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The UK has free public health care but maybe introducing a price for a doctors or hospital visit would help lessen this problem? One could introduce a fee of s

by chvid 7y ago

The UK has free public health care but maybe introducing a price for a doctors or hospital visit would help lessen this problem? One could introduce a fee of say 20 pound pr. visit. Something that is low enough that anyone in UK could pay it but also high enough to remind people that what they are consuming is finite resource.

pbhjpbhj 7y ago
>Something that is low enough that anyone in UK could pay it // The problem is with such things that they're regressive taxes. Rich people can still afford to go to the doctors when they have a sniffle but poor people will re-consider even when they have a life-threatening illness because £20 is a months food bills for the poor person.
- dragonwriter 7y ago
  You could have income-dependent copayments to mitigate the regressive nature of this, but you are still stuck with the fact that you are incentivizing delaying care without urgency, which is mostly routine and preventive care, which does save money (IIRC, in total as well as just on that care) but also has an adverse impact on health outcomes.
  - markdown 7y ago
    > copayments What's a copayment?
    - dragonwriter 7y ago
      A required payment by a recipient of insurance-covered service of part of the cost of service, like the fixed £20 per doctor visit suggested upthread.
      - markdown 7y ago
        Thanks
- jquery 7y ago
  Your hypothetical poor person isn't just poor, they're suffering in extreme poverty, and the system could be designed to accommodate them. Tolls on a congested bridge are "regressive" but are practical and make sense. We shouldn't structure society around what makes things less convenient for the rich, there just isn't very many of them by definition. We should structure society around what improves the lives of most people, within the current realities that exists. This is the classic sin of envy where we'd actually rather be worse off if the person we envied was also worse off. Now maybe there are other reasons to avoid co-pays, such as higher death rates in areas with co-pays. I'd be interested to see a study that demonstrated the tradeoffs of co-pays.
  - SolaceQuantum 7y ago
    I don't feel comparing healthcare to tolls is that useful. Systems to accomodate people based on economic need have a tendency to introduce more costs and overhead which will reduce the efficiency that the system was attempting to solve in the first place! This cannot be said for tolls.
    - jquery 7y ago
      I was comparing copays to tolls, not healthcare costs in general. Copays should generally be small, bearable even for a minimum wage worker, perhaps pegged to an hour of the local minimum wage.
- michaelbrave 7y ago
  This actually happens in the US...
spinach 7y ago
£20 for some people is a lot though. That is definitely not something that 'anyone' could just pay when they wanted. You'd be hurting the most vulnerable people.
- tomatocracy 7y ago
  And more to the point, it's enough to put many many more people off seeing the doctor, even if they could easily afford it, because they think "it's probably nothing so it's not worth it". Inconvenient times/rationing by queueing has the same effect but on a slightly different group of people. A prescription charge doesn't work in quite the same way because if you are getting a prescription then you already know you need it, unlike going to the doctor.
crispyporkbites 7y ago
Or, you treat people who are abusing the system with the treatment they really need: mental heath support. If there aren't enough nurses for the sick people, we need more nurses. We can't control the number of sick people by excluding the poor.
- drocer88 7y ago
  Raise wages, you'll get more nurses. Same with any other product or service. Nursing is not different and is not resistant to the laws of supply and demand.
  - luckylion 7y ago
    Especially since, at least from what I hear from friends, nurses aren't that expensive, and you don't need to hire a new doctor with every new nurse to make quite the difference in patient's experiences. The whole system amazes me all the time. We have the people who need to think very clearly and be very awake do 18, 24 and more shifts. That doesn't sound like they'd be at peak performance at all times.
    - ceejayoz 7y ago
      > That doesn't sound like they'd be at peak performance at all times. They're not. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200708/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200708/ > Health care workers need to begin to think of coming to work impaired by chronic sleep deprivation as similar to coming to work impaired by alcohol. Studies reveal that as ethanol and sleep loss increase, psychomotor performance decreases and memory is impaired. A 2-hour sleep loss is equivalent to a 0.045% breath-alcohol concentration, and a 4-hour sleep loss is equivalent to a 0.095% breath-alcohol concentration — above Texas' legal limit of 0.08%. > In the traditional-schedule group, interns were on call every third night, working 24 hours or more. In the intervention group, interns worked no extended shifts (>17 hours) and averaged 65 work hours each week. Besides having about 6 hours less sleep each week and twice the number of attentional failures (EEG evidence of severe drowsiness), the traditional-schedule group made 36% more serious medical errors than the intervention group.
esotericn 7y ago
We already have a charge for prescriptions. The vulnerable get them free because if they didn't they wouldn't pay for it. This would necessarily have to function identically.
neilwilson 7y ago
The NHS charges by time, not by money. People 'pay' by waiting. Rich people waiting the same time as poor people pay more in money terms because their time is more valuable. The queue is managed via clinical need as assessed by professionals. That breaks when people can pay in real money. Since the system is supply constrained all that does is reserve scarce medical resources for those with money rather than those with the most need. It allows rich people to jump the queue - just like the 'VIP' lane at a theme park. Queue jumping in the UK was always frowned upon. The ultimate social faux-pas. That seems to be weakening in recent years and the 'time as money' system is weakening with it.
- jquery 7y ago
  >People 'pay' by waiting. Can you elaborate here?
  - luckylion 7y ago
    I understand that as "you can work an hour and give the proceeds of that work to the doctor, or you can sit in his waiting room for an hour".
  - vbtemp 7y ago
    So long as there is contention for a finite resource the market always exists. If you don't pay with cash, you pay with something else that has value - your time.
  - MaxBarraclough 7y ago
    I believe it's true to say the NHS generally has worse waiting times than, say, American healthcare.
- deleted 7y ago
  [deleted]
DanBC 7y ago
There are considerable numbers of people who cannot afford £20 for a visit. So, for those people we'd need to implement a bureaucracy to give them free healthcare, and the cost of that would eliminate any potential benefits it would have. There's no evidence it would work. There's some evidence it wouldn't work. Don't forget this study was done in in-patient settings: those patients were actually ill and needed treatment.

by chvid 7y ago

pbhjpbhj 7y ago

>Something that is low enough that anyone in UK could pay it // The problem is with such things that they're regressive taxes. Rich people can still afford to go to the doctors when they have a sniffle but poor people will re-consider even when they have a life-threatening illness because £20 is a months food bills for the poor person.

dragonwriter 7y ago
You could have income-dependent copayments to mitigate the regressive nature of this, but you are still stuck with the fact that you are incentivizing delaying care without urgency, which is mostly routine and preventive care, which does save money (IIRC, in total as well as just on that care) but also has an adverse impact on health outcomes.
- markdown 7y ago
  > copayments What's a copayment?
  - dragonwriter 7y ago
    A required payment by a recipient of insurance-covered service of part of the cost of service, like the fixed £20 per doctor visit suggested upthread.
    - markdown 7y ago
      Thanks
jquery 7y ago
Your hypothetical poor person isn't just poor, they're suffering in extreme poverty, and the system could be designed to accommodate them. Tolls on a congested bridge are "regressive" but are practical and make sense. We shouldn't structure society around what makes things less convenient for the rich, there just isn't very many of them by definition. We should structure society around what improves the lives of most people, within the current realities that exists. This is the classic sin of envy where we'd actually rather be worse off if the person we envied was also worse off. Now maybe there are other reasons to avoid co-pays, such as higher death rates in areas with co-pays. I'd be interested to see a study that demonstrated the tradeoffs of co-pays.
- SolaceQuantum 7y ago
  I don't feel comparing healthcare to tolls is that useful. Systems to accomodate people based on economic need have a tendency to introduce more costs and overhead which will reduce the efficiency that the system was attempting to solve in the first place! This cannot be said for tolls.
  - jquery 7y ago
    I was comparing copays to tolls, not healthcare costs in general. Copays should generally be small, bearable even for a minimum wage worker, perhaps pegged to an hour of the local minimum wage.
michaelbrave 7y ago
This actually happens in the US...

spinach 7y ago

£20 for some people is a lot though. That is definitely not something that 'anyone' could just pay when they wanted. You'd be hurting the most vulnerable people.

tomatocracy 7y ago
And more to the point, it's enough to put many many more people off seeing the doctor, even if they could easily afford it, because they think "it's probably nothing so it's not worth it". Inconvenient times/rationing by queueing has the same effect but on a slightly different group of people. A prescription charge doesn't work in quite the same way because if you are getting a prescription then you already know you need it, unlike going to the doctor.

crispyporkbites 7y ago

Or, you treat people who are abusing the system with the treatment they really need: mental heath support. If there aren't enough nurses for the sick people, we need more nurses. We can't control the number of sick people by excluding the poor.

drocer88 7y ago
Raise wages, you'll get more nurses. Same with any other product or service. Nursing is not different and is not resistant to the laws of supply and demand.
- luckylion 7y ago
  Especially since, at least from what I hear from friends, nurses aren't that expensive, and you don't need to hire a new doctor with every new nurse to make quite the difference in patient's experiences. The whole system amazes me all the time. We have the people who need to think very clearly and be very awake do 18, 24 and more shifts. That doesn't sound like they'd be at peak performance at all times.
  - ceejayoz 7y ago
    > That doesn't sound like they'd be at peak performance at all times. They're not. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200708/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200708/ > Health care workers need to begin to think of coming to work impaired by chronic sleep deprivation as similar to coming to work impaired by alcohol. Studies reveal that as ethanol and sleep loss increase, psychomotor performance decreases and memory is impaired. A 2-hour sleep loss is equivalent to a 0.045% breath-alcohol concentration, and a 4-hour sleep loss is equivalent to a 0.095% breath-alcohol concentration — above Texas' legal limit of 0.08%. > In the traditional-schedule group, interns were on call every third night, working 24 hours or more. In the intervention group, interns worked no extended shifts (>17 hours) and averaged 65 work hours each week. Besides having about 6 hours less sleep each week and twice the number of attentional failures (EEG evidence of severe drowsiness), the traditional-schedule group made 36% more serious medical errors than the intervention group.

esotericn 7y ago

We already have a charge for prescriptions. The vulnerable get them free because if they didn't they wouldn't pay for it. This would necessarily have to function identically.

neilwilson 7y ago

The NHS charges by time, not by money. People 'pay' by waiting. Rich people waiting the same time as poor people pay more in money terms because their time is more valuable. The queue is managed via clinical need as assessed by professionals. That breaks when people can pay in real money. Since the system is supply constrained all that does is reserve scarce medical resources for those with money rather than those with the most need. It allows rich people to jump the queue - just like the 'VIP' lane at a theme park. Queue jumping in the UK was always frowned upon. The ultimate social faux-pas. That seems to be weakening in recent years and the 'time as money' system is weakening with it.

jquery 7y ago
>People 'pay' by waiting. Can you elaborate here?
- luckylion 7y ago
  I understand that as "you can work an hour and give the proceeds of that work to the doctor, or you can sit in his waiting room for an hour".
- vbtemp 7y ago
  So long as there is contention for a finite resource the market always exists. If you don't pay with cash, you pay with something else that has value - your time.
- MaxBarraclough 7y ago
  I believe it's true to say the NHS generally has worse waiting times than, say, American healthcare.
deleted 7y ago
[deleted]

DanBC 7y ago

There are considerable numbers of people who cannot afford £20 for a visit. So, for those people we'd need to implement a bureaucracy to give them free healthcare, and the cost of that would eliminate any potential benefits it would have. There's no evidence it would work. There's some evidence it wouldn't work. Don't forget this study was done in in-patient settings: those patients were actually ill and needed treatment.