WEBlue

Is this question for me, Boiler? East Anglia.



I think on further reflection that both nations undoubtedly have problems with their medically underserved rural areas. It's part of the way medicine has had to become a (profitable) business in both countries.

UK: Funding change could force rural GP practices to close, BMA warns | Society | The Guardian

US: Access to Care: Overcoming the Rural Physician Shortage - Appalachian Regional Commission
(Covers possible remedies including J-1 visa Waiver Program.)

scrubbedexpat099

I had thought that most GP practices had been businesses since the NHS inception?

The Guardian link was about a cut in funding so that their businesses were no longer profitable and would have to close.

Biggest health cost is labour, most people want to profit from their labour.

Pulaski

It doesn't matter whether you are delivering milk, electricity, or medical services (among many other things) if the population density is low, there isn't much money to be made. If the business model can't be modified sufficiently, or the price increased to make delivery of the product or service profitable, and the government won't subsidize it, the business is doomed. End of story.

[Queue arrival of RoadWarriorFromLP to the discussion. ]

scrubbedexpat091

We have the rural doctor issue in Canada as well, the doctors just don't want to live and work in these small rural area's for the most part, and government can force a doctor to do so.

They do provide incentives to get doctors into rural area's, but it doesn't always work, some places are just too rural for most.

Living in a rural area means giving up things available to an urban area, just part of life, sometimes it makes no sense to provide a service any service in rural area's.

WEBlue

I would disagree with both of you. IMO, the NHS as originally set up was a funded part of the welfare state and did not have to worry about being profitable, just deliver nationwide services. I think devolution in the late 90s and then the reorganisations of the last decade have changed the original model radically....

scrubbedexpat099

The NHS is profitable!

Pulaski

"If". I said "if".
I don't think you have any thing to disagree with me about. I wasn't passing comment on whether the government should, or should not, subsidize the service (though I will if you like ), I was merely observing that if the government does not subsidize the service in rural/ low population density areas, that the service is doomed to fail/ disappear.

That said, the NHS might not have to be "profitable", but which ever way you slice and dice the story of the NHS, it is all about the allocation of finite resources, and that, on some level is going to mean either some degree of rationing and consequential inequality of service, OR gross inefficiency of delivery. It might, for example be possibl to ensure that there is a primary care physician's urgery within five miles of every home in the UK, but you're going to have some GPs in northern England, Scotland and Wales with very few patients.

WEBlue

Who said that??

OK, I don't disagree with you, Pulaski....

scrubbedexpat099

You did.

Bob

And that doesn't happen in the US?

Pulaski

The Pulaski family's contact with the medical professions has been thankfully very limited, but my perception is that US medical service providers are aware that we are customers who could take our business elsewhere. I find US medical staff to be friendly and welcoming, whereas with the NHS I sometimes felt like an irritation to be tolerated and/or dealt with.

On one occasion in the UK when I had a badly sprained knee my GP prodded and poked the knee briefly, then wrote a prescription for an elastic support knee sleeve, and left..... left the room, and the building, ahead of me, jumped in to his car and drove away! "I'm sorry I was an inconvenience.".

robin1234

Again, back to the supply and demand equation.

I stopped going to the local urologist because I, and all other clients, were treated so poorly. Three to six month wait for an initial appointment. Reception staff unbelievably rude and unhelpful. Not enough chairs in the waiting room, so elderly men had to stand and wait. Torn carpet, rickety old wooden chairs. Permanent hand scrawled notice on the wall: "wait will be at least three hours. If you would prefer to reschedule, see reception staff."

When you finally got to see the doc, he was super friendly and had all the time in the world to tell me all about his latest holiday to the UK to see his grandparents etc.

But clearly they had more patients than they could handle so had no great incentive to spend money on improved premises or other enhancements.

scrubbedexpat099

That can be said for any monopoly supplier.

Bob

You do get that here though...less so from the PCP side of things, but else where, it's common enough because they don't need to care as they still get the supply. Can definitely see them get snippy if you refuse service.

When the missus was getting a bunch of scans, they offered another scan afterwards on next visit and she refused. They said what the issue was as insurance would pay it and it's only $1200....errr...no, insurance was only going to pay for 2 scans and they were done on the last visit.

hungryhorace

In my experience, which admittedly is very limited here, if the insurer says 'no' to a bill, that's the end of it. I went to see a specialist here recently and he submitted two bills. One was paid with no issue, the other was denied as the insurer considered it 'experimental' treatment. The EOB stated I, the subscriber, could not be billed for this procedure.

Would this have been the case with your wife's scan do you think?