Should we be told how much our healthcare costs?

There NHS is running out of money. We are told this on an almost daily basis and unless you live in a cave, you’ll also know that GPs like me have been told that we are now going to be the people in charge of balancing the books. One of the reasons that  GPs have been given this large responsibility is that we generally run our own surgeries fairly efficiently and it would appear that the coalition feel that this effective management can be extended to the entire NHS. The truth is I don’t really know much about accountancy. My surgery runs efficiently enough but only due to my heavy reliance on our practice manager. She steadfastly makes sure that there is enough money for everyone to get paid and that we get the best deal on our toilet roll order. I get on with trying to make the patients get better and as a business plan it works well enough.

I was against the bill, but am not totally against both doctors and patients actually knowing how much things cost. Each day I sit with a metaphorical book of blank cheques of tax payers money and I write up prescriptions, order tests and make hospital referrals. All of these have a price and therefore cost money to the NHS and hence all of us who pay tax. Up until recently I was blissfully ignorant as to how much these all cost, but as a result of GP commissioning I am now beginning to get an idea. Many doctors and patients are scared of thinking of health care in terms of money. The fear is that we medics will no longer see you all as real people in need of medical support, but instead as pricey leaches draining away our budgets. I would like to think I am capable of thinking about the financial value of what I do, without it having a detrimental affect on my clinical decisions.

If it was up to me, I would make up for the NHS short fall by scrapping the recommissioning of trident nuclear submarines. £20 billion would make the commissioning meetings easier to bare. With that sort if injection of cash, the improvements we could make to patient care would be staggering. Of course, the whole point of this health bill is to make do with less money rather than more and therefore the only places we’ll find any cash will be through our reductions of our own inefficiencies. Anyone who works within the NHS could list several ways in which we could work more efficiently. Traditionally, doctors have thought of these shortcomings in terms of wasted time for us and poor service for patients, but now we will be encouraged to think of them from a more financial perspective.

My first job after qualifying was as a junior surgical doctor and I had a particularly frightening consultant. His ward rounds were terrifying and when he demanded a patient’s blood results, I was expected to know them. If I didn’t have them to hand I was on the end of a bollocking that could be heard from the other side of the hospital. My response to this was to do blood tests on all my patients everyday to make sure that I had every possible result to hand. Not only were my poor patients often unnecessarily stabbed with a needle each morning, but I must have cost the NHS a small fortune. How much? I have no idea. Still to this day I don’t know the cost of a standard blood test, but I should shouldn’t I? I’m not suggesting that doctors shouldn’t order blood tests anymore, but clearly knowing the financial value along side the clinical value of what we do is important.

One of my patients got the shock to his life recently when he discovered the actual cost of the injections he is having for his rheumatoid arthritis. He has one per week and they cost £178.75 each. That’s twice his weekly rent. He wanted to know if he should add them to his house insurance as when he has 4 syringes of the stuff sitting in his fridge, they are more valuable than anything else he owns. Of course I don’t begrudge him these injections. I am extremely proud that the NHS provides them for him. They make a massive difference to his quality of life, but I’m glad he knows their financial value as it means that he treats them with the respect they deserve. He understands how precious each vial is and ensures that they don’t get dropped or accidentally thrown out with the mouldy leftovers when his fridge gets a clean.

The government are soon going to be sending us all a breakdown of exactly what our tax is spent on. Should we be sent something similar about how much we cost in terms of our health care? I don’t want anyone to be made to feel guilty about using the NHS, but how many of my patients who miss a hospital appointment, realise that each failed attendance costs around £120. Or that it costs £59.48 for the inhaler that keeps getting left on the bus and £244 for the ambulance needed to get to A&E after drinking to oblivion on a Saturday night. I don’t advocate anything other than a free health service at the point of delivery, but just knowing the financial value of what is provided is a good thing for patients and doctors alike, isn’t it?

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• drbendaniels

  I imagine that the overall costs for the care of your wife and yourself have been high, but thank goodness we have the NHS, as with many people it sounds like you might not be still with us without it! Nice to hear a positive story about the NHS. Thankyou for your continued support at York hospital.

• drbendaniels

  just meant that elderly patients are often undemanding, wasn’t trying to imply that young patients are in any way undeserving

• Bob_T

  My wife has been very healthy for 60 years and then got cancer I can tell you health care is very important to the individual.  The French health care system saved her life without doubt.  In the UK she probably wouldn’t even have got diagnosed in time.  They have far too few scanners and doctors are too overworked to properly diagnose.  We live in a very rural part of France and they have all the modern equipment you can imagine.  We can get a doctors appointment the same day if required and always with the same doctor not some lottery as to who you see.  The same goes for dentistry.  As far as I can see there is not much paperwork in the French system for a doctor because the system is electronic.

• private_patient

  According to an independent 
  ComRes study, about 31%  people
  with private medical insurance said that they would like to see a consultant
  that is recommended by their GP rather than someone suggested by their
  insurance company. Almost 50% of the people felt that  the open referral process threatens their
  choice. 70% of them are of the opinion that with open referral  they would not be able to see the
  consultant they have seen previously.

  Private Patient’s Forum advises patients to review their policies when they
  come up for renewal and take a logical decision.

  http://blogs.privatepatientsforum.org/

• http://twitter.com/Nubnos Adam Brown

  Not myself. I’ve only been in A&E once in the last 10 or so years, after a traffic accident involving a car that didn’t bother to look and myself on a motorcycle.

  The other times are from taking relatives and friends there.

• http://twitter.com/Nubnos Adam Brown

  It wouldn’t be a completely privatised system. You would need to define what is an accident and what is an emergency.

  Someone getting steamed on a night out, and needing hospital attention through drinking too much. Neither an accident, and if it’s like most cases, not an emergency either.

  Charging someone when they cause an accident by careless and dangerous driving would be done through the courts, as they are offences.

  STDs? If the other person doesn’t tell you, and there are no outward and obvious signs, that’s hardly stupidity. Also not an A&E case.

  Smokers, bad diets, and non-exercisers? Yes to smokers if they constantly relapse. The NHS has run cessation clinics for years, and there are a huge number of products to aid cessation. It is a matter of willpower for some people, but it’s also a matter of being bothered for some.
  Bad diets… Who is going to be the body that decides if a diet is bad? Bodybuilders tend to have vastly unbalanced diets. Would you charge them, despite them being probably in better shape than someone who eats a so-called “balanced, healthy” diet?

  Now, dangerous sports… I’d imagine that if a person is of sound enough mind to do them, they should be of sound enough mind to have insurance for them. No one forces them to base jump, so their accidents and screw ups shouldn’t be forced on the tax payer.

  For the record, yes, I do have health insurance, I’ve not had to claim on it for a while, and I would be in favour of the Dutch system of semi-private covering. The only part I don’t agree with is opting out based on religion.

• Kerisdale

  The extraordinary thing about the NHS is that even the most advanced treatment is available to the poorest patients. Most patients will find the high cost of injections etc. incomprehensible and I would be very surprised if it changed anything at all in practice, but it would certainly cost a lot to produce and distribute the information.