Viewpoint: What's really happening with the U.K.'s health system

March 6, 2009

How is socialized medicine going? Just look to the U.K.'s newspapers.

I checked first with the Telegraph, where I read about a British accountant who, faced with a 39-week wait for cataract surgery through the NHS, chose to have the surgery privately-in Norway. Despite consumer costs in that country that seem high even to visiting Brits (about $14 for a pint of beer), the prices for elective private surgery in Norway pale in comparison to Britain: Cataract surgery on two eyes that costs £4,000 ($5,719) privately in the U.K. costs £2,750 ($3,932) in Norway-and that includes air and travel insurance, and a hotel room for the patient and a companion.

Evidently, there are patients out there who are vocal about what they see wrong with the NHS and are prepared to put their money where their mouth is. There was an article in the Daily Mail about a 23-year-old accountant-what is it with accountants?-who decided to have private cosmetic surgery to shorten her toes so she would look better in today's fashionable "peep-toe" shoes. It will be months before she can walk, so she better hope that style of shoe is still in fashion when she finally is able to slip on her stiletto.

The public showed its ire in a report that general practitioners were being given bonuses for not referring patients to hospitals. It seems, under the scheme, a primary care doctor's practice could earn up to an additional £20,000 ($28,594) above its usual compensation by treating patients who might have previously been sent to specialists.

In the United States, the American Academy of Family Physicians has long maintained that a very high proportion of all problems can be treated by family physicians, but this U.K. concept is something quite different. It's being viewed by patient-support groups as an unethical attempt by bureaucrats to deny services. In County Oxfordshire, incidentally, 80 of 82 GP practices have signed up for this "non-referral" scheme that only began last October.

It's quite a struggle to read the daily news and not feel it's a script for a Monty Python sketch. A woman was admitted to a hospital in Manchester after a fall at home. The 78-year-old fell out of bed in the hospital two months later "because of an insecure [bed]rail." Four days later, an X-ray revealed a neck fracture; she died the next day. The pathologist described the injury as the only recent fracture identified, but later said he'd made a mistake by using the word "recent." The death was then said to be the result of natural causes. The family protested, but the subsequent inquest, five years later, cleared the hospital.

Maybe George Bernard Shaw was right. We really are two countries separated by a common language.

Eric G. Anderson, MD, is a retired family physician in San Diego, California. Send your feedback to meletters@advanstar.com
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