The Balance Between Private and Welfare Medicine

The British National Health Service (NHS) has long been cited as an example of a system that is broken and a system that works and the viewpoint often depended on the the individual making it and their personal beliefs

Those that have experienced it find it hard to complain too much and like Social Security in the United States it is considered the “third rail” in politics. Don’t mess with it! For the British public it is an essential component of life and while it has failings and difficulties for the most part it delivers excellent care to the the British population. Coming form that circumstance to the United States was a severe shock to the system and the wallet and loosing what certainly feels like a fail safe coverage option is very difficult to swallow as you struggle to provide for yourself and your family.

So this article form the NY Times in February this year (Paying Patients Test British Health Care System) that covered the issue that has been for the most part glossed over for many years the “hopscotching between the two systems – private and public. If you have money you can pay for portions of care that might otherwise not be covered by the NHS. In the case detailed Debbie Hirst’s was ready to sell her house to pay for treatment with Avastin (Bevacizumab) a recent monoclonal antibody treatment with a very high associated cost – $120,000!!! But even though she is willing to make those personal sacrifices:

Officials said that allowing Mrs. Hirst and others like her to pay for
extra drugs to supplement government care would violate the philosophy
of the health service by giving richer patients an unfair advantage
over poorer ones.

Unfortunately for Mrs Hirst she is the straw that broke the back or the focal point for the issue that has been present in the system for many years. IN fact there is a whole insurance industry that supplements NHS  treatment with private offerings that essentially allow line/queue jumping and access to treatments or choices that would not ordinarily be allowed.

Is it just me or does this seem entirely wrong – there is an existign system that provides a catch all, it fails in some circumstances often due to overwhelming needs and insufficient resources. The things that end up missing or delayed are elective non-urgent care and very high cost care. Those that can afford off load the burden from the already stretched system, access the care and everyone wins. No doubt there is resistance because some of the problems associated with inappropriate care or poor choices end up back in the NHS system (ie the NHS ends up paying and treating others mistakes). While that’s true it is an inevitable part of any system that offers choice.

I’d bet dollars to donuts that if the patient had been Alan Johnson’s (The Health Secretary in the current UK government) wife, parent, daughter or <insert close family relative> the result and reaction would be different.

Meanwhile the “good news” is that Mrs Hirst’s condition deteriorated and now she is eligible as a last resort for Avastin (not a cure but to extend her life) but as she says

“It may be too bloody late”

My sympathy goes out to her and her family – all this is difficult no matter how you deal with it but with all things balance and reasonable behavior should prevail. Do I wish al patients who coudl benefit it coudl receive it sure. If that’s nto possible those that can should be able to access the care/treatment.

In my mind the more fundamental issue and concern is how ANY drug can have a cost so high – we understand the high costs of developing drugs and much of this is regulation and supposed protection but the prices and difference in prices charged is not part of that reasonable behavior. Fix that problem and we might have a better chance of fixing some of these problems