24 November 2016
ID, Insurance and the NHS
Other countries manage.
by Lynda Goetz
‘Show your passport to see the doctor!’ screamed the headlines, as if this was heralding the terrifying imposition of a police state. ‘Every NHS patient could be asked to show their passport before they receive healthcare’, the permanent secretary to the Department of Health is reported to have told the public accounts committee. Meg Hillier, the committee chairman, on hearing of these “controversial” plans to recover money from foreign visitors and tourists, expressed concern about British citizens with no suitable photo ID (because they have never been abroad and do not drive). Have I missed something, or do most of us over the age of 18 who are citizens of the UK not have an NHS number and a National Insurance number? Visitors to the country (oh, alright, unless they are illegal immigrants) all have passports.
Some years ago we had a young Australian living with us. This young woman was charming, capable and organised, so of course she had her Medicare (the Australian healthcare system) papers with her when she travelled. She was unfortunately taken ill with pneumonia and admitted to St. Thomas’s Hospital in London. She was treated and discharged, but much to her surprise no-one at any point asked her to produce her passport or those Medicare papers – with which, under reciprocal arrangements, the NHS would have been able to recoup from the Australian system the cost of her care.
However, had the boot been on the other foot, so to speak, the story would have been somewhat different. Some friends were in Australia for 3 months, during which time the husband discovered he had suspected bladder cancer. Treatment was given, but in accordance with the regulations and information published on the Australian Government website, it was necessary for him to provide evidence that he was a British citizen (his passport), and entitled to benefit from the reciprocal arrangements, and to complete the necessary Medicare enrolment forms. Any payments made are then reimbursed into your nominated bank account.
When I damaged my anterior cruciate ligament (knee) skiing in France some years ago, the treatment, including x-rays, was provided with impressive speed by the local health centre (I guess they deal with rather a lot of that sort of thing), but not before I’d produced my debit card and paid up-front; the E111 (the precursor of the EHIC) covered hospitalisation, but not necessarily treatment by local doctors. Of course, I had travel insurance and was able to get most of the costs reimbursed in that way.
Why on earth is that in this country we appear so terrified of anything which threatens the NHS mantra of ‘free at the point of delivery’ or which even suggests that money should change hands at any point (unless it is to pay out rather than go to court over a negligence claim)? In another item buried in the news this week, spokesmen from the Association of Personal Injury Lawyers (APIL) have apparently warned that hospitals are letting slip the opportunity to claim back ‘hundreds of millions of pounds’ from insurance companies for the cost of treating accident victims. It seems that ‘overworked managers’ are failing to chase up costs and ‘unwittingly cushioning the costs of the insurance industry’.
Current legislation puts the obligation on the insurers to notify the Department of Work and Pensions’ Compensations Recovery Unit when a pay-out is being claimed by an injured party. The Unit then contacts the hospital. According to APIL, however, not only could more money be recouped if trusts proactively went after insurers, but Department of Health rules which put a cap on the total recoverable cost per patient at £48,849 further reduce potential revenue. APIL estimates that this cap deprives NHS trusts of some £20 million a year. This is admittedly a drop in the ocean when compared with the £2.45 billion NHS deficit, but when translated into 750 nurses’ salaries it does not seem like ‘such a small amount’.
These were effectively the words used by the head of the British Medical Association (BMA) on the Radio 4 Today programme the other day when referring to the issue of the £200 million pounds lost annually treating overseas visitors. He actually used the words ‘such a small problem’, but the meaning is the same, and surely the attitude revealed is worrying? As John Humphries pointed out after his slightly stunned silence ‘in the end, every procedure has to be paid for’. Doctors, and I do have several in the family, seem so often to be unaware of the financial and business aspects of running a public health care system. In many ways that is good. They are intent on helping people and saving lives, so far better for them to concentrate on their professional development and on keeping abreast of the knowledge, technical and scientific, to ensure competency in their field than addressing the question of entitlement. However, this can make for a rather blithe and naïve approach to the financial framework necessary to keep the whole lumbering edifice going and, furthermore, a resistance to any suggestion of introducing the dirty word ‘money’ into the equation. In fact it is of course unlikely that the doctors and nurses would be required to deal directly with this sort of administration, other than perhaps to sign a confirmation that they have conducted the procedures. We hear constantly that there has been a proliferation of layers of management in the NHS. Surely it must be down to these and to front-line receptionists and administrators to deal with these issues?
The NHS costs some £100 billion a year to run, making it the largest public service. Both the public and the staff need to be aware of the inefficiencies, duplications, incompetencies and plain lack of interest which cost money in an organisation where every penny should be made to count. Whether or not the NHS can continue in its present form is one question, but the cavalier and dismissive attitude of some of those working within the system to any form of charging, reimbursement or improved ‘housekeeping’ is surely counter-productive?
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