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A slippery slope for health?

Mark Mardell | 07:06 UK time, Wednesday, 12 December 2007

Left-wing Labour MPs are girding themselves for a rebellion over a European Union plan which they say could spell the end of the National Health Service.

NHS logo

The European Commission will publish its health directive next week and it is meant to make it easier for people to travel to get specific medical treatment in another EU country.

British diplomats say this is NOT the same as making sure that if you fall sick in Slovakia or have an accident in Austria you can get treatment straight away.

It is what some people call "health tourism” and both critics and fans say it will allow people to shop around for health care.

The British Government is at pains to stress its going to be pretty limited in its impact. No wonder.

But the Compass group is claiming that it would mean that patients could pay for private medicine in one country and claim the money back in Britain, and that could eventually destroy the NHS.

They've got 33 MPs to sign a motion condemning the plan which they say could be the beginning of the end for the NHS.

The former health secretary, Frank Dobson, says it will be "catastrophic" for the NHS if this directive goes through.

Frank Dobson"The Commission either has no idea what damage this will cause to our NHS, or they simply don't care," he says.

"It will allow the rich to 'top up' NHS costs to get better treatment. MPs and trade unions will do all they can to avoid this Brussels directive becoming law here."

“Nonsense,” says Labour’s health spokesperson in the European Parliament.

“If it was like that we’d chuck it out,” Linda McAvan told me.

She says that the aim is not to promote people moving around seeking health care, but to clear up the current situation, where people get treatment, then have to go to the European courts to force their country to cough up for the cost.

“We need to have a law," she says. "At the moment it ends up in the courts. Nobody knows their rights.”

Both Linda McAvan and British diplomats stress that your local national health trust would have to approve both the treatment and its cost before you go abroad. And the decision has to be taken on medical grounds.

This story is interesting for another reason : just how will it be portrayed ? 
At one time I would have bet it would have been seen in certain newspapers as a threat that the Good Old NHS could be overwhelmed by a horde of sick foreigners.

Now its more likely to be "a savage indictment" (F8 on any good hack's keyboard) of the state of the NHS.

That aside, are the left wing MPs right that it’s the top of a slippery slope? Do you believe the reassurances? Or, for that matter, what on earth is wrong with health tourism?

Do tell me.

Comments   Post your comment

  • 1.
  • At 08:04 AM on 12 Dec 2007,
  • Reuven wrote:

Instead of worrying about people running away from the UK to get better treatment, and thus bringing about the end of the NHS, why don't they fix up the NHS and attract the health tourists to the UK.

As an American, I look at the NHS with the saying 'you get what you pay for'. Its no wonder that in its current state they are worried about people running away to seek better treatment.

  • 2.
  • At 08:58 AM on 12 Dec 2007,
  • JerryEdgar wrote:

Most European countries operate an insurance-based health care scheme. Citizens are obliged to pay into state-operated or state-recognised insurance funds. Hospitals and general practitioners (and specialists who offer primary consultations) claim back all or part of the costs of treatment from the relevant insurance providers.

There have long been difficulties in citizens getting costs covered by their state-recognised schemes when they seek treatment in a neighbouring country whose facilities are more convenient to travel to (e.g. the German-Dutch border area around Aachen).

Regulation 1408/71 was supposed to deal with this but clearly doesn't. That Regulation, insofar as it covers healthcare, is designed essentially to allow the government of one country to get back from other governments the money spent on treating their citizens. So the UK government, for example, pays money to the French and Spanish governments for treatment given to British tourists and ex-pats in France and Spain.

Article 152 expressly forbids EU harmonisation of member states' health care systems. I don't see this proposed directive as a threat to the way the NHS is operated. Regulation 1408/71 would still have full effect. That already allows for citizens from one country to be referred to facilities in another on grounds of clinical need.

  • 3.
  • At 09:05 AM on 12 Dec 2007,
  • Malcolm Franke wrote:

I would be interested in more reporting on this subject. I have been very surprised that there is very little coverage of problems expats are experiencing in France with French state medical care being withdrawn, surely a matter of great concern to those of us planning to move to France or already living there. However, apart from one website there has been no coverage in the media.

  • 4.
  • At 10:15 AM on 12 Dec 2007,
  • Martin Richards wrote:

Coming to Britain for "health tourism" would be like going to Basra for a relaxing holiday.

  • 5.
  • At 10:20 AM on 12 Dec 2007,
  • Max Sceptic wrote:

Hmmmm, tough choice. Go abroad and get good medical care, or stay at home and risk MRSA. I guess we could convert our most infected hospitals to stealth 'euthanasia' clinics. Get rid of all those tiresome old folk who don't contribute anymore...

British healthcare (like British education) has suffered from the tender administrations of New Labour. Billions upon billions wasted on poorly devised and (over)managed systems. It may once, in the 1940s, been the crowning glory of British society, but since then it has grown into a bloated, moribund and over-complicated bureaucracy that is more concerned with 'securing resources', 'engaging with stakeholders' and 'achieving targets' than with what best suits and benefits us patients (aka taxpayers) who pay, and pay, and pay again for the whole rotten edifice.

Thanks Mark. If the EU will indeed spell the "beginning of the end for the NHS" then, on this occasion, three cheers for the EU.

  • 6.
  • At 10:47 AM on 12 Dec 2007,
  • Bedd Gelert wrote:

These may well be the same 'reassurances' that only a few people from the EU Accession countries would turn up here looking for work, oh, and the benefits of living in a country with an NHS...

  • 7.
  • At 12:56 PM on 12 Dec 2007,
  • Adam wrote:

"It will allow the rich to top up NHS costs to get better treatment" says Frank Dobson. First time I've heard Mr Dobson admit that treatment abroad is better than what the NHS provides in Britain! Pretty soon he'll be agreeing that we should organise our health services more like they do...

  • 8.
  • At 01:30 PM on 12 Dec 2007,
  • JulianR wrote:

Surely, the whole point of the EU is that it should be possible for citizens of any EU member state to travel to or even live in any member state as if it was one's own home. An essential part of that is the right to be able to access health care without the need for expensive insurances - and indeed to be able to access treatments that may be denied in one's own home state.

Anything that the EU can do to facilitate this should surely be welcomed by everyone.

  • 9.
  • At 01:47 PM on 12 Dec 2007,
  • Lukas wrote:

According to general knowledge, the NHS is one of the worst systems of its kind in Europe. Thus it makes sense that people go somewhere else. This would also take pressure of the NHS and they can even do more with the money they get.

  • 10.
  • At 01:56 PM on 12 Dec 2007,
  • John wrote:

A few years ago when travelling in Vietnam I met two locals – a brother & sister in their 20’s. The guy worked for a major French motor manufacturer that had sponsored the 1998 World Cup and he had been based in Paris at that time with access to tickets. His sister visited him during the tournament, saw some games, and had some laser eye surgery performed during her trip. Unfortunately they operated on the wrong eye. Unable to read from either eye she later had to abandon her university course in Saigon. The French doctor offered her $100 compensation. This is of course just one anecdotal story of what can happen with international health tourism, but it is obvious that more can go wrong when there are language barriers and that it will be harder to put right afterwards.

In practice what people want is local healthcare; Local doctors that speak their language who can establish a long-term understanding of their condition; Hospitals close enough to home that friends and relatives can visit. This is why people complain about a lack of local NHS dentists or whenever a local hospital or medial facility is threatened with closure. This move by the EU Commission does not therefore address any true problem. Once again we see that real-world problem-solving is a distant secondary concern, even an accidental by-product, for the EU Commission whose primary goal when formulating policy is always the transfer of more powers to itself.

Supra-national organisations should not be able to mandate spending programs onto their member states because this removes a basic decision over how tax revenues are spent from the democratic arena. Without the strong solidarities of an pan-European ‘demos’ (or people), taxpayers will not stomach the closure of local hospitals while being told that their taxes are required - by a force of supranational law that their votes cannot touch – to be spent on subsidising the healthcare of peoples in other countries.

Since there is no ‘demos’ at supranational level one must always make a fundamental distinction between supranational law that removes harmful restrictive barriers between countries (which is a win-win situation for all parties and therefore relatively uncontroversial) and supra-national spending programs which are a zero-sum redistribution of money in which each country will always support whatever policy results in it benefiting from the most financially. It is no accident that when the EU addresses the former (e.g. common market) it is popular, and that all of its most unpopular policies (CAP, etc.) fall into the second category. The weakness of pan-European solidarity is such that the EU’s agricultural spending program (which consumes ~0.4% of GDP) is widely regarded as illegitimate. It is inconceivable that the EU Commission play any role in the ‘big ticket’ spending areas of healthcare or social security that consume the bulk of 40+% of GDP raised by taxation. These areas must always be determined by democratic politics which can only ever exist within the context of the nation-state.

  • 11.
  • At 02:04 PM on 12 Dec 2007,
  • Oliver wrote:

Once upon a time it was "bloody foreigners taking British healthcare". How times have changed! Now it's "bloody Brits, taking foreigners' healthcare"! The EU is parliamentary itching powder; blow it into a piece of legislation and someone will object. From what I know of the proposal it seems quite reasonable, and could be quite good at matching spare capacity in one country with shortages in others.
Mark, what was the position of the MPs objecting to this proposal, when the government (and the opposition) were talking about putting more choice in the NHS?

  • 12.
  • At 02:06 PM on 12 Dec 2007,
  • Euromac, Brussels wrote:

Patient Mobility is a real hot potato.

It can be argued – with some justification – that this is a route by which the European Commission can get power over an area where they have limited influence, namely national healthcare expenditure. Now, how the Member States set and spends their budgets is up to them. However, this does mean that countries can and do use rationing of services through waiting lists, etc., to restrict expenditure. For obvious reasons, most Member States want to keep hold of this power

However, with patients allowed to travel for treatment, governments will lose the ability control of their healthcare costs through waiting lists and the like. As your blog says, it is not clear who will pay for what.

The consequence of such a lack of control and lack of clarity would be a cry to centralise standards of healthcare provision, which would put the Commission at the forefront. Proponents of the scheme say this is not the case, but it is obvious that where treatment is restricted in one place and available in another, there will be an inevitable follow, and the rationing of access will no longer be effective.

Whether this is a bad thing or not is another debate, but be under no illusion of the changes it will bring. The implications for where these healthcare services will be centred – to match supply and demand – are anyone’s guess. However as we use more services as we get older, look to the Med, where people retire to, to become centres for conditions such as heart bypass, hip replacements and so forth. Talent and resources will concentrate there, drawing it away from other countries

In addition, of course, once you have central coordination for healthcare, you will need similar controls for social services, pensions, etc. Basically, this will become a European competency by default. Whether you think this is a bad thing is up to the individual, as someone who has lived outside the UK and seen a better healthcare system in operation, it worries me not a jot. However, do not believe governments who say, “it’s going to be pretty limited in its impact.” If they believe it, they are fools, if they tell citizens that, they take them for fools.

  • 13.
  • At 02:11 PM on 12 Dec 2007,
  • Margaret James wrote:

I for one would be more than happy for the EU to bring in changes, as stated in your article. In fact, the one thing guaranteed to make me positively a europhile would be moving to a continental health system as practiced in Germany, Holland and France. Time people, political parties of all persuasions got their heads out of the sand over the NHS, a leftover of Stalinist proportions. No one from the developed world would suggest imposing a NHS style service on their populations because of the rationing of health care that comes with it. Social insurance is the only way forward to ensure a decent health care system, one thats see operations carried out within 4 week, not the 18 weeks the government keeps banging on about, let alone access to various drugs readily available in Europe but not here, unless you pay privately or have private medical insurance.

  • 14.
  • At 03:03 PM on 12 Dec 2007,
  • A Dilbert wrote:

Over the years I seem to have drifted towards the Eurosceptic side but anything that would challenge the bloated ediface that the NHS has become would be welcome. I think the NHS is a socilist totem, 'equality of treatment for all', which is something most people would agree with in principle. However, it is now apparent this can only be achieved by degrading the service for everyone. If the ultimate judge of the quality of a system is the number of people it saves, then there is evidence to suggest that the US is doing a better job. Former New York Mayor Guliani pointed out that the chance of surviving prostate cancer is 50% in the UK but 80% in the US. I suppose if you are too poor to afford health insurance then being in the UK at least gives you some hope but the fact remains that 30% more people die to achieve this equality.
An emotive issue which has more to it than straight forward survival rates (although most NHS enthusiasts won't be campaigning under 'we save fewer people but it's fairer' banner).

  • 15.
  • At 03:25 PM on 12 Dec 2007,
  • CHRIS WOOD wrote:

the evil EU strikes again ...one more step to a superstate

  • 16.
  • At 04:52 PM on 12 Dec 2007,
  • brian wrote:

The NHS has become a bloated monster where patients get passed around so that staff can tick boxes. Nobody does anything but everybody wants paid. Efficiency must be in single figures. NHS hospitals are fithly and riddled with MRSA, yet BUPA seems to have no MRSA or C-difficile problem. Why not? Could it be that they don't tolerate the lax NHS approach to hygiene?

The NHS needs to get back to its original aim of being the "catch-all" medical service. Watch how all the time-servers and bureaucrats will sit up and look busy if the EU looks like it will turn off the gravy and empty the trough. Expect to hear screams of anguish, but not from the patients....

  • 17.
  • At 05:36 PM on 12 Dec 2007,
  • gwenhwyfaer wrote:

Max Sceptic said:
"Go abroad and get good medical care, or stay at home and risk MRSA. I guess we could convert our most infected hospitals to stealth 'euthanasia' clinics."

Soylent Green is sick people!

  • 18.
  • At 07:24 PM on 12 Dec 2007,
  • Euromac, Brussels wrote:

A Dilbert is right; the NHS is a socialist totem

I heard Lord Darzi roll out the old chestnut that "The NHS is the envy of the world" on the 'Today' programme a few weeks ago. At least John H had the wherewithal to challenge him on this. I wish more people would

It's not the the envy of the world, has not been for years and will never be again. This is because one size does not fit all, and the NHS is built on a chassis of providing the kind of public health which was required 40-50 years ago.

Our needs, and what healthcare can offer, has moved on. Diseases are more diverse, much of what the NHS used to provide in the way of prevention is either no longer required or provided elsewhere.

Until people accept the obvious - that the NHS model is outdated, ill-fitted to modern needs and a highly inefficient way to spend money, it is doomed to failure. It is the equivalent of trying to build a new, improved steam engine when hybrid powertrains are already with us.

  • 19.
  • At 08:20 PM on 12 Dec 2007,
  • JulianR wrote:

Surely, the whole point of the EU is that it should be possible for citizens of any EU member state to travel to or even live in any member state as if it was one's own home. An essential part of that is the right to be able to access health care without the need for expensive insurances - and indeed to be able to access treatments that may be denied in one's own home state.

Anything that the EU can do to facilitate this should surely be welcomed by everyone.

  • 20.
  • At 11:28 PM on 12 Dec 2007,
  • Björn wrote:

It seems to me that there's no apparent problem:
High wage countries (often with even unproportionally higher medical costs) will see falling medical costs because of health tourism: Sick people get treated cheaper abroad, the health insurances or national health programs save a bit of money. Not much, at any rate, as sick people often don't enjoy traveling, and like to have expensive operations done by doctors expert enough to practice in a place of a high and expensive standard of living.

The little money that is saved feeds a lower bidder, raising the standard of living there. Its effect will be like a bit of a structural fonds, or rather, of a free trade area. Something we really need more of anyways, if we want to make Europe work as a Union. The only trouble is that free markets are often used by our leaders to tailor (often well hidden) trade barriers to their (our?) taste. In the case at hand, a politician might decide that losing a nurse's job in their country might be worse publicity than the concurrent effects of creating a nurse's job in another EU country plus lowering health care expenses for all of the politician's constituents.

Such thinking, by the way, has allowed us to have, by world market standards, incredibly expensive food as well as starving farmers in the third world. Ah yes, and a few more votes from farmers. For which party, I ask? And why don't all the food consumers vote for a different party?

I have a suspicion that most problematic issues with health care systems are symptoms of a fundamental problem that I have never found discussed:

If producers of medical drugs have legal monopolies (through intellectual property protection), and morality as well as design of many European health care systems (definitely those of UK and Germany) guarantee enabling everybody to purchase such drugs at no or very low additional personal expense, then the producer's profit maximizing will lead to prices raising without bound. Or, in practice, they of course raise only to the point where the health system's cost becomes such a burden on the people that the immoral consideration of limiting benefits (or setting health insurance costs higher than at least some people's incomes, America's approach) becomes unavoidable.

Why doesn't anyone think of a simple rule such as allowing health insurances to pay only for products free of IP royalties? Companies could recover their development costs for new drugs on a market that can freely decide what their products are really worth, and everyone is guaranteed the very best drugs known by 1967, good enough to heal most diseases. Plus, there is really no reason to have IP protection for the eternity that is 50 years!

Sure, the true cost problem seems to be in health service, not the medication, but I have a vague feeling that with regards to other health care costs, there's a similar, if more subtle, effect at work that equally inflates prices.

Björn,
Germany

To Bedd Gelert: Are you referring, perhaps, to the influx (tidal wave?) of Poles to the UK? Well, it may surprise you to find out that Poland has a national health care system.

In fact, many of our doctors and especially dentists have moved to the UK in order to make a living wage so, don't worry, it's just as bad (if not worse) here in Poland than it is in the UK. Of course, for Poles that qualify for NHS and happen to end up with a Polish doctor ...it's the best of both worlds!

Meanwhile I would be all to happy to be able to shop around for major health care purchases. I'd trust the Dutch or Germans over the average hideously underpaid and overworked Polish surgeon any day.

  • 22.
  • At 04:54 AM on 13 Dec 2007,
  • MJB wrote:

In many areas of the UK they are worried if their nearest hospital is going to be scaled down or even closed! With 'super hospitals' built to cover a larger area.
One letter suggests we may have certain opperations being done in Southern Spain if the EU has its way! They may say this will not happen but we all know honesty is not their strong point.If that did happen dont expect too many vistors over your stay.
I know the NHS is not performing but we can fix it.Look at the well run hospitals all over the world and they are not state run.The NHS has passed its sell by date and we should repair it ourselves.

  • 23.
  • At 09:21 AM on 13 Dec 2007,
  • Norbert wrote:

Apart from adding a lot of burdensome bureaucracy for the Member State, this
directive will more or less only codify the jurisprudence of the European Court of Justice in the health services sector. EU citizens already have the right to compensation from their insurances for services (stationary or ambulant) carried out in another Member State. What is new to the directive is that the national insurance may no longer refuse to approve the treatment abroad if the patient proves that treatment is "appropriate" to the patient's health state, which can be the case, in particular, if treatment can be received quicker abroad. In these cases even the travel cost must be compensated.

Health service tourism is in principle positive insofar as it provides for better health care for patients, but it can become a problem for those countries with an allegedly more advanced health system as they will have to shoulder a higher burden when they are stormed by patients from neighbouring countries with less advanced healthcare. And this will inevidently lead to problems with the transborder clearance. This is the case with Austria, for example, which currently has 15 million Euros receivables against the Italian state's health care system for services provided to Italian health tourists. Recently I read a story on Polish mothers who went to a German clinic over the border to give birth and the Polish healthcare system refuses to pay the German health insurance because they only have to pay in case of urgencies.

By the way, it is interesting to note that this new directive faces opposition from the UK, of all Member States. Health services were initially included in the services directive that was so championed by the liberal UK, and it was only taken out from the directive because of the European Parliament's refusal.

  • 24.
  • At 10:10 AM on 13 Dec 2007,
  • David wrote:

Comment #1 is spot on:

You get what you pay for, and even after Labour's spending increases (essential, long overdue and repairing the damage from decades of neglect) the UK spends less per head on health than any other major developed nation.

People just have to learn to cough up for better health care instead of swallowing all the 'low tax' wishful thinking that is banded around by people who are all on Bupa anyway...

  • 25.
  • At 11:07 AM on 13 Dec 2007,
  • Tony Wicks wrote:

When can we get rid of the unelected europeans running Britain - overriding British laws etc.

OR

Perhaps we should get rid of Westminster and the whole Legal system as it just seems an extra layer of cost which cannot contribute much and let the rest of europe decide what we should do1

  • 26.
  • At 05:29 PM on 13 Dec 2007,
  • Tom Cahill wrote:

What's wrong with health tourism? Really simple actually. The well-off can afford it, the poor cannot. Then again, maybe the health of the poorer people in society is no longer a concern in Britain. You have the money you get the product. If you don't have the money, you don't. Simple really. But maybe some Brits don't see what is "wrong" with that.

  • 27.
  • At 08:02 AM on 14 Dec 2007,
  • Peter wrote:

The NHS is totally past its sell by date, a stalinist organisation run by self interested people. Patients come last every time. A&E overloaded - they close it to ''manage demand'' even if that means 90 miles to get x-rayed. Dentistry is mostly privatised and works. Give everyone cash vouchers(its OUR Tax money)to take their treatment where they want, anywhere in europe - It won't be at Guildford Royal Surrey for sure.

  • 28.
  • At 08:59 AM on 14 Dec 2007,
  • Philip Edwards wrote:

Tony Wicks wrote: When can we get rid of the unelected europeans running Britain - overriding British laws etc.

Sorry to shatter your Eurosceptic dreams but ALL the major decisions in Europe are taken by the Council of Ministers at which the UK is represented by its elected politicians. They enjoy the same voting rights as representatives from France and Germany. The European Commission then acts on what the Council has decided and comes up with a draft text which passes through the European Parliament, again with elected UK representatives, and then to the Council of Ministers again.

The number of civil servants working for the Commission (to whom I assume you are directing your comment about "unelected europeans") is actually less than the total number of (equally unelected) civil servants employed by Manchester City Council.

  • 29.
  • At 06:55 PM on 14 Dec 2007,
  • Marcel wrote:

@ Philip Edwards

Sorry to shatter your EU-phile dreams of having an unelected elite rule by decree, but the EU isn't democratic by any definition. No national politician ever asked for or received a mandate to permanently transfer legislative powers to Brussels. Therefore all and any power transfers to Brussels are by definition illegal.

Every country should have 100% control of its own legislation.

And why did you forget to count the millions of bureaucrats who work for the member states on paper but working on EU directives and regulations for real. Those should also be counted. Like a cancer spreads if not stopped, EU control has also spread, deep into national affairs and departments.

  • 30.
  • At 05:22 PM on 16 Dec 2007,
  • Brendan Young wrote:

People in Britain may regard the NHS as bad, but they don't come to Ireland for treatment! In Ireland we have a two-tier healthcare system: those who have private health insurance get relatively prompt treatment - often in public hospitals through the space reserved for treatment of private patients as part of the private practice of the same consultants who work in the public hospitals; and the public patients, who can't afford private insurance - including those who have medical cards entitleing them to free treatment (you have to have a weekly income of less than 200 euro to qualify) who go on the waiting lists. We recently witnessed the tragic death of a woman waiting seven months for cancer diagnosis - who while in a public hospital met another cancer patient who had waited only seven days for the same treatment. The reason for the difference was that the second patient had medical insurance. As Dr. John Barton of the Health Services Action Group has explained, private health insurance and medical cards for the poor lead to the emergence of waiting lists - because the fees from insured patients are an incentive for doctors and hospitals to prioritise insured patients. People without insurance who are waiting for more than three months can apply for treatment under the National Treatment Purchase Fund - see ntpf.ie This fund pays for people to go to British private hospitals for treatment. It also pays for people to to to Irish private hospitals for treatment. This is of benefit to some patients, but as others have mentioned, is not a good long-term solution. I'm reasonably sure it is not suitable for ongoing treatment such as that for cancer. It also acts as a state support for private healthcare, which contributes to the ongoing two-tier system. So those who are worried about the potential 'Europeanisation' of the Irish NTPF have good reason to be: it will accelerate the fragmentation of universally accessible health services and promote privatised healthcare. PS: it now costs 60 euro to go to an A&E in an Irish hospital; and the charge for a GP visit is 50 to 60 euro, including for children. So hang on to the NHS, bad and all as it is.

  • 31.
  • At 08:07 PM on 16 Dec 2007,
  • evangelia holliday wrote:

It is a blessing to be able to travel to any world class centre of expertise if you are a patient with a rare disease.(Not if you are a patient with something "not rare",this is best sorted out locally. If Great Britain/NHS does not have such expertise in the "rare disease", it is absolutely necessary to have access to such medical and paramedical expertise. That is the blessing of such proposals.
And let us be sensible.The NHS of the UK is superb. Only outsiders seem to realise it, not UK inhabitants. Permit me to comment, as a person who worked in the UK NHS for 14 years prior to working in another two "old EU" NHS systems. I think the most likely result of such new legislation is that there will be an influx of other Europeans for treatment in to the British NHS, as it not only has superb medical experts but most Europeans can manage the language easier than French, German, Italian etc...

  • 32.
  • At 01:54 PM on 19 Dec 2007,
  • Lucas wrote:

In 21st century Europe, such a Directive would come long after it was due, and in a very diluted form. The original idea is great, and it should be applied as such: allowing people to go to any country, get the best treatment (as long as it's medically necessary) and get their money back (or better not pay in the first place, within some limits).

As a mobile European, I would like to see member states relinquish their crazy stronghold on medicine and education and use the money to allow every European to get the best treatment.

In other words, the money will go to the best service providers, in free competition. Of course, there should be price controls, so that they don't proffit off knowing that the state pays for everything, but otherwise, there should be no cap and no pre-approval of the country / place of treatment.

Europe would become the first place in the world where sickness would not be a headache anymore.

  • 33.
  • At 02:33 PM on 19 Dec 2007,
  • Kirsteen Fraser wrote:

Why is there always this bashing of the NHS? Would you all really prefer a system similar to the USA where it is not unheard of people dying as they do not have the ability to pay for their medicines. Here in the UK the NHS pays for most of the cost of medication and we only have to pay a paltry £6.00 odds.

I have been seriously ill for the first time in my life and I have had to have ultrasounds and other tests and I am currently on enough medication to open my own pharmacy! Out of interest I googled what I would pay in other countries and found that elsewhere I would be paying £750 plus for my medication

Doctors have been reassuring and helpful even though my symptoms were very frightening and debilitating.

It can't be an easy job in the NHS having everyone bash you all the time as you are underpaid over worked and undermined.

  • 34.
  • At 05:00 AM on 20 Dec 2007,
  • MJB wrote:

Kirsten (32)
I understand what you say but we could and should do much better.
My young sons life was saved by the NHS in the fantastic Great Ormand Street Hospital some years ago so i do not 'bash' it.
However i am not sure it would be more money for us to go someway towards insurance, i may be wrong but look at this way.
We of course would have to have a safty net for non workers etc. but take a look at your last wage slip.The money they deduct for N.I.C. is money that is supposed to be spent on the NHS. Instead of that money going to the government, if we paid it into a private medical insurance we may get more for our money.It seems to work well in other parts of the world.

  • 35.
  • At 01:50 PM on 20 Dec 2007,
  • Neil wrote:

We all agree the NHS has a fixed amount of money to spend to meet the ever increasing demands for service. Some where in the system there has to be a form of rationing, currently this is mostly in the form of waiting lists.

If the E.U. proposal came to be I could afford to go to France and get an operation ahead of my neighbour, who may not be able to afford to. I would get the actual cost of treatment back, but travelling and other sundry expenses would be down to me. The money for my treatment would be taken from the NHS budget,
so there would be less money to spend elsewhere. It may be that my neighbour, who perhaps has a higher clinical need than me, has to wait longer fo their operation.

It is for this reason I am against it. It is not fair and wil mean a two tier health system, those who can afford to travel will get treatment quicker than those who can't, regardless of clinical need.

If it was a rare operation that could not be done in this coutry, then of course the situation is different. But everything I have read and seen says this will aplly to all operations, from a hip replacement to a kidney replacement. It in effect means the end of our National Health Service, based on free and fair health treatment for all our citizens.
Reading the previous entries it may be that the NHS is no longer up to this, but if this is so I want it decided in our own Parliament, not by the E.U.

  • 36.
  • At 09:46 PM on 23 Dec 2007,
  • greypolyglot wrote:

A couple of examples of which I have direct personal knowledge might serve to show some of the reasons not to use the NHS.

A village pharmacist in Belgium had the equipment to prepare an unusual eye ointment to treat the symptoms of Fuchs dystrophy. No PCT or pharmacist in Dorset did.

Having diagnosed severe arthrosis of both hip joints a surgeon in Belgium apologised for making the patient wait two weeks for the necessary operations.

A general ward in a hospital in Leuven has four beds. A private room with en-suite bathroom costs an extra €30. There is no MRSA.

I could go on but what's the point?

  • 37.
  • At 11:09 PM on 01 Jan 2008,
  • peter.baker wrote:

I am just fed up with putting shed loads of money into a system that does not care for individuals needs.

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