Friday, February 22, 2008

Public? Private? Either? Both?

A concluding chapter about health issues in the UK. Arriving at Heathrow Airport on Sunday, I saw the following advert whilst waiting in the immigration queue:

Private health? World Class Care.

It was a billboard for HCA Hospitals, a private company offering a variety of specialties side-by-side with the public National Health Service. The poster noted in small letters at the bottom, "GP referral may be required."

Not understanding the relationship of this parallel private system to the public system, I was further enlightened by this story by Sarah Lyall in the New York Times, which was sent by a friend upon my return. Here's a teaser quote:

Created 60 years ago as a cornerstone of the British welfare state, the National Health Service is devoted to the principle of free medical care for everyone. But recently it has been wrestling with a problem its founders never anticipated: how to handle patients with complex illnesses who want to pay for parts of their treatment while receiving the rest free from the health service.

As I have mentioned elsewhere, there seems to be a convergence between the health care systems in Europe and that in the United States:

I predict . . . that the systems will start to look more and more alike over time. Pressure in the US for a more nationally-determined approach. Pressure in Europe for more of a private market approach. It shouldn't surprise us to see this convergence. After all, the countries are dealing with the same organisms, both biologically and politically.


lynnie said...

Hi Paul, once again I'd just like to say thank you for this education.
Well, I had a 35 year old cousin who rescently died from lung cancer. She left behind a 6 year old daughter, many friends family members who loved her, including myself. Its painful to think that she could still be here if she'd had the resources to pay for private care.

Anonymous said...

Actually, I run into this from time to time with VA patients.

They have both VA benefits and private insurance. The VA pharmacy is way cheaper. They have $100+ meds for an $8 copay. Most meds are free.

But in order to use the pharmacy, they have to see their PCP at least twice a year.

That leaves me with patients that want to see me for acute visits, but the VA for chronic disease management, or vice versa. It all gets confusing, especially when the patients don't tell me about the arrangement. I don't really want to fire the patients, I can't persuade a single one to stop using the VA system.

Anonymous said...

"It shouldn't surprise us to see this convergence. After all, the countries are dealing with the same organisms, both biologically and politically."

While I agree with the thrust of this comment, I think there is a general sense that Europeans have a more collectivist mentality and are willing to pay considerably higher taxes as a percentage of income than Americans in order to support a robust social safety net.

Economists generally frame this in terms of a tradeoff between less inequality and more economic security under the European systems vs greater economic growth potential and more economic opportunity (and mobility) in the U.S. system. It is quite likely that our respective cultures reach very different conclusions as to just where the optimum point on this tradeoff lies.

Anonymous said...

What actions can hospital patients take regarding the
a. hospital overbilling?...
b. billing for services not rendered?... or
c. billing for services not rendered completely?... or
d. billing for services not rendered properly?...

Anonymous said...

I don't know. Maybe someone from HCA or the NHS can answer this.

Anonymous said...

There are more than one HCA, please spell it out as well as NHS for purposes of clarity!

Anonymous said...

Hospital Corporation of America, as you can see on their website to which I have linked.

And National Health Service, as mentioned above.