Healthcare and Privatisation
In England, Scotland and Wales our predominant form of healthcare is public via the National Health Service (NHS). All citizens pay National Insurance and general taxation, which in part goes to fund the NHS. The NHS provides free care at the point of access (GP, emergency care) to residents and non-residents. Established in 1948 after the Second World War, the NHS was part of a larger goal of general social reform. Some individuals choose to also pay for private healthcare, which often has the advantage of being faster than standard social care.
In other countries there are different systems for healthcare. In Scandinavia as with the UK, all healthcare is funded by taxpayers. In the USA, the majority of healthcare provision is private and only the poorest are treated by the state. In France there is a mixed system, where there is high taxation to finance a public system available to all and then individual practitioners choose how much to charge and a set tariff is reimbursed to the patient by the state. The difference between the fee and the tariff is picked up by a private insurance company if the patient has bought excess insurance.
There are several advantages and disadvantages to these different forms of providing healthcare.
What are the arguments for private healthcare in the UK?
It takes patients away from NHS waiting lists, so reduces the wait for everyone
Patients still pay national insurance contributions, so more money is available for the NHS
Some private healthcare subcontracted back to NHS, so money is not lost
Allows supplementation of a doctor’s income, thus providing more incentive to work in the UK
If there is no private healthcare in UK, patients may go abroad, and any later complications would have to be treated by the NHS
There is an element of personal choice and liberty, whereby patients have the right to pay for different treatment if they wish.
Mandatory private healthcare reduces ‘time wasting’ patients as there is incentive to not see a doctor unless necessary
What are the arguments against private healthcare in the UK?
It unequivocally benefits the wealthy. Only those with wealth can access private healthcare, and thus if they receive better care you are disadvantaging vulnerable people
It only benefits those who are largely healthy. If mandatory, insurance can become incredibly expensive when a person is or has been ill, disadvantaging those with chronic and congenital conditions
Where private healthcare subcontracts back to the NHS, this essentially allows ‘queue jumping’ of shared resources.
It can be argued that private healthcare is financially driven rather than altruistic, which may result in a commercial doctor-patient relationship which can result in harm. For instance doctors may recommend unnecessary examinations in order to receive more money.
What is privatisation?
There is currently a lot of news and debate on the privatisation of the NHS – and it’s a good idea to read around it extensively. This is slightly different from the idea of private healthcare in itself, but you may still be asked about it in an interview. In essence, there is a gradual increase in the amount of NHS budget going to large private firms such as Virgin Care, Care UK and Bupa.
The BMA reports that every year for the past five years, the amount of money spent by the NHS England on healthcare that is provided by the independent sector has increased, with the current yearly total at almost £7bn, totalling 6.3% of the total NHS budget. They also found that more than two-thirds of doctors are fairly or very uncomfortable with independent sector provision of NHS services, with the most common concern being that it destabilises NHS services. There is some fear that the steady increase in contracts to large private companies is part of a larger campaign to privatise the NHS wholly and bring about a more mixed model of service rather than being free at the point of access.