Hospital Treatment Tourism

[CJ]

There are plenty of countries with better healthcare systems in place...

But they all cost a great deal more per capita to run.

For all its faults and by any rational analysis, the British NHS provides astounding value for money.

[hjd10]

There are plenty of countries with better healthcare systems in place...

But they all cost a great deal more per capita to run.

For all its faults and by any rational analysis, the British NHS provides astounding value for money.

How up to date is that article or rather relevant to what is going on at the moment?

[tanglewood]

Sure - but think of it this way. We get to vote but whatever the result some of us are disappointed. So, how about the rules for tax change to allow us to reflect that? Let's say the basic rate is 20% at the moment. So, make the basic rate 18% but make it a mandatory requirement that a further 5% must be given to registered charities. HMRC would be required to route your donations for you according to your notification to them of your charities you support. Maybe 5, with 1% going to each of them.

This way you still pay tax to the government you didn't support, although just a little less than currently, but you can send some of your income to charities that you think can address the policy issues your vote didn't achieve. And the scale would be enormous - transformational for the role of charities in our society.

That would be a bureaucratic nightmare IMO.

Just a form once a year, or log in to HMRC's website. Or when you do your self assessment. Compared with Universal Credit it would be a doddle.




I'm a trendy consumer. Just look at my wobbly bog brush using hovercraft full of eels

[bovlomov]

There are plenty of countries with better healthcare systems in place...

But they all cost a great deal more per capita to run.

For all its faults and by any rational analysis, the British NHS provides astounding value for money.

How up to date is that article or rather relevant to what is going on at the moment?

Purely anecdotal, but multi-anecdotal over several years:

It seems to me that, increasingly, much of the inefficiency and waste in the NHS is a direct result of internal markets. That is, GPs, District Nurses, Ambulance Services, Out-of-hours GPs, A&E, and non-emergency hospital services, all in conflict (over budgets) rather than in cooperation. Then the NHS is in conflict with local authorities over health versus social care. Thus, a minor ailment becomes an emergency; a minor social care issue becomes a health issue, and a health issue becomes a social care crisis.

A stitch in time might well save nine, but no one wants the first stitch to be on their department's account.

A related problem, about social care. Every residential street in the country is visited by care staff from half a dozen agencies. Most have travelled from some distance, often by bus. It is costly and dispiriting for the carer, who isn't being paid for the bus fare or the time (though I believe this is changing to some degree). Then each one will spend 15, 30 or 45 minutes with a client before travelling across town to another client. The whole thing is madly inefficient - comparable with the early days of bus deregulation. You could hardly devise a more wasteful use of human resources if you tried. I'm not necessarily arguing for all to be taken into public ownership, but the system cannot continue without a certain amount of cooperation and regulation. Home care is crumbling while a large proportion of human endeavour is wasted on travel between jobs.

[tanglewood]

But they all cost a great deal more per capita to run.

For all its faults and by any rational analysis, the British NHS provides astounding value for money.

How up to date is that article or rather relevant to what is going on at the moment?

Purely anecdotal, but multi-anecdotal over several years:

It seems to me that, increasingly, much of the inefficiency and waste in the NHS is a direct result of internal markets. That is, GPs, District Nurses, Ambulance Services, Out-of-hours GPs, A&E, and non-emergency hospital services, all in conflict (over budgets) rather than in cooperation. Then the NHS is in conflict with local authorities over health versus social care. Thus, a minor ailment becomes an emergency; a minor social care issue becomes a health issue, and a health issue becomes a social care crisis.

A stitch in time might well save nine, but no one wants the first stitch to be on their department's account.

A related problem, about social care. Every residential street in the country is visited by care staff from half a dozen agencies. Most have travelled from some distance, often by bus. It is costly and dispiriting for the carer, who isn't being paid for the bus fare or the time (though I believe this is changing to some degree). Then each one will spend 15, 30 or 45 minutes with a client before travelling across town to another client. The whole thing is madly inefficient - comparable with the early days of bus deregulation. You could hardly devise a more wasteful use of human resources if you tried. I'm not necessarily arguing for all to be taken into public ownership, but the system cannot continue without a certain amount of cooperation and regulation. Home care is crumbling while a large proportion of human endeavour is wasted on travel between jobs.

NHS"s inflation rate is double the inflation rate for the whole economy. The reason is of course that the prices the NHS pay for things expands to use up exactly the increased budget the NHS gets each year. Basic economics, no surprise, Department of Health know all about it of course - but we voters keep demanding more cash for the NHS and demanding no real reform of it, and you can't get elected unless you promise both those things. So governments keep their promises, hand over the cash, and watch it burning up in NHS inflation year after year. Odd.


I'm a trendy consumer. Just look at my wobbly bog brush using hovercraft full of eels

[roubaixtuesday]

NHS"s inflation rate is double the inflation rate for the whole economy. The reason is of course that the prices the NHS pay for things expands to use up exactly the increased budget the NHS gets each year. Basic economics, no surprise

This is so counterfactual it's hard to know where to start.

NHS inflation is driven by two things:

1. Aging population
2. Cost of new medical technology.

Essentially we have ever more people needing medical help, and we have ever more sophisticated (and therefore expensive) ways of providing that help.

The NHS is the most cost effective health system in the OECD. There are others that provide better outcomes, but they are *much* more expensive.

[reohn2]

Just a form once a year, or log in to HMRC's website. Or when you do your self assessment. Compared with Universal Credit it would be a doddle.

How hard would it be for a millionaire or a group of them to set up their own registered charity,then cooking of the books begins.It's happening presently with the current system of loopholes and slick lawyers,so I've no reason to believe it won't under such a system you propose.
BTW I don't do a self assessment as many people don't,so more bureaucracy if I had to for the sake of designating an amount to charity .

You can call me a cynic if you like,I won't mind .

[pwa]

You earn £50,000 and above and you got a 5% reduction in income tax!
Multinationals don't pay their fare share of taxes out of the billions profit made in the UK!

All part of a future debate on how we pay what we need to pay. I feel we are at a tipping point where the politicians begin to think that we are ready to talk about paying more, as a nation. How we collect that extra money, and from whom, is a matter for debate.

I get very confused about this "is a matter for debate" so often stated, particularly by our politicians. With our political system what difference does public debate have. Where there is clear public consensus (disagreeing with what the politicians in power want) then that consensus is rejected and the politicians do what their ideology (or Press Barons) want anyway. The "is a matter for debate" from politicians is a complete ruse these days where they are trying make themselves appear "open and thoughtful" but public consensus disagrees with them and they do what they always wanted to do anyway. Lets have a "debate" about selling arms to middle eastern countries with unending allegations of human rights abuses and watch what our politicians don't do ..., etc., etc. What about Landsley's NHS reforms - certainly plenty of public debate and public opinions about that and ... no effect atall.

Politicians calling for "is a matter for debate" is nothing more than PR/spin, giving them time to implement what Press Barons wants before too much public opposition can build and/or to hope the press "forget" about the issue as other events take prominence and they can then do what they want quietly behind closed doors (and refuse Freedom of Information requests for long enough that the massive arms shipments have been paid for ...).

Ian

I say that how we collect the extra money, and from whom, is "a matter for debate" because I think that we, as a nation, first need to agree that we need to be significantly adding to to what we put into social care and the NHS. That is the important first step that I think we are approaching. The realisation, for anyone in doubt, that efficiency savings alone will not be enough.

[Psamathe]

All part of a future debate on how we pay what we need to pay. I feel we are at a tipping point where the politicians begin to think that we are ready to talk about paying more, as a nation. How we collect that extra money, and from whom, is a matter for debate.

I get very confused about this "is a matter for debate" so often stated, particularly by our politicians. With our political system what difference does public debate have. Where there is clear public consensus (disagreeing with what the politicians in power want) then that consensus is rejected and the politicians do what their ideology (or Press Barons) want anyway. The "is a matter for debate" from politicians is a complete ruse these days where they are trying make themselves appear "open and thoughtful" but public consensus disagrees with them and they do what they always wanted to do anyway. Lets have a "debate" about selling arms to middle eastern countries with unending allegations of human rights abuses and watch what our politicians don't do ..., etc., etc. What about Landsley's NHS reforms - certainly plenty of public debate and public opinions about that and ... no effect atall.

Politicians calling for "is a matter for debate" is nothing more than PR/spin, giving them time to implement what Press Barons wants before too much public opposition can build and/or to hope the press "forget" about the issue as other events take prominence and they can then do what they want quietly behind closed doors (and refuse Freedom of Information requests for long enough that the massive arms shipments have been paid for ...).

Ian

I say that how we collect the extra money, and from whom, is "a matter for debate" because I think that we, as a nation, first need to agree that we need to be significantly adding to to what we put into social care and the NHS. That is the important first step that I think we are approaching. The realisation, for anyone in doubt, that efficiency savings alone will not be enough.

But who should do that debating ? If it is the public then it will be nothing more than a waste of time as the politicians will ignore any public opinions and do what their ideology and Press Barons want irrespective of any "public debate". If it politicians doing the debating then these days it means the Leader of the party in power telling her minions (sorry, MPs) how they MUST vote (under threat of "getting a strong letter" if they don't do what they are told).

So, suppose there is a public debate and outcome is massive public opinion that the likes of those prominent companies not paying tax (Amazon, Starbucks, Vodafone, etc.) should start paying tax and that the wealthy should not keep getting more and more tax cuts - will the politicians say ok, lets do it or will our Government ignore it and decide they will give more tax cuts to their wealthy mates ...

so we have a public debate where public opinion comes down in support of a public NHS (not to be sold to US for-profit Healthcare corporations) that justifies more funding. In fact that seems to be the general opinion at the moment (from various research and polls) - yet are our politicians acting on that ? No, they continue to cut funding and pursue privatisation (irrespective of public opinion/debate).

In our society "debate" seems no longer able to influence what is then done (irrespective of the conclusion of that debate).

(Sorry, probably din't express myself clearly before).

Ian

[reohn2]

The best thing for you (in fact, all of us) is to add the amount of tax we think we can afford to the amount of charitable giving we already do.

That of course is a matter of personal choice though I do take your point.

Just going back to this point,many people dislike paying any tax at all,such people mostly are hardly likely to want to give to or increase their giving to charity I should think.

[tanglewood]

Just a form once a year, or log in to HMRC's website. Or when you do your self assessment. Compared with Universal Credit it would be a doddle.

How hard would it be for a millionaire or a group of them to set up their own registered charity,then cooking of the books begins.It's happening presently with the current system of loopholes and slick lawyers,so I've no reason to believe it won't under such a system you propose.
BTW I don't do a self assessment as many people don't,so more bureaucracy.

You can call me a cynic if you like,I won't mind .

You're a cynic!!!!!

Clearly if massively more money was to be routed through charities we would need a massively more effective charity regulator.

If you don't want the bureaucracy then carry on paying the basic rate, PAYE.

By the way, I would end PAYE. I would also only expect people to pay the balance between the tax they owe and the benefits they get. For about half of all households their tax bill would drop to zero, because they get more in benefits than they pay in tax.

Despite what you might think, over time the rich are paying more in tax and receiving less in benefits and the poorer households are contributing less in tax and receiving more in benefits.

Centre for Policy Studies:

"53.4 per cent of total households received more in benefits than they paid in taxes in 2010/11 – compared to 43.1 per cent in 1979 and 43.8 per cent in 2001. "


I'm a trendy consumer. Just look at my wobbly bog brush using hovercraft full of eels

[Vorpal]

The thing about charitable giving, is that people shouldn't have to depend on it to stay alive. When someone is unable to support him or herself, there should be a social safety net available. That safety net should meet basic needs for health care, food, shelter, and things to return the person, if possible, to being a contributing member of society.

Health care is a basic need. there are lots of models available for providing health care. Some, like the systems in the Netherlands and Switzerland have better care statistics, but cost more money. Others, like in USA, are riduculously expensive, and provide a worse overall service.

Despite media sensationalisation, I don't think the system in the UK is such a bad one. Try living in the USA for a while. It's very much worse.

I also don't think that so many people travel to the UK for the express purpose of obtaining medical care. There are actually quite good rules about who has to pay and who doesn't. They are doing a better job of enforcing them than they once were. If they keep improving, in a few years the UK will be spending very little on 'health care tourism'.

If you really want to improve the NHS, benchmark some other countries. Look at the areas (like cancer care) where the UK doesn't perform as well others, and implement some improvements.

As for funding, well that is more prioritisation than anything else. The government seem to want to follow the USA in developing wealth at the top, rather than the bottom. Well, if that's what people keep electing, it's not going to help the NHS. The OECD have done some very good analysis about economies, income inequality, and health care funding. Go read them. Or ask your MPs to. The government could do much worse than following OECD recommendations in this regard.

Unless, of course, the target is to make the top 10% wealthier.

[tanglewood]

All part of a future debate on how we pay what we need to pay. I feel we are at a tipping point where the politicians begin to think that we are ready to talk about paying more, as a nation. How we collect that extra money, and from whom, is a matter for debate.

No,it's all part of this debate,there's a pot of money the government decided to reduce or not increase,by not collecting the taxes it should and providing loopholes for those who can afford it to exploit.And by giving tax reductions to those who can afford to pay the 50% rate as was.
They then spend money on things we don't need(HS2) and can't use(Trident),etc.
Whilst allowing the old and infirm to bed block hospitals due to a total lack of decent social care.
Whilst at the same time trying to put the blame on foreigners,much like the Brexit argument that we have too many foreigners in the country,when it's those foreigners who are working in the NHS!

Come on - even Gordon Brown now admits that raising the higher income tax rate to 50% reduced the amount of tax collected. It's called the Laffer Curve.

By all means call for an ideological increase in tax rates for high earners. But at the same time you must introduce spending cuts to schools and hospitals.

The vast majority of the money needed to run public services already comes from just a relatively few high earners. You may not like that but it is true. Getting the rate just right to extract the maximum amount of money from this group is an art form, and in the UK it seems the £50,000 threshold for a 40% rate is the perfect revenue-raising formula.




I'm a trendy consumer. Just look at my wobbly bog brush using hovercraft full of eels

[Psamathe]

The best thing for you (in fact, all of us) is to add the amount of tax we think we can afford to the amount of charitable giving we already do.

That of course is a matter of personal choice though I do take your point.

Just going back to this point,many people dislike paying any tax at all,such people mostly are hardly likely to want to give to or increase their giving to charity I should think.

I don't know the figures but I think charity donations are to an extent suffering because of the highly paid "charity professionals" that seem to be doing "if I was running a business I'd be paid ££££££". My parents and most of their friends will no longer give to national charities because of this (instead they give to local largely volunteer run charities). They do see charities then feel need donations and are inclined to donate but don't because of the "CEO salary issue".

(Ok, "giving" it in tax goes on e.g. MPs expenses, letting Vodafone of massive tax bills, etc., etc.).

Ian

[reohn2]

Come on - even Gordon Brown now admits that raising the higher income tax rate to 50% reduced the amount of tax collected. It's called the Laffer Curve.

By all means call for an ideological increase in tax rates for high earners. But at the same time you must introduce spending cuts to schools and hospitals.

The vast majority of the money needed to run public services already comes from just a relatively few high earners. You may not like that but it is true. Getting the rate just right to extract the maximum amount of money from this group is an art form, and in the UK it seems the £50,000 threshold for a 40% rate is the perfect revenue-raising formula.

In your view maybe,the HMRC could close the loopholes and let the rich know that there's no hiding place for tax evaders/avoiders.
Of course that would need a straight and honest system society that looks after the week and needy and not skewed to the rich and powerful.
If you think that's a revolutionary outlook you'd be right,YVMV mine won't.

EDIT:-just to add,the gap between the rich and the poor is increasing at an alarming rate,one needs to ask where do the rich earn their money,is it not from exploitation of the poor and if they're paying the majority of the tax in the UK then so they should and IMO it isn't enough as things stand.