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The true value of the NHS

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Economists are well aware that, if goods or services are provided without reference to their cost, their perceived value plummets. And it’s become a truism that this is a partial cause of the current NHS crisis.

This is not to say that medical care in the UK is free or cheap – of course, the NHS takes a hefty bite from the payslips of our patients and people who never see a doctor – but that its value is diminished by the psychological disconnect between payment and provision.

I have to confess to having no firm idea where I stand on the debate about charging per consultation, and doubtless all GPs have their own views. Maybe as the cohort of patients who remember life before the NHS diminishes, it will become a necessary step, regardless of whether individual GPs agree with it. Perhaps, though, it’s not quite too late to emphasise the cautionary stories of those who have been separated by geography, rather than time, from care that is free at the point of access.

A patient I saw last month must be one of the strongest supporters the NHS has. The medical specifics of his story are fairly distinctive so I’ll have to be hazy with detail, but I’ll leave the bones of his story intact.

Until last year he worked in a country outside the EU, and was in perfect health. Then he started to develop symptoms of an illness that he knew was prevalent in his family.

He hoped for a while that symptoms would settle down, but eventually paid for a check-up. He was then offered expensive secondary care investigations that he couldn’t afford.

His symptoms worsened to the point he was forced to make a costly trip to A&E, where his poor health forced him into accepting an operation that was many times more expensive than the initial offer of secondary care.

Maybe he’d have needed the operation anyway, maybe not, but in any event the patient underwent the operation, sold his house to pay his medical bills, wound down his business. He subsequently moved back to the UK to rebuild his life.

As GPs, we all know that major illness is tragedy enough without personal bankruptcy riding in its wake. For my patient, his situation was made even worse by nauseous uncertainty over his decision at that initial check-up.

We could take the hard line and say it’s the patient’s own fault for making what seems, in retrospect, a bad decision. Perhaps he could have paid for insurance before the situation arose, but applying cold logic to one’s own mortality isn’t easy.

For sixty-five years the UK has been largely spared this kind of agonising choice but it seems increasingly clear that care which is free at the point of access is no longer tenable. I hope the public appreciates the gravity of the decision being made in their name, and that the dissolution of the NHS will leave more people with these kinds of crushingly heavy choices.

And I hope it isn’t only when stories of financial ruin following gut-wrenchingly awful diagnoses
hit the papers that it becomes clear what has been lost.

Dr Nick Ramscar is a GP in Bracknell, Berkshire.

Readers' comments (5)

  • Vinci Ho

    I am no health economist . But common sense tells me even if patients paid a small fraction of the total fee of a big operation , e.g. £200 for a hip replacement for sake of argument , the whole picture in NHS will be already different ??

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  • Any move to charging at the point of delivery will bring in the private insurance market. In the USA administrative costs are approximately 25 % of the cost of healthcare whereas in the UK it is around 6%. Whatever the current problems in the NHS charging will massively increase cost and increase inequality. £200 for a hip for an MP on £65k plus expenses compared to a pensioner on £7k.

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  • I'm really glad to see Dr Ramscar acknowledge that healthcare in the UK is, indeed, not free: "This is not to say that medical care in the UK is free or cheap – of course, the NHS takes a hefty bite from the payslips of our patients and people who never see a doctor" So true.......

    ....yet we are all charged a nominal sum to have dental treatment (except children and people on certain benefits). Would charging a nominal sum to see a GP be any different ? Other countries, such as France, manage things this way with certain categories of patients not being charged.

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  • A partially private service is now inevitable in England thanks to Sarah Wollaston and her public school chums the other countries in the UK may escape as the Tories are not in power.the BMA is shirking its responsibility to the profession and the public by not negotiating a fee structure with the DOH the pages of pulse are full of more woe for the contract next year not sure about everyone else but I can't do it anymore

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  • Patients pay not only at Tax/ NIC, but also by waiting for years on lists and hours on trolleys. As a patient of another care system where there is a small fee, the system is much better. A small fee to see a GP, a small fee each day for hospital expenses. Why should food and lighting be free.
    The best health care systems in the world charge a small [ sometimes recoverable] fee.

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