Wednesday, 19 August 2009

Pricey advice

If you had any sneaking suspicion that private health care might be better than the state-run system, the way a worried Times journalist was fleeced should be a wake-up call.

Richard Kerbaj phoned a private doctor because he thought he might have swine flu. The doctor asked if he had any symptoms, pronounced him fit and well, gave him the number for the NHS helpline - and charged him £99.

But suppose he did actually catch swine flu, he asked? Stay in bed, said the doctor, ring the NHS helpline and if necessary they'll provide some medicine.

And the cost if he had got exactly the same advice from his NHS doctor - or from an online source? Precisely nothing.

Despite all the evidence, there's still a general assumption that private care is always superior to public provision, that paying huge sums of your own money guarantees something extra.

But apart from merely being told something you could have been told by the NHS, you're just as likely to experience medical errors. It's simply that they're easier to conceal in private clinics.

If a routine operation leads to a serious complication like cardiac arrest, a private clinic may not have the specialist equipment or staff to deal with it. If they can't get you to an NHS hospital fast, you could die.

Many private surgeons are the same surgeons who work for the NHS, and the chances of their making a mistake are much the same. They're equally likely to be overworked, stressed, tired or simply incompetent.

Yes, you can probably jump a queue for treatment and get an operation in a few days. But if the operation goes wrong, what have you gained?

If I ever have £99 burning a hole in my pocket, it won't be going to Dr Tell-You-The-Bleeding-Obvious, that's for sure.


  1. Dr Nick, you talk a lot of sense!

  2. Dr Grannymar - You'd probably give me better advice than one of these ripoff private medics!

  3. Are you saying that he was charged for an over the phone diagnosis? If so, that's unethical and outrageous. Same here . . private doctors work in the public sector because often that's where the facilities are. The care in each system is the same but the convenience for private patients is definitely better plus you get private hospital access. My only objection is if you're admitted to a public hospital and declare that you have insurance, you're charged through the nose for the same care/facilities as a public patient. Say nothing and it's free!

  4. Baino - He was indeed charged for a phone diagnosis, though he also asked for a personal consultation and it was arranged. Re charging extra for an insured patient - a good way of raking in extra money for the public service!

  5. Amazing that he got charged that for a phone consultation. How unethical. UCLA pediatrics has a doctor on call that you can consult with for free, but if the symptoms seem serious, they recommend that you bring the child into the urgent care, and then you have to pay. Sometimes I think my health insurance must not know about it because if they did, they'd create some sort of charge for it!

  6. Liz - I was reading about the free medical clinic in LA for all those people who can't afford to pay - thousands attended, and lots more had to be turned away. How can people keep defending such an obviously inadequate healthcare system?

  7. This is something that confuses me, why are doctors overworked? Is there a shortage? If so is the shortage due to a lack of enough people interested in being a doctor or excessive requirements to enter the profession? Medecine here requires phenomenal results, the main reason given being that there is competition for the places in the university, if so there is clearly a lot of people wanting to do medecine. Is there then a limit in the number being educated due to lack of teaching resources? Or is it a deliberate choke point to maintain the limited numbers and control competition in the marketplace?

  8. Thrifty - I think the overwork is due to several things - not enough doctors being trained, doctors working well over the EU norm of 48 hours a week, doctors doing both private and public work, and constantly increasing patient numbers and demands.

  9. Hi Nick! I'm supposed to be working, but had to comment as it's so interesting--

    My family, through Sarge's job, has some of the best health insurance available, and it is still quite awful to deal with. We have a choice between private doctors who are partially covered (but they are hideously expensive and it takes forever to be reimbursed), and the crowded clinics that are fully covered, so I have experienced and continue to make use of both. In my experience, the private doctors are the better bet, only in terms of one's feeling of well-being--they know me, it's not so dehumanizing, and they don't seem to have the low morale that comes to doctors who are enmeshed in the bureaucracy and overburdened caseload. However, even with health insurance, it is just too damned expensive, and I end up resenting them terribly for billing us at a rate we can ill afford!

    On the other hand, the clinic I go to is dreadful--hours waiting time, a different doctor each time, who doesn't know me, a cursory exam and often I feel short-changed. However, it's "free" and I have never actually had poor care when all is said and done. It's just that it's a miserable, anonymous visit that feels like I'm being run through a mill. People who work a day job end up missing a whole day's work and pay just for a routine doctor's visit--I always hear them complaining about it in the waiting room.

    I'm beginning to think the problem at bottom that needs to be addressed is--why is health care (not insurance, but the actual care) so expensive in America? Case in point is the birth of my daughter 8 years ago. It was a routine pregnancy and labor and delivery, no C-section, hardly even a doctor in attendance till the last 15 minutes of actual delivery, 2 nights in hospital--the bill: nearly 15,000 dollars. It was covered by our insurance, but WTF? That means that the hospital is getting the money from somewhere, and why should routine procedures cost so much?

    So whether it's clinic care, or private care, the ultimate cost to someone is just too high--ludicrously high!

    I hope Obama will address the root cause of the fucked-upness of the system. I think, from what he's said, that he does realize what the problem is.

    and p.s. I seem incapable of leaving less than a full essay here in your comment section!

  10. Leah - I think there's less of a distinction between private and public care here because so many people use the NHS and they all demand high standards. My local health centre is very attractive and welcoming.

    I imagine the medical costs you mention are realistic in terms of specialist staff, time taken, high-tech equipment etc, but not many people can afford the full cost out of their own pocket.

    But as I said to Brighid, just a tiny fraction of the colossal US military budget would enable every citizen to have full health care coverage for free. So what's more important, nuclear missiles or a healthy population?

  11. Well, here's a story for you. :)

    Last time I moved, a shelf fell out of a bookcase and onto my foot, doing unspeakable things to my big toe.

    Had to go to the emergency room as it was bleeding copiously, and it was quite late on a Sunday so the clinic was closed.

    I was seen by: the admitting clerk who took my insurance info, the gal who took my temperature, the gal who had me sign extra release forms, the Nurse Practitioner who decided what to do, the doctor who did a brief look-in and agreed with the NP's diagnosis, the girl who made me sign more forms because they were going to have to give me a shot, the guy who gave me the shot, the NP again who fixed the toe, the doctor who looked in briefly to confirm it was done right, the nurse who gave me extra wrappings, the doctor who stepped in again to write me a prescription for pain medicine, and the desk clerk who checked me out.

    Total bill to the insurance company - over $3,000. Total time spent at the hospital - about three hours. Total time anyone actually spent working on my broken toe - about ten minutes...

    Bwahaha my word verif: proffit

  12. Megan - Well, if that's typical, no wonder US health care is so expensive and clearly there's huge scope for cost-cutting. There'd be nothing like that rigmarole in the NHS. It might take just as long but you wouldn't have so many people involved and so much form-filling.

    I bet you're ultra careful with bookshelves nowadays!

  13. We do not have NHS here. What we have are some GPs with hearts of gold and a whole lot of specialists sans hearts. I am fortunate to have two great specialists in my life who have been extremely good to my family. The cardiologist who looked after my wife and my Orthopedic Surgeon who revised my replaced hip joints. I have blogged about all three immediately after my wife passed away.

  14. Ramana - It's good that you have specialists who give you such excellent care and attention. Most NHS consultants are first-rate but some are less impressive.