The National Health Service - Referat
The National Health Service – as good as it was intended to be?
Today we are going to talk about The National Health Service and if it is as good as it was intended to be.
Before going into detail I wanted to explain to you why I chose this topic.
I thought it was and still is an interesting topic that I realized I didn't had much knowledge about. Nowadays there are constantly discussions about health care policies in different countries so I found it interesting to get to know more about the health care System in Great Britain.
• Basic Facts
• Beveridge Report
• What is universal health care?
• Government involvement
• National Health Service (NHS)
• Financing NHS
• The NHS crisis
• The NHS crisis and Brexit
• The German health system
• The American health system
• Which one is the best?
In 2015 65.64 Million people lived in the UK. The same year, 9.9 % of their GDP was spent on health care, which were about £179 Billion. This leads to a health expenditure per capita of £3030.
The British health care system was presented to the Parliament in November 1942 by Sir William Beveridge who provided the foundation of the modern Welfare State. He was inspired when working in slums during his community service to improve the social situation of all people in the UK.
In his idea the health care system should be public and tax-financed, so everybody would have access to it.
But what is universal health care?
So universal health care basically means that health care should be equal and free for all. It should be paid by the government as well as managed and regulated by the government. The costs should be covered though taxes paid by the inhabitants.
Next, talking about the government involvement, the health care legislation is governed by the Parliament, more specifically by the Department of Health and the Secretary of State for Health and Social Care, who at the moment is Jeremy Hunt.
The government pays and provides for all services and fees and also regulates the doctor’s salary.
The National Health Service
Or short called NHS, is the provider for health services in the UK and was launched on 5th July 1948.
It consist of four independent organizations:
• The NHS England
• The NHS Wales
• The NHS Scotland
• HSC Northern Ireland
The NHS is based on three core principles:
• That it meets the needs of everyone
• That it is free at the point of delivery
o So when people go into hospital or to any doctor, they do not have to pay anything.
• And that it is based on clinical need and not the ability to pay
The NHS is actually the biggest employer in the UK with more than 1.5 Million employees. It also deals with over 1 Million patients every 36 hours.
It remains free with the exception of prescriptions, although children and students till 19 years, as well as people with chronical disorders do not have to pay anything. When you need to pay for a prescription, you usually pay about £7 to £11.
Sometimes you have to pay a part of optical and dental services just like in Germany.
The NHS organization
The NHS is organized over three tracts.
• Primary Care
o Where mandatory general practitioners, also called GPs, are used for basic services and referrals. The GPs are chosen depending on where you live. If you have problem with your GP you could always get another one though. Before going to any other doctor you need to get the approval or your GP. That is why they are mandatory.
• Secondary Care
o Includes hospital and community care
• Tertiary Care
o Includes highly specialized treatments such as transplants or chemotherapy.
The NHS is mostly financed through general taxation with 78%. 18% are paid through national insurance and only 6% of the NHS are financed through co-payments like prescriptions, optical and dental services and other contributions.
The NHS crisis
Now we are going to talk about the more critical parts of the NHS. So if you have heard about the NHS for the first time today, you should know that the NHS has quite a negative reputation in the EU as well as in the USA. On 5th February 2018 Donald Trump actually tweeted that he thinks the NHS would be “broken and not working”.
Since about four years the situation of the NHS, especially the situation of their hospitals, gets more and more difficult. Not only are there long waits, there is also a lack of beds as well as a lack of doctors, nurses and paramedics. There are only 2.8 doctors for 1000 citizens, so the NHS is drastically understaffed and has not enough room for all of their patients.
This year’s winter (Winter 2017/2018) has been especially bad for the NHS. A lot more people are going to hospitals because of flu symptoms. Hospitals had to shift important operations and a lot of people were waiting for several hours in the emergency rooms at the hospitals. There have been a lot of protests, that blame Theresa May and Jeremy Hunt for the bad situation, since it seems like they are not changing anything about it.
To visualize the tense situation I will show you a short video.
The NHS crisis and Brexit
As you could see in the video there is not enough room for people and this has been a problem for almost four years now.
Possible reasons are the budged cutback by £15.9 Billion since 2010. Without that money the hospitals are unable to expand. The leave campaign for Brexit actually used the NHS crisis to get more votes and were advertising with busses saying “We send the EU £350 million a week. Let’s fund our NHS instead. Vote leave”, which turned out to be wrong of course. But that tricked a lot of people into voting to leave, hoping they would get more money for the NHS.
Brexit advocates put the blame on the three million EU-citizens that work in the UK to be the reason for the NHS crisis. But the reality is that ¼ of all doctors in the UK are from EU countries as well as on out of six nurses.
Since Brexit the registration of nurses from EU-countries has fallen by 90%, so 40,000 jobs are already unstaffed.
Experts say that Brexit might have been the end of the NHS.
UK in comparison with Germany and the USA
After talking about the British health care system we are going to talk about the German and the American health care system.
The German health system
The German health system is based on the “Bismarck-model” which includes statutory health insurance as well as private insurance. People can choose their insurance company which creates a competition between the different insurance companies. These insurance companies are financed by regular dues which depend on how much you earn.
2016 Germany spent 11.3% of their GDP on health care which are about €356.5 Billion, so they spent only 1.4% more than the UK despite their larger number of inhabitants.
The American health system
In America the health insurance is employer-based which means that if you are unemployed you are most likely to be uninsured, as well as when your employer simply does not insure his employees. That leads to 40 – 50 Million people being completely uninsured in the US.
If you belong to the middle to upper middle class, you are more likely to be insured by a private health insurance, which are pretty expensive.
These private health insurance companies though can refuse “high-risk” and elderly patients, which means that if you have an illness which would need a lot of treatments you could be rejected by the insurance companies.
The USA actually spent 18.57% of their GDP on health care which are about $345.8 Billion. This makes it the most expensive system in the world.
So now, after seeing these three different health care systems, I would like to ask you which one you liked the best.
My own conclusion
So coming back to my original question if the NHS is as good as it was intended to be. I think before the crisis, the British health care system has some really good points and is a good example of socialism. It is really great that it is free at the point of delivery, so you don’t have to worry about any extra, hidden costs, especially, if you are in a hospital or in community care. Also it has been ranked the most-efficient system a lot of times.
But that was before their budget shortcut. And since that reason, it didn’t go well for the NHS. Extremely long waits, understaffing and lack of room are the results.
Adding the Brexit with the possibility that all EU-citizen-workers could leave, I don’t think it is looking good for the NHS, but I think we will have to wait a bit to see the full development of the crisis.
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