Opinion by Milena Popova
Scottish news: Andrew Lansley and my cat
I have had cause recently to compare private and public health care systems - with unflattering conclusions for both.
After a week at home with the flu and still not feeling the least bit better, I finally cracked and tried to book an appointment with my GP. The process normally goes something like this: I call at 8.29am, only to get their answerphone which tells me they don’t open until 8.30. I hang up and and redial, at which point the line is already engaged. I then proceed to redial every two minutes for the next half hour or so, until I finally get one step further - into the hold queue.
Five to ten minutes later I normally get to speak to a person who gives me an appointment at a generally inconvenient time. On that particular morning, though, by the time I got through (9.20), no more appointments were available. As it is also impossible to pre-book appointments for the next day, I was put on a waiting list and promised a call back which never came. I gave up trying to see my GP and eventually got better anyway.
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A couple of weeks later, my cat developed a nasty urinary tract condition. Mid-morning, my partner phoned the vet, who picked up the phone immediately and promptly offered a range of appointments. Chili was taken in and hospitalised for a few days. Upon discharge he was given a follow-up appointment - no “phone up on the day and try your luck” here.
When the problem recurred on Good Friday, we again got an appointment immediately for the same day and when it turned out that further hospitalisation would be required over the holiday weekend we were referred to the out of hours service. The duty vet examined the cat, and when it turned out that major surgery would be required a more senior vet was called in to perform it - yes, on Good Friday. We got regular updates by phone for the rest of the day and were invited to visit Chili in hospital the next day - a traumatic experience for everyone involved, I assure you.
For about two weeks after Chili’s second discharge from hospital we kept going back pretty much every other day. Being the fussy sort of humans, we were on the phone to the vet practically every time the cat mewed. This included phone calls at 10pm and vet visits on Saturdays, Sundays, and at times of day which conveniently accommodated the fact that I have a full-time job - practically unheard of when it comes to getting a GP appointment.
The catch? At our usual vet practice, the minute we walked through the door we were asked to pay fifty per cent of the estimated bill up front. At the out of hours vet hospital, where larger bills are more common, we got away with paying the excess on our insurance and leaving a signed claim form so the vet could claim directly from the insurer. As over the two weeks I watched the bill get to four figures and then some, I was very glad Chili was insured. Bottom line: for those who have easy access to several hundred pounds and can afford the monthly cost of pet insurance, their pets get better, more convenient healthcare than they do from their GPs.
There are other issues with privatised healthcare too. When my partner moved back from Scotland - where eye tests are covered on the NHS - to England - where they aren’t - he took several weeks to find an optician who wasn’t offering hugely overpriced eye tests which included lots of checks unnecessary for someone his age. I am to this day convinced that a private dentist I saw several years ago drilled and filled two if not three completely healthy teeth. Both of these are classic examples of the kind of information asymmetry.
As Andrew Lansley hands control of NHS budgets in England to GPs already too busy to see patients, only for them to hand those budgets further to the private sector, we will probably see more of the kinds of issues associated with privatised health care. Whether existing problems, such as the quality of care and capacity issues, are addressed by these reforms remains yet to be seen. I must admit I have no good solution to the challenges presented by 21st century health care but my gut feel at this point is that Scots are lucky to be able to watch this one from the sidelines.
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