Spain plans to privatise more healthcare- is this the way forward?

Roly2: You havn't actually answered my question. You have specifically stated you would introduce charges at hte point of service. This being so *how* would the poor access these services? Secondly, how do you suggest the poor recieve dental care, if it should be eliminated from the NHS system? Have you fully thought this through? Finally, given that the NHS is not actually in crisis as an insitution, but a political one borne out of ideological fanatacism, why is change an imperative? Given that the NHS has been subjected to "permanent revolution" by government dictat for over 20 years, the NHS is in far greater need of consistancy and stability than yet another ideological fad.

But then, if the people using the NHS are busy standing in line and not out earning money, unlike the people using private walk in centres, we have to be brutally honest and admit they may not be putting in a positive figure on the spreadsheet. Thus "thinning the herd" would be a great move to help improve the bottom line. Every good Libertarian knows that there is no such thing as externalities or societal costs.

 I would introduce some charges, to those who can afford to pay.   The UK has a very wide benefit structure and for example, those claiming certain benefits could simply receive back anything they pay out.    

As I say, over the years, I have seen a lot of incompetence in the health service - and of course my opinions are influenced by this.

People would pay for dentistry the way they do in the rest of Europe.   I am of the opinion it is too expensive to keep in the NHS.

Claim it back? How do they afford it up-front? What if they can't? What if they don't know how to claim it back - learning disability, can't speak English etc.?

As for the European model of dental care. The only one I'm really familiar with is the Spanish one I knew of many cases where people just waited until they had severe dental pain then got a tooth pulled and hoped that would do the trick. This is certainly an improvement on the British system where people may have to undergo root canal work or having crowns. They hurt, and take longer. For those on benefits, they may even have to undergo such work for free.

As for incompotence in the NHS. Sure there's some. Of course, charging will end this once and for all, unlike - say - more stringnet qualification filtering in recruitment, longer trainee / student dcotor status, on-going professional development support, peer shadowing and review, etc.

Nah, just demand money from patients before they get treatment. It'll work. After all, user fees for banking services has led to an industry of unparalelled compotence. Our health service needs nothing less than the professionalism of UBS, RBS, Barings and BCCI. Captains of Commerce, our physicians salute you.

 However, I was under the impression that those whose income did not exceed $400 a month would get free health care at a county hospital.

No. You are referring to Medicaid and various State run 'equivalents'. You are ignoring the fact that there are other qualifying criteria. One of the key ones is that it is strictly means tested not only in terms of income, but also assets. The net effect of this is that say, for example, you had , temporarily, a very low income ($400 is seriously poverty level), but owned a house or car or had a small sum in savings. Those assets would be seized to pay your bills before you could qualify. This could (and does) put entire families out on the street. Literally.  In effect, you have to be proverty-stricken and totally broke, and even then, unless you are in one of the other qualifying categories, you get no coverage whatever. The main beneficiaries of these programs are very poor families with dependent children, and even then, the quality of care given leaves much to be desired. It is not a system to aspire to.

66d pretty much hits it on the head. I lived (briefly - thank the gods) in California, and one of my friends had a mental health issue which meant she couldn't work, and she had a Sec. 7 apartment (private apartment where the government subsidised the rent - like a MUCH more restrictedform of Housing Benefit) and no car. Anyway she was about as near to homeless and destitute as you could get, yet she was not entitled to Medicaid. We went through all her affairs together to try and find some way she could be covered and got absolutely nowhere. I even took it too my boos at work, as in HR we were responcible for the company health programme, to see if we had missed anything but the rules were clear. She wasn't covered and would have to pay for everything.

The old adage that the poor can always use ER (A&E) is false and misleading. The only requirement is that hospitals cannot insist you pay up front for ER. You WILL be billed after the minimum life saving treatment has been given a which point if you don't pay you will be taken to court, your home (if you own it) and car will be siezed etc. In some states you could be sent to prison.

In addition, the idea of use-now-pay-later access to ER (not free of charge, as the GOP often claims) is some kind of substitute for actual real health-care is absurd. Level of health in the US between rich and poor is far higher than in any other industrialised nation, as minor ailments develop into acute and life threatening conditions because a doctors visit to obtain simple diagnosis and prescription for antibiotics is unavailable to vast swathes of the population. The result is that when these people die, are imprisoned, or bankrupted, the state picks up the tab, spending tens of thousands on low quality often failed ER treatment, rather than fund a course of anti-biotics or other routine care.

Health care charges are not only deeply unethical, they are also just ineffective and inefficient as a means of  ensuring effective healthcare in terms of both outcome and total cost.

 "Health care charges are not only deeply unethical, they are also just ineffective and inefficient as a means of  ensuring effective healthcare in terms of both outcome and total cost."

That is a political statement, and does not address the economic reality.   You may think it unethical, and therefore be prepared to accept a substandard health service for the sake of keeping it free - others will not agree.   I have used the French system which does make a small charge on users, and I am not surprised it is at the top of the WHO rankings.  I have never considered the French to be unethical - many other thing yes, but not unethical.  

The NHS must be one of the most inefficient organisations on the planet, and I believe greater efficiency would lead to better patient care, though I don't know how you achieve that with an organisation the size of the NHS.

In terms of dentistry, the NHS does in fact make a charge for dental treatment (to those who can afford it), and the economic reality is that this charge is not so very much less than paying a monthly amount into Denplan.  It is just a different mind set.

LLegaralasestrellas, I think we maybe have a different view of poverty, as I am puzzled at the whereabouts of all of those starving barefooted people who cannot afford to pay £10 for a missed doctors appointment.   All it would take to avoid that charge would be to pick up their mobile phones and cancel it.  The way the poverty statistics are put together in the UK are that the bottom x% are seen to be 'poor'.  So the poverty line is constantly changing - so the number of 'poor' never gets fewer.   But the nature of poverty does change of course. 

As your name implies, you want to reach for the stars (and that is lovely), but you have to be rooted in economic reality.

Privatisation of the NHS will mean that clinical care will be a number crunching operation and profits will be put before medical care, as the service still will be free at the point of use so share holders of the company will have to get their money from having restricted drugs formularies and procedures. I know a GP which worked for a while for an out of hours run by a private company and she was performance managed according to how many patients she saw in one hour rather than according to the quality of the care provided.

Still I thinks the NHS needs to change as to continue as it is, is unaffordable. However, as a difference with a private company, savings made in an area can be used to improve care in another.

I also think if patients were to make a small contribution, they would value the service much more.

 Well, now that we've sorted the NHS and the American system (with a bit of side trip to Canada and France) what about the Spanish system?  The plans to privatise "healthcare" is neither new (it was being talked about in January) nor does it actually apply to "healthcare" as in doctors and nurses.  In fact, no-one seems to know exactly what will be privatised.  Torrevieja hospital is already a public/private partnership and has been since it opened.  This is an extremely well run and efficient establishment where, on the out-patient side at least (apart from the receptionists who refuse to speak to you until you've taken a number from their machine regardless of whether there is a queue or not) it provides a service second to none.

If these proposals take the form of management in hospitals then I see no problem with that.  Some of those in UK which have been taken over by private management companies are very efficient and well run.  Many of the ambulance (non-paramedic manned) services in UK have been privatised already and appear to work quite well (these are the routine ambulance car and transport services not the ones that attend emergencies).  From what I remember in UK, the purchase of supplies for individual practices was very high.  Discounts could be obtained but if one, centralised buying department was set up the discounts could be negotiated to a greater extent (the purchase of flu vaccines, for example, worked in UK.  One practice could negotiate a discount of around 25% but a centralised buying department negotiated a 60% reduction).  Having supplies provided by the private company direct to all practices within one trust could mean significant savings, for example.

The privatisation of these services haven't adversely affected the services to the patients.  They still don't pay for ambulances, they still don't pay for flu vaccines, they still don't pay for dressings etc.  

The biggest waste in the NHS is patients not bothering to turn up for appointments.  In France, they did have a system where you paid 10 euros to make an appointment and, if you turned up, were given a voucher to claim 9 euros back.  (I don't know if that still happens as I'm actually going back pre-euro days and it was the equivalent in Francs).  It got so bad at our practice that we got to a 30% non-show of patients at one time. We ended up texting patients to remind them of their appointment which did cut it down a bit but still not to a workable level.  Dentist will charge you £10 if you don't turn up for an appointment.  The problem is that everything that is offered "free" - ie paid for by the taxpayer - will end up being abused.  If a sort of "fining" system was introduced, only the relatively well off would suffer as the poorer paid would find a way of claiming it back.  (Funnily enough, our well to do patients were never a problem - maybe a case of the way they were brought up). 

But for Spain, I think we'll have to wait until what is being privatised is actually announced.

(By the way, most pharmacies in the Valencia region are on strike this week due to non-payment by the autonomous government.),

Yes you are right about the Valencia Pharmacies! €450 million in outstanding payments....

Read the EOS news blog

San Jaime in Torrevieja is, as far as I understand, different to what is being proposed. San Jaime is a fully private hospital in towns of ownership, staffing etc.  that agreed to allocate a small portion of bed capacity to Insalud patients in return for the construction project being given approval. At the time there was a big fuss about it in Torrevieja, as oringally USP (the company that owns it) wasn't going to handle any Insalud cases at all.

I was living in Torrevieja at the time it opened, and my grandmother feel ill. We had to take her to Vega Baja hospital in Oriheula, as at the time San Jaime wasn't taking Insalud cases. I think it started doing so not long after (this was in 2000).

"but you have to be rooted in economic reality."

Economic reality is that if you charge people at the point of use for healthcare,  if they don't have the money, then you are kicking them out the door. You can call it increasing efficiency, or demand management or whatever you wish, but someone still has to get kicked out the door.

 It has been clearly demonstrated in many previous cases that the poorest groups in society are less likely to sucessfully claim what they are entitled to, as the poorest generally include higher than average levels of people with diagnoised and undiagnosed mental health issues, non-English speakers, those with learning disabilities, the elderly etc. who are unable to navigate the system sucessfully.

The Tax Credits system are both a testament to this, where there are large numbers of people entitled to support who don't claim simply because there are a huge number of people who cannot navigate the system. Rather than kicking them on the street I would rather close the loopholes that allow foreign companies to avoid UK tax by over-charing UK subsiadries for on-paper 'services' to show zero profit in the UK. Altering this alone could bring up in anything from £5b to £15b p/a, and is only one of dozens of similar scams.

^^^ One of my old employers used to do this. Virtually the whole operation was in the UK, but the "parent company" (just a dummy holding company) was based in St. Kitts, and billed the UK "subsidary" for back office services and equipment at grossly inflated prices, so the UK company showed some ridiculously low annual profit. They actually brought said services from India. Nice little arrangement.

 I meant the Torrevieja hospital, not the San Jaime one.  It is a public hospital under private management.

Torrevieja Hospital

Oh, I'm with you now. Sorry, I thought you meant SJ.