4 ms·

> We need a system where you pay a deposit say £10 for an appointment, refunded in full if you show up on time, say £5 if you are late. For many people having

> We need a system where you pay a deposit say £10 for an appointment, refunded in full if you show up on time, say £5 if you are late. For many people having to pay a £10 deposit to place a doctor's appointment would be the difference between seeing the doctor or not. Especially near the end of the month there are people for whom £10 is the difference between eating or not eating.

eric_b 9y ago
At what point do we hold people accountable? If a $10 fully refunded deposit is an insurmountable challenge (which, at least in the US does not at all apply to "many" people.) what would work? We can't just allow people who give no thought to others, who make bad choice after bad choice, the option to continue to ruin it for the rest of us. I'm sympathetic to low income folks, but surely a 10 dollar deposit you get back if you simply do what you say you're doing to do, is not too much to ask?
- mirchibajji 9y ago
  As a UK resident earning a comfortable wage, I personally wouldn't mind paying a bit more, and hope the NHS continues to be easily accessible. Money can solve many problems, but these kind of "solutions" only adversely affect those don't have enough of it. It isn't like managing such a system has zero overhead.
  - jon-wood 9y ago
    Glad to hear I'm not the last bleeding heart liberal round here! The solution is to increase taxes and properly fund the NHS.
    - gaius 9y ago
      The solution is to increase taxes and properly fund the NHS. What would you say that involves? The current budget is £125Bn, so are we looking at £150Bn, £200Bn, £500Bn? Put a number out there and we'll have a national debate on what we are willing to do to finance that. Noone seems to know what "properly fund" actually looks like, and noone has any appetite for tackling waste, such as missed appointments, or IT outsourcing contracts. £10Bn flushed down the toilet on NPfIT, when you say "save our NHS" you are really saying "save CSC's shareholders", do you realize that? https://www.theguardian.com/society/2013/sep/18/nhs-records-system-10bn https://www.theguardian.com/society/2013/sep/18/nhs-records-... Windfall tax on Accenture et al I say.
      - toyg 9y ago
        Aren't you tired of rehashing the NPfIT failure, literally decades since it started and even 4 years since the press last covered it? It's just become a talking-point, a right-wing meme. The new systems are not faring much better; it's just a set of hard problems from an organizational perspective. Conflating IT mistakes (10bn over 20 years, 500m per year - peanuts, from a government perspective) with the entire NHS expenditure, is just misleading propaganda. This is why we can't have a civil debate on what the NHS should and should not provide: the fixation on cost-cutting and its opposite knee-jerk reactions stifle any attempt at reasoning about actual problems.
        gaius 9y ago
        It's just become a talking-point, a right-wing meme. The new systems are not faring much better That's a really weird thing to say: are you asserting that the "right wing" is complaining about billions in public money being funnelled into the pockets of capitalist shareholders? Or is "right wing" just your word for "anyone who disagrees with me"? I'll grow tired of it when the government stops doing business with these companies, insources all the IT work, and hits them with a windfall tax to claw it all back. Is that what you call "right wing"?
gaius 9y ago
OK, so only apply this system to someone once they miss an appointment then. At some point people have to take a little bit of responsibility. If you don't need an appointment anymore just call and cancel. Oh but what about those who can't top up their phones? What about what about what about... This is 20% of appointments. I in no way believe that 12 million people in the UK can't afford a fully refundable £10 deposit.
jdietrich 9y ago
There's a very real possibility that a small cash deposit could increase the rate of no-shows. Right now, a lot of British people feel quite protective of the NHS. They see it as a scarce and precious resource that should be used sparingly. Many people feel a real sense of guilt if they inadvertently miss an appointment, because they feel that they're taking something away from someone who might need it more. Converting this reciprocal relationship to a transactional relationship is very risky. Many people who would otherwise make an effort to keep their appointments could take the attitude that they're just paying for a service; the lost deposit takes away any guilt about missing the appointment. £10 is a fraction of the actual cost of a missed GP appointment, so the NHS could make a substantial net loss. I think a far more productive approach would be to use behavioural nudges. It wouldn't be difficult or expensive to give an SMS or automated voice reminder of an appointment. People who persistently miss NHS appointments could be offered support in keeping to their appointments, while being gently reminded of the costs to the NHS and the effects on other patients. I suspect that a bit of psychological carrot-and-stick would be far more effective and far less risky.
- gaius 9y ago
  They see it as a scarce and precious resource that should be used sparingly This is not even slightly true. £11Bn a year is spent on Type 2 diabetes, 80% of which is caused by obesity (source: Diabetes UK). A&E every Friday and Saturday night is full of drunks. People take the NHS for granted. take the attitude that they're just paying for a service Well SOMEONE is paying for it. Generally, the people who can't get GP appointments...
- kpil 9y ago
  An interesting real-life example of failed economical incitements is a case here a kindergarten started to charge an extra cost for "late pickups", ie later than the what the contract stipulated. The end result was that "late pickups" increased as the shame of being late was replaced with a transaction fee, signalling that late pickups where allowed by the rules.

eric_b 9y ago

At what point do we hold people accountable? If a $10 fully refunded deposit is an insurmountable challenge (which, at least in the US does not at all apply to "many" people.) what would work? We can't just allow people who give no thought to others, who make bad choice after bad choice, the option to continue to ruin it for the rest of us. I'm sympathetic to low income folks, but surely a 10 dollar deposit you get back if you simply do what you say you're doing to do, is not too much to ask?

mirchibajji 9y ago
As a UK resident earning a comfortable wage, I personally wouldn't mind paying a bit more, and hope the NHS continues to be easily accessible. Money can solve many problems, but these kind of "solutions" only adversely affect those don't have enough of it. It isn't like managing such a system has zero overhead.
- jon-wood 9y ago
  Glad to hear I'm not the last bleeding heart liberal round here! The solution is to increase taxes and properly fund the NHS.
  - gaius 9y ago
    The solution is to increase taxes and properly fund the NHS. What would you say that involves? The current budget is £125Bn, so are we looking at £150Bn, £200Bn, £500Bn? Put a number out there and we'll have a national debate on what we are willing to do to finance that. Noone seems to know what "properly fund" actually looks like, and noone has any appetite for tackling waste, such as missed appointments, or IT outsourcing contracts. £10Bn flushed down the toilet on NPfIT, when you say "save our NHS" you are really saying "save CSC's shareholders", do you realize that? https://www.theguardian.com/society/2013/sep/18/nhs-records-system-10bn https://www.theguardian.com/society/2013/sep/18/nhs-records-... Windfall tax on Accenture et al I say.
    - toyg 9y ago
      Aren't you tired of rehashing the NPfIT failure, literally decades since it started and even 4 years since the press last covered it? It's just become a talking-point, a right-wing meme. The new systems are not faring much better; it's just a set of hard problems from an organizational perspective. Conflating IT mistakes (10bn over 20 years, 500m per year - peanuts, from a government perspective) with the entire NHS expenditure, is just misleading propaganda. This is why we can't have a civil debate on what the NHS should and should not provide: the fixation on cost-cutting and its opposite knee-jerk reactions stifle any attempt at reasoning about actual problems.
      - gaius 9y ago
        It's just become a talking-point, a right-wing meme. The new systems are not faring much better That's a really weird thing to say: are you asserting that the "right wing" is complaining about billions in public money being funnelled into the pockets of capitalist shareholders? Or is "right wing" just your word for "anyone who disagrees with me"? I'll grow tired of it when the government stops doing business with these companies, insources all the IT work, and hits them with a windfall tax to claw it all back. Is that what you call "right wing"?

gaius 9y ago

OK, so only apply this system to someone once they miss an appointment then. At some point people have to take a little bit of responsibility. If you don't need an appointment anymore just call and cancel. Oh but what about those who can't top up their phones? What about what about what about... This is 20% of appointments. I in no way believe that 12 million people in the UK can't afford a fully refundable £10 deposit.

jdietrich 9y ago

There's a very real possibility that a small cash deposit could increase the rate of no-shows. Right now, a lot of British people feel quite protective of the NHS. They see it as a scarce and precious resource that should be used sparingly. Many people feel a real sense of guilt if they inadvertently miss an appointment, because they feel that they're taking something away from someone who might need it more. Converting this reciprocal relationship to a transactional relationship is very risky. Many people who would otherwise make an effort to keep their appointments could take the attitude that they're just paying for a service; the lost deposit takes away any guilt about missing the appointment. £10 is a fraction of the actual cost of a missed GP appointment, so the NHS could make a substantial net loss. I think a far more productive approach would be to use behavioural nudges. It wouldn't be difficult or expensive to give an SMS or automated voice reminder of an appointment. People who persistently miss NHS appointments could be offered support in keeping to their appointments, while being gently reminded of the costs to the NHS and the effects on other patients. I suspect that a bit of psychological carrot-and-stick would be far more effective and far less risky.

gaius 9y ago
They see it as a scarce and precious resource that should be used sparingly This is not even slightly true. £11Bn a year is spent on Type 2 diabetes, 80% of which is caused by obesity (source: Diabetes UK). A&E every Friday and Saturday night is full of drunks. People take the NHS for granted. take the attitude that they're just paying for a service Well SOMEONE is paying for it. Generally, the people who can't get GP appointments...
kpil 9y ago
An interesting real-life example of failed economical incitements is a case here a kindergarten started to charge an extra cost for "late pickups", ie later than the what the contract stipulated. The end result was that "late pickups" increased as the shame of being late was replaced with a transaction fee, signalling that late pickups where allowed by the rules.