This isn't a lymphedema question per se, but I am interested in the answers. I am in the US and personally have private payor health insurance through my work. Most of you are in the UK and I have seen you mention your healthcare system and what is covered and what isn't. I just listened to a radio program discussing whether America could have a single payor health system and they used Canada and US as an example. I was just wondering if you UK residents have to pay a tax or a monthly premiun for your health care? Is out of pocket expense based on your income or is it same for all? Do you have easy access to providers? We have millions without insurance so i can see how it would be a good system, even though my costs will go up. Thoughts?
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GabbiD
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Wow - small question with a HUGE answer! The NHS (70 years old this year) was introduced to allow access to healthcare 'from cradle to grave'. The money is raised through Income Tax and National Insurance contributions, which everyone has to contribute to via salary payments - or annually via Tax Returns. By default, everyone employed person contributes something to the national pot - not sure how many pence in the pound - there is probably lots of information via Google about how the NHS is funded.
I lived and worked in the US for a few years (90-93) and know how difficult it can be to get healthcare if you have no insurance.
Thanks Lynora! I always forget to google. Lol. I will look it up. The radio interview just made me think of all of you. I know that a few members have mentioned services that are or aren't covered by NHS so I wondered. So as an employed person do you all pay the same or is it based on your earned income?
Depends on earnings - some people contribute more depending on their tax bracket. Every British citizen is entitled to care regardless of their situation. Even foreign nationals, in emergency circumstances (trauma) are treated and hospitalised - the finance department sorts out the costs later. We are so lucky. It really does annoy me when I read/hear people complaining. Yes, there are certain services that are so stretched they simply cannot be covered by the NHS - related to this forum, it’s usually MLD! However, on the whole, it’s bloody amazing!
I live in Scotland - we have free prescriptions - which I actually feel badly about. Even simple meds like paracetamol can be prescribed - I always decline - very happy to pay 17p for a packet from the store!!!
Thanks for the insight. Fingers crossed and for sure new leadership and maybe something will change. I work with cancer patients, many of whome dont have health care coverage. One has no citizenship so she qualifies for nothing. It is so sad.
Paracetamol over the counter is more expensive in England, Lynora, or at least the south of England. Our problem is getting access. Waiting times can be long. I have not been able to see a doctor, face to face, for over two years, but I can get access by telephone or see a nurse. One gets prepared to care for oneself on a day to day basis, knowing that if one collapses in the street emergency services would help.
I'm concerned to hear that you have find it impossible to access primary care ?
You are living in the south of England if I understand correctly ?
I live in SE England.
I am able to see my GP on the day I need an appointment. Should he be on leave, for example, I am confident with other GP's in the practice as most have undertaken Lymphoedema training modules and some the Lipoedema training module too.
( I have both conditions. )
Incidentally I pay 39 pence for 16 paracetamol tablets from my local pharmacist.
Perhaps you mean you have a long wait to see a Consultant ?
Certainly they have too many patients but the longest I've waited is 4 months for an NHS appointment or 8 weeks for a private one.
I can get to see a nurse, for my annual checks. But my GP I only speak to on the telephone. What does concern me is the cost of making a telephone call to see if any doctor can speak to me. It is an average cost of £1. Most much in the scheme of things but significant if the only paid calls one makes are for health issues.
I was referred to a local hospital, to be seen by Macmillan nurses initially. Then referred back to my GP's practice. So I feel I have no source of expert medical help with Lymphoedema.
I am even more concerned to hear that your care is so poor.
Why can’t you make an appt to see your GP ?
Our practice offers telephone consultations but 7 times out 10 they result in a visit to the surgery.
The practice always rings the patient however and it’s an enhanced service and does not replace a face to face consultation.
I have been running our surgery’s patient group for some time now . Telephonecalls are now charged at local rate. That was our first project.
Do you have a patients group ?
Surgeries are now duty bound to have one but I know some still don’t.
I don’t understand a lot of things about your situation including you mentioning the cost of paracetamol. I obviously missed something in the previous post.
I phone the practice and a doctor rings back. It is the doctor on duty for the day. Usually their name is unknown to me. If they consider I need an appointment, (I have other problems) I am referred to a doctor.
My last face to face appointment was with an F1, whatever that is.
The health issue that gives me the most day to day concern is my leg. For this I was seen by a nurse at my GP's practice and referred to nurses at the local hospital. The F1 did not appear to understand the use of compression garments.
I have a heart condition that was diagnosed on a yearly Lymphoedema assessment. I believe this has worsened and I look forward to my next assessment to ask!
What is the use of a patients group if the doctors do not have time to see patients. I am in the south west where some people have difficulty in getting any GP.
My initial comment of the flow of this blog was the cost of paracetamol.
Patient Participation Groups are in place to make sure all patients views are put forward to the practice and effect change when things aren't going well.
NHS England now requires every practice to have one.
We have been a very successful group but I know our practice is exceptionally good scoring " Outstanding" in 2 categories at its last inspection including "caring."
I was part of that recent inspection and thoroughly enjoyed the process.
As your practice still seems to charge a high rate for making a telephone call then I would be asking its PPG to look at that, for example, as we did.
As I wrote before it's always easy to make an appointment on the same day to see my GP.
(I use their online system a lot.)
They are a young dynamic team and I'm proud of the work our group does to help keep them informed. We host health education events 3 or 4 times a year which have always been well received.
Our next topic is health screening for example.
An F1 student is in the first year of their speciality training in General Practice who are very closely supervised by their nominated GP trainer. A telephone call does not seem an appropriate way for them to be consulting with patients in my view and I fully understand that they would not know about the use of compression garments as LE training is woeful at medical school.
I guess there's no chance of introducing them to LSN's learning module as I did ?
I'd be very interested to read your practices CQC inspection report which will be on their website.
I'm very sorry to hear your services are so inadequate and I would enocourage you to find a better practice.
I am aware of some of the difficulties in the SW as I have family living there. I am recently widowed and will, most probably, move to the SW to have family close by so I have already read some practices CQC inspection reports and I know that my practice is hard to beat.
Sorry to write such a lot and I will duck out of this thread now but I wish you all the very best.
I’m a multi-national ie citizen of UK, Canada and the US. In my adult years i’ve lived in the US (1990-2004), Canada (1985-1990) and the UK (2004-present) . Before 1985 I lived in Germany, Japan. Greece and Switzerland. I have therefore had ample opportunity to experience the real life differences between socialised health care/national healthcare systems and private such that the US has.
The US model makes the insurance companies the winners - their fees structure benefits them and their incentive is to make bigger revenues, not improve health.
From a patient perspective, I’ve consistently had longer waits to see my GP/primary care doctor in the US than anywhere else, a 6 week wait was standard no matter how flexible I could be with my availability. My GP wait here for routine appointment is 2-4 weeks. And my ER/A&E waits in the US exceeded 6 hours! while in Canada and UK my waits have ranged 1-3 hours. My NHS tax comes out of my monthly pay (just like social security tax taken from US payslip) calculated by my tax bracket. We do not have a co-pay system like in the US. You turn up for your appointment, give your name and that’s that, no shuffling through forms to give insurance info/ proof of insurance. Only prescriptions require a small ‘co-pay’ of what equates to about $10. The standard of care I’ve received in the UK is generally superior to that I’ve had in US (4 excellent surgery experiences in NHS hospitals). In the US I always had such long waits at my GP appointments after checking in (45-90 minutes followed by 2 seconds with a doctor who was always terribly hurried). In the UK i wait between 10-45 minutes and never feel rushed by GPs or consultants but know they are under time constraints. My LE specialist consultant spent 45 minutes with me at my recent appointment which felt very substantial. I had waited for months to see her as she is in very high demand. Other consultants are usually 2-5 weeks wait in my experience. While the NHS has its problems, it’s a far cry better than the privatised system - I’d not be able to get insurance cover for LE treatment/garments were I to live in the US unless the LTA is passed by Congress. For all Lymphies in the US I do hope it passes soon, it’s taken years to get the congressional signatories it now has and still requires much more backing in Congress in order to become legislation. We get our compression on the NHS here which is hugely reassuring than having to pay entirely out of pocket the way many US Lymphies have to due to lax insurance cover or no cover.
Thank you so much. I appreciate your comparisons. What experience you have had! Your explanation is exactly as Bernie Sanders (an Independent Senstor from Vermont) explains the pros of a universal system. It is criminal how the insirance companies govern what can be covered and not covered here in the US. Because I work for the government my cost would likely go up some because I pay very little now, but it would be worth it if everyone had access to care. Thanks again!
Oh, I meant to say though, my LE care has been covered with a copay for office care. My compression garments are limited to 4 pair per year but I pay 20% and since mine are custom, that is pretty spendy.
Indeed, garments are so very expensive, especially made to measure flat-knit garmants which are much more than off the shelf circular-knit. It sounds like you’re health cover is quite good since you work for the government - do you work for state or federal government? I would think there’d be a variance of cover for state employees across all the states.
Sadly, I don’t think a universal system of care will ever be implemented in the US. The majority of politicians oppose it, and for so many decades the politicians have brain washed the public (with outright lies) into thinking it’s a dreadful, failed model in all the countries that have socialised care. That notion is preposterous; but so many Americans believe the lies that they don’t think it’s the solution for America. Therefore the current system is likely to continue in the long term. Obama attempted to implement a version of care but the implementation of it was quite disastrous and couldn’t recover a good reputation after such a problematic start. It wasn’t a perfect model but at least it didn’t leave millions without any health care. It’s a complex issue and very political which is unfortunate
Agreed on all accounts. Our political system is more concerned about the other side NOT winning than about doing what is best for its people. I have hope though. The current system is going to fail for sure. And then what?
I work for county government. And for now insurance is good. But we are seeing federal and state governments doing away with unions and other avenues that protect workers. So I am not sure we will be able to get good coverage forever.
I think it's also worth saying that across the UK access to NHS lymphoedema services is very variable. For example, where I live there are extensive and good services for people with lymphoedema post cancer treatment, but very limited services for anyone (such as me) with lymphoedema from all other causes. Whereas across the whole of Wales, I believe they have comprehensive lymphoedema services for all regardless of the origin. In some areas of England there are no specialist lymphoedema services for people with lymphoedema not caused by cancer treatment.
Despite all that, I really do appreciate and value our NHS system, and will do whatever I can to protect and where possible extend it. I know many people like me who would happily pay higher taxes in order to sustain and improve the NHS. We just lack a government with a mind to go down that route....
Interesting!! I didnt know it varied so much. Thanks for sharing. I too would be willing tonpay more for universal c9verage. However then I would also be unemployed because I run a cancer screening program that helps people with no insirance access care. I am willing tonlook for work though. Lol
Yes, sadly Lymphies in England with Secondary LE due to cancer treatment do seem to receive more robust LE services than for Secondary from other causes and Primary LE. (However I’ve heard it’s also variable to some extent). I have a Global Primary LE diagnosis and am fortunate that my Clinical Commissioning Group/CCG contracts with my local LE Clinic for Primary and all Secondary. The clinic is located in a cancer hospice but I think many LE clinics are. Luckily the lead LE specialist nurse where I go has had training to deal with lower limb LE but she said many nurses have only upper limb training which may account for so many clinics restricting their service to mainly breast cancer related LE. Although other types of cancer treatment can also result in LE so I’m not sure how consistent a service they receive across England.
The CCGs are the real culprit - they determine whether clinics will accept Prmary and all Secondary LE which is why it’s so variable. It’s a post code lottery which isn’t fair. I would think treatment for MS, Parkinson’s and other such diseases are not so variable but I could be wrong
Whilst it can sometimes be easier to get appropriate care if you have a secondary diagnosis most of us have to know enough to make sure that happens as I know you understand too well !
I know far too many BC patients who are told that their LE isn't "too bad so they can self manage " without the appropriate knowledge to do so.
Your group and this forum are vital to us all I would suggest.
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