The Real NHS

Old Sep 20th 2012, 5:36 pm
  #106  
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Default Re: The Real NHS

Originally Posted by Giantaxe View Post
Health tourism is a "convenient" scapegoat for other inefficiencies and issues in the NHS. I'm all for the NHS enforcing it's residency requirements (I once tried to pay for NHS treatment as a visitor and they declined to take my money - wtf?), but let's be realistic here - the NHS has rather more significant issues to address. Of course, that won't stop the Daily Mails of this world from their agenda.
Amen.

As for returning expats not being able to use the NHS because they haven't paid in, I see many flaws in that argument.

First, an ex-pat who returns at age 40 and earns a high income may pay more in taxes in his remaining work days than some UK residents will pay over his whole lives. Does that mean the minimum wage worker should have his care rationed? And what about UK residents who earn enough to pay the 45p rate (or is it 50?), and never left the country. Should they get better care because they paid in more? This is the logical extension of the 'you only get out what you pay in' argument.

Also, the ex-pat who has been out of the country for years may not have paid in, but they also haven't used the system and therefore haven't cost the country a penny. Now they're back, they will go into the system like anyone else - paying taxes and going to the doctor when they need to, but they'll likely never use as much NHS care as a person who's been in the country forever.

Whatever the solution is for the NHS, I believe it must be applied to all residents and that any attempts to divide people into 'them' and 'us' and feed paranoia are part of a larger agenda. It's not just that the tabloids aren't particularly accurate. It's that they are actively pushing a political agenda and manipulating public opinion through these one-off stories.

Last edited by sallysimmons; Sep 20th 2012 at 5:40 pm.
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Old Sep 20th 2012, 5:57 pm
  #107  
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Default Re: The Real NHS

Originally Posted by sallysimmons View Post

Also, the ex-pat who has been out of the country for years may not have paid in, but they also haven't used the system and therefore haven't cost the country a penny. Now they're back, they will go into the system like anyone else - paying taxes and going to the doctor when they need to, but they'll likely never use as much NHS care as a person who's been in the country forever.
The strength of the NHS is that it delivers care free at the point of service without regard for your ability to pay. That is what makes it better than the US system. However, a returning expat might actually cost the NHS far more than they contribute.....this is in no way a bad thing and the way the NHS is organized recognizes such situations will exist and is explicit in saying they are NOT an issue.

Take my situation. I left the UK at age 25 and I have lived outside the UK for 26 years. I have paid voluntary NI contributions and now have 30 years of contributions, but I've never paid UK income taxes or any UK tax for that matter. I have not consumed much health care so far just like most people who are quite health before the age of 50. As we get beyond 50, 60 and 70 people consume drastically more health care. Old people are expensive when it comes to health care. When I return, I will be paying some UK taxes, but not income tax as I'll be retired, and my UK tax amounts will be less than I've paid during my working life. So the peak of my health care costs will coincide with the minimum in my taxes.

Last edited by nun; Sep 20th 2012 at 6:08 pm.
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Old Sep 20th 2012, 7:52 pm
  #108  
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Default Re: The Real NHS

Originally Posted by nun View Post
The strength of the NHS is that it delivers care free at the point of service without regard for your ability to pay. That is what makes it better than the US system. However, a returning expat might actually cost the NHS far more than they contribute.....this is in no way a bad thing and the way the NHS is organized recognizes such situations will exist and is explicit in saying they are NOT an issue.

Take my situation. I left the UK at age 25 and I have lived outside the UK for 26 years. I have paid voluntary NI contributions and now have 30 years of contributions, but I've never paid UK income taxes or any UK tax for that matter. I have not consumed much health care so far just like most people who are quite health before the age of 50. As we get beyond 50, 60 and 70 people consume drastically more health care. Old people are expensive when it comes to health care. When I return, I will be paying some UK taxes, but not income tax as I'll be retired, and my UK tax amounts will be less than I've paid during my working life. So the peak of my health care costs will coincide with the minimum in my taxes.
.. and, to extend the thought, the United States is getting a free ride, since you won't be consuming the Medicare health care that you paid for while you worked in the US. Meanwhile it doesn't work the other way around; Americans who have lived, worked and paid taxes in the UK can only retire to the US with Medicare if they have at some time worked for ten or more years in the US, and even then they have to pay their Part B and Part D etc.
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Old Sep 20th 2012, 11:09 pm
  #109  
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Default Re: The Real NHS

Originally Posted by robin1234 View Post
.. and, to extend the thought, the United States is getting a free ride, since you won't be consuming the Medicare health care that you paid for while you worked in the US. Meanwhile it doesn't work the other way around; Americans who have lived, worked and paid taxes in the UK can only retire to the US with Medicare if they have at some time worked for ten or more years in the US, and even then they have to pay their Part B and Part D etc.
Actually a US citizen retiring to the US with no FICA payments history can pay for Medicare Part A when they reach 65. It will cost them $465 a month, Part B will be $100 and then you have to add a Medigap policy too. The big problem would be for someone returning to the US to retire before 65 and having to buy private health insurance. In most states that would currently be very expensive and might be hard to get if you had any pre-existing conditions.

The US/UK reciprocal SS agreement cannot be used to qualify for Medicare. Its only applicable for the SS pension, so the US citizen who has lived in the UK for most of their working life should plan on working for at least 10 years in the US before they retire there if they want to get Medicare Part A without a premium.

http://www.ssa.gov/international/Agr....html#medicare
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Old Sep 21st 2012, 11:36 am
  #110  
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Default Re: The Real NHS

Originally Posted by Mummy in the foothills View Post
Did you know the whole of England is computer linked by the NHS? ... So it won't be long before Tourists are actually billed for care as they won't have a GP and address to be looked up on the computer. She also said that eventually everyone would be issued with a healthcare card like a credit card to access care which I think would be a brilliant idea.
I seem to recall, a few years back, that when NHS records were being computerised, there was an option to ask your GP to keep only paper records and not upload your information to the central computer system. Which was then known as SPINE.

The NHS is notorious for promising confidentiality and not delivering by leaking routinely. I would not trust the NHS beyond a strict "need to know" basis. Some patient groups with particularly sensitive conditions, for example VD, psychiatric or intersex conditions, have been livid at leaks and gossip.

So can one still opt out of computer records?
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Old Sep 21st 2012, 4:29 pm
  #111  
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Default Re: The Real NHS

Originally Posted by holly_1948 View Post
I seem to recall, a few years back, that when NHS records were being computerised, there was an option to ask your GP to keep only paper records and not upload your information to the central computer system. Which was then known as SPINE.

The NHS is notorious for promising confidentiality and not delivering by leaking routinely. I would not trust the NHS beyond a strict "need to know" basis. Some patient groups with particularly sensitive conditions, for example VD, psychiatric or intersex conditions, have been livid at leaks and gossip.

So can one still opt out of computer records?
Over here in the good old USA people that have access to medical records have been selling out info to major corparations, anything for a buck.
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Old Sep 21st 2012, 5:15 pm
  #112  
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Default Re: The Real NHS

Originally Posted by holly_1948 View Post
I seem to recall, a few years back, that when NHS records were being computerised, there was an option to ask your GP to keep only paper records and not upload your information to the central computer system. Which was then known as SPINE.

The NHS is notorious for promising confidentiality and not delivering by leaking routinely. I would not trust the NHS beyond a strict "need to know" basis. Some patient groups with particularly sensitive conditions, for example VD, psychiatric or intersex conditions, have been livid at leaks and gossip.

So can one still opt out of computer records?
I'm not sure if you can opt out, but practice receptionists routinely divulge information inadvertently while on the phone to patients, or in person. As you say, someone with HIV, a bladder infection (poor Prince Philip, the whole world knows), etc. or some other more personal illness doesn't want the whole world knowing.

I was in the chemist the other day to pick up the remainder of a prescription they hadn't been able to fill earlier in the week. I was asked for my name, then my address, then the name of the medication was said (out loud). Luckily for me it wasn't anything embarrassing, but they really need training on patient confidentiality.
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Old Sep 24th 2012, 4:03 pm
  #113  
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Default Re: The Real NHS

This is one way I see the NHS in the future.

http://www.telegraph.co.uk/health/he...o-private.html
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Old Sep 24th 2012, 5:57 pm
  #114  
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Default Re: The Real NHS

Originally Posted by Bud the Wiser View Post
This is one way I see the NHS in the future.
I think there may be something wrong with that link - when I clicked on it, it launched dozens of Web pages that wouldn't stop, even when I clicked them closed. I had to go into Task Manager to close down Explorer because it was going mental opening up tab after tab, all with that link ... or maybe it's just a gremlin in my machine ...
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Old Sep 24th 2012, 6:14 pm
  #115  
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Default Re: The Real NHS

Dunroving, I tried the link from my post and it appeared to work OK. If you can't access it, try the telegraph web page. There's a header on there for the article. Interesting reading and comments.
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Old Sep 24th 2012, 6:28 pm
  #116  
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Default Re: The Real NHS

Originally Posted by Bud the Wiser View Post
Dunroving, I tried the link from my post and it appeared to work OK. If you can't access it, try the telegraph web page. There's a header on there for the article. Interesting reading and comments.
Worked for me.
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Old Sep 24th 2012, 6:31 pm
  #117  
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Default Re: The Real NHS

OK, that's good to know - thought I'd put out a warning just in case. I know my mousepad has been acting up so maybe it "stuck" on the link - though I don't know why it would have continued to open the link.

Ah well, back to your seats, panic over.
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Old Sep 25th 2012, 12:22 pm
  #118  
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Default Re: The Real NHS

Dunroving, did you manage to open the link?
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Old Sep 26th 2012, 9:43 am
  #119  
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Default Third World NHS

http://www.dailymail.co.uk/health/ar...-medicine.html

...Just wait for Chris to jump in saying that you can't rely on the Daily Mail. Just read who is quoted in the article.
Speaking from personal experience, the NHS is appalling. Worst cancer outcomes in Europe, GPs who have a diagnosis ability of zero, squalid and dirty conditions, nurses who cannot even communicate and hail from real nations of healthcare quality-Nigeria, Russia and Zambia.
The big problem in the UK is that the private sector is not comprehensive, so you have to use the NHS
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Old Sep 26th 2012, 9:47 am
  #120  
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Default Re: The Real NHS

Originally Posted by Bud the Wiser View Post
This is one way I see the NHS in the future.

http://www.telegraph.co.uk/health/he...o-private.html
Possibly but the issue is that the private sector does not offer a comprehensive set of services so for certain things you will continue to have to use the NHS. The other issue is that it is difficult for private hospitals to market what they offer because it is not considered acceptable in the workers paradise to criticise the NHS (or for that matter anything) even though the NHS is so bad.
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