Who pays the Health Care Piper?

Last week I found myself standing in line at our local pharmacy waiting to pick up my prescription. Whenever I do this, the Rolling Stones’ song ‘You can’t always get what you want’ comes to mind. However, my pharmacy is not a Chelsea Drug Store, it’s just a normal Cohens store (there are other chemists available). As I was standing there with the Rolling Stones song playing in my mind, I became aware of the man in front of me discussing with the store assistant the cost of getting his prescription filled (I don’t know if he was Mr Jimmy or not). In the UK each item costs £9.35, and he had 3 items, but didn’t have that much money.

In the end, he only took 2 of the items prescribed. I know there are plenty of provisions for people on certain benefits, or who have certain health conditions which exempt them from paying for their prescriptions. But there will be others, perhaps like this man, who for whatever reason simply haven’t got enough money. I wondered how many times this dilemma gets played out every day. Such situations provide us with a glimpse of the real costs of health care. However, depending on what the prescription was for, the real cost of Mr Jimmy’s health care may well have been heavily subsided.

Our little dog Dylan recently became seriously ill with a liver infection. He required emergency veterinary care and then ongoing in-patient care for four days last week. Not a single decision, test, or treatment was undertaken until we had given our consent and signed to say we would pay the costs. Those costs mounted up at an alarming rate over the four days, and ended up north of £4000. Thankfully we have pet health insurance, but even this has its limits. Sadly, he is still unwell, but he is getting better each day. The experience has been salutary in reminding us of how fortunate we are in the UK to have a National Health Service that is almost completely free at the point of service.

It is not the same for many other countries; notably in the US, where health care is largely private health insurance based, or for those who qualify, Medicaid is available. Since the pandemic started nearly 77 million people now receive Medicaid, an increase of some 10%. Each one of these additional Medicaid enrolments represents an individual and/or family whose income has fallen low enough for them to qualify. This doesn’t reflect well for the world’s largest economy. The US also spends more on health care than any other country. Currently this stands at £8,136 per person each year. This compares with £3,371 per person in the UK, the world’s fifth largest economy.

What I also find interesting is that in many States in the US, people on Medicaid will be charged for pitching up at A&E for something that is not an actual emergency. This is a cost the individual has to bear themselves and is not covered by Medicaid. I wonder what would happen to the current extraordinary demand being experienced by emergency and urgent care services in the UK, if such a charge was levied. I would expect overnight attendances would fall by at least a third.

However, such a scenario is unlikely to ever happen in the UK. Likewise, we are unlikely to consider the suggestion made last week by Martin Hirsch, the Head of Hospitals in Paris, who raised the question of whether individuals who had refused the Covid-19 vaccination ought to be charged for emergency and critical care should they become seriously ill with the virus. His suggestion is fuelled by the frustration caused by difficulties facing the French health care system similar to those here in the UK. Just as here in the UK, many French hospital beds are filled with Covid-19 patients, 80% of whom are unvaccinated. These beds cannot be used to reduce the waiting lists of folk who may be facing life-limiting conditions. Hirsch says this is unfair.

One day in critical care costs the French taxpayer £3,850. The cost of the vaccination is £16.60 per dose. There is a ‘pay for your health care and get reimbursed’ approach to health care provision in France. People have to pay up front for most health care and are then reimbursed by the State, although it is not a 100% full reimbursement. Even so, I don’t think Hirsch’s suggestion will gain much traction. Like health care services everywhere, nobody wants to get into the situation of patient selection – do we make smokers pay for lung cancer treatment or charge those who are morbidly obese because they eat too much? I don’t think so.

The NHS, like many other international health care systems, has always provided comprehensive and unconditional health care to everyone who needs it. It’s a service provided by professionals who are non-judgemental in the way they use their skills, knowledge and experience to help others at a time where the individual cannot help themselves. The provision of care and treatment should be and is often free from any economic, social, cultural or political constraints. In the UK, health care is also largely free at the point of accessing it. 

However, not every cost can be measured in monetary terms. The last two years have shown what a huge emotional and physical price has been paid by those working in health and social care services across the UK. There can be no denying the huge cost in terms of mental health and wellbeing there has been for many providing care during the pandemic. Sadly, we are not done yet. Let’s remember to be there for each other. Likewise, let’s remember these challenges will pass.