Thoughts on the NHS

I'm really not into politics, but since health care reform is a major issue in America right now, and since living here I've used the NHS (National Health Service) - I thought it would be interesting to explain my experiences and what the American healthcare system has the potential to turn into.

As many of you know, my less than graceful husband toppled over on a run a week before our wedding (around July 10th) and did a serious number on his ankle.  The next day he was recommended to an orthopedic ankle specialist by a family friend.  He was able to have X-rays taken and reviewed within an hour and the doctor determined his ankle wasn't broken.  She wanted to do an MRI because of the extreme bruising and swelling, but since we were leaving for England in a week, she said there was no point because there wasn't enough time to treat him.  She advised him to get an MRI when we returned to England.

When we got back to England I accompanied him to the GP and found it to be completely disgusting.  The waiting room was smelly, overcrowded, the walls were cracked and dirty, covered with falling down posters.  My favorite poster is the one that tells you not to abuse the staff... I'm pretty sure posters like these are only necessary if the staff is doing a pretty bad job.  We had to wait ages and there were no good magazines to read.  Highlights anyone?  The receptionist called Nick and we went upstairs to an equally not sterile looking room.  This was a bit weird because the doctor's office was actually in the room - like a desk with a computer and covered in papers, and there was one of those patient bed things in the corner with used paper lining, behind what looked like a hideous floral shower curtain.

The doctor asked Nick what the problem was, but didn't bother to look at his ankle, or the CDs with the X-rays the American doctor had given him.  He said he'd schedule him an MRI, which he got on Nov. 2nd.  This means it took about 3 months to get an MRI.  I'm clearly not a doctor, but it seems to me in the 3 months he's waited, if anything was wrong his ankle would have attempted to heal itself... so it's potentially healed itself improperly which could cause him a lot of problems in the future.

The MRI was sent to his doctor's office, who called our house and asked Nick to schedule an appointment with them.  This is an indication that something is wrong, since the NHS wouldn't bother telling him to come in if everything was OK.  However, when he called to schedule an appointment, he couldn't get one.  You can only call to make an appointment 48 hours in advance, and since its so crowded, he has been unable to schedule anything.  The verdict is still out as to when he'll actually get an appointment.

Meanwhile, I called the doctors office on Friday to make an appointment for my prescription to be reviewed on my day off, Monday.   They said they had no appointments available.  This is a problem because my prescription is about to run out.  Nick's mum said if I showed up when they open at 9 then they might be able to fit me in - I'd just have to wait around and hope for the best.  So I went at 9 and after standing in a long line I finally spoke to the receptionist explaining my situation.  I told her I was sorry I didn't have an appointment and that I'd called on Friday to make one, and she said, "I know.  This place is terrible!"  In the end she was somehow able to schedule me an appointment for 4:30 today.  So I get to spend my day off visiting the doctor for a routine check up not once, but twice!

Another anecdote Nick's mum shared with me is her friend got knee replacement surgery this week.  He was completely crippled because of his bad knee, and went to the NHS.  They said they couldn't do anything about it till February, so he opted to go with private healthcare.  This cost him £12,000.  I know American insurance policies can be pretty dodgy, but my understanding of it here is most people don't have health insurance because they rely on the NHS.  But what do you do when you need healthcare and can't get it because the government run system is poorly managed and inefficient?  You have to go to private practices and pay for your treatments completely out of pocket.  

I must admit the positive thing about the NHS is it's free.  There are no co-pays and my prescription which cost me $45 a month in America is totally free here - though I think sometimes a small fee (£6 or so) must be paid for some medications.

While I completely understand the need for healthcare reform in America, I sincerely hope I never see American healthcare turning into a mirror image of the NHS.  Personally, I think the main problem with the NHS is it creates no incentives for doctors to run their practices well.  You're stuck with the doctor you have whether you like it or not - so you have no ability to bring your business elsewhere if you're not happy with their services.  They'll get paid via your tax dollars either way.  Also, because England is such a friendly nation, and will let anyone immigrate here, myself included, the systems set up cannot cope with the vast numbers of people.  I've also noticed that in England, if you say you have any small ailments (stomach ache, head ache, common cold) people will tell you to "Go to the doctor."  I think this is because it is free, so why not.  But when everyone shows up for silly things like stomach aches - it's no wonder the system is over run.

America has great, innovative doctors who have incentives to pioneer new treatments and procedures.  I think government healthcare does not challenge doctors to perform at their best.  Most Americans I've spoken to about our healthcare system say they'd like to see the equivalent of the NHS in the US, but is this really what you want to see in America?