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PT and the Greater Good

A Huge HMO

Published March 27, 2012 1:04 PM by Dean Metz

I posted last week that the UK has a two-tiered system of care. One receives a basic level of coverage (the NHS) through payroll tax deductions or one can opt for a higher level of service through privately paid insurance. Now, that higher level of service doesn't necessarily mean higher-quality care. It means you may get a semi-private room, shorter waits for elective procedures or more one-on-one experiences, as I described last week. It may be that one sees exactly the same professionals with private insurance as with the NHS, but you won't wait as long to see them. The current cost of this upgrade... about $80/month.

Essentially the NHS functions like a huge HMO with a huge risk pool (the whole UK). This enables lower individual costs and for all people to receive a basic level of care. What also helps keep costs lower are no paperwork to complete, no pre-approval for treatment, no arguing over claims denial, and a reasonably standardized approach to care. One has to choose from a list of GPs within his postcode.

Is it perfect? No, Most definitely not. With each passing day I become a greater supporter of David Cameron and his efforts to overhaul the system. It is top heavy with enough bureaucracy to make the Center for Medicare and Medicaid Services look like the picture of modern efficiency. Some days my frustration levels are through the roof.

Is it a bad approach? I don't think so. Everyone has health care, everyone can choose a reasonable upgrade option, and the UK still has better mortality and life-expectancy rates than the US. I read Janey Goude's post from last week and I am convinced, it is more equitable and compassionate than what is currently available in the US.



Nice overview of the system there. I think that's the most clearly I've ever "heard" it explained. Thanks.

Ironic. The stereotype of the British is stoic, which doesn't seem to fit with it being the more compassionate country. However, with the posts you have made since you've lived there, it would appear in the provision of basic medical care it is.

Jane Goude March 28, 2012 7:34 PM

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About this Blog

    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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