UK to stop issuing S1's to early retirees from April 2014?

[NormanH]

'are we saying that these countries should become immediately responsible

for their health care - even though they have contributed not one cent

to their respective new home countries.   Further, if on relatively low

incomes they may continue to contribute at a minimal level - if at all'.

Well that is what happens if a national of another European country settles in the UK.

And if a UK pensioner settles in France they contribute nothing to the French system out of their own pocket, (leaving aside any 'top up insurance') unlike French pensioners.

The suggestion above would get rid of those two anomalies.

And as for 'At the moment the harmonised system, says that where you were last

employed and paid significant contributions will pick up the bill' is not quite accurate.

If you live in a country who pays you a pension(even tiny) it is that country who picks up the bill. It is only if you live in one that doesn't give you a pension that the one where you most contributed covers you.

[YCCMB]

[quote user="EuroTrash"]. It's bad psychology to make people think that medical care comes for free, so no worries about wasting your doctor's time, it costs nothing.[/quote]

I would actually argue the exact opposite. In France, I'm forever coming across people who believe it's absolutely fine to have 3 weeks in a convalescent home after a minor op. because they're "entitled" to it, even though they could just as easily (and successfully) recuperate at home. I've been to the pharmacy in France with a sore throat and asked for something to take, only to be told quite forcefully that I should see a doctor immediately, when I know there's no need. I went along to translate for a friend who had a sore mouth, and she (and I ) were taken aback that the GP wanted to immediately send her for a raft of x-rays....I think the overall mentality in France is quantity above quality, and, as I have said before, people feel short changed if they don't come out of the doc's with a prescription for a carrier bag full of drugs. I'd argue that the fact that people have to pay for their medical treatment seems to encourage them to wring the absolute maximum out of the system because, well, they've paid for it. I don't think they value it any more, they simply think they're entitled to their money's worth.

[Daft Doctor]

I agree yccmb, I am astonished at the 'waste' in the system here in France, dressed up as 'good care'. My wife had a knee op, she had 2 appointments with the surgeon before the op, a separate appointment with the anaesthetist before the op (even though she's a completely healthy 43 year old), and since the op she's already been twice to see the surgeon and needs to go again in 2 months. Fact is she's doing fine, she's in and out in 5 minutes (after a one hour drive to the appointment) and each time she's relieved of 45 euros. That she gets it back doesn't matter, its being paid for somewhere along the line.

Our local Pharmacist asked me if in England Pharmacists were allowed to split packs of drugs to give the exact amounts for a course while giving me almost twice the amount of medication that my son needed because he wasn't allowed to do that. Can you imaging how much money the French health service could save if they just allowed pharmacists to do what is for many reasons the logical thing? If you need 56 tablets, give 56, not 100 because they only come in packs of 50 so you have to give 2 packs!

Having a service free at the point of delivery like the NHS may mean the system is abused in terms of GP time in some circumstances, I should know that, but on the other hand it means the doctor is under no moral pressure to prescribe just to make it worthwhile for the patient. I once read that the average French GP consultation ends with a prescription for 3 items, that compares with 1 in the UK (and bear in mind UK GPs are often being criticised for overprescribing). Point is, yes, the funding issues for all modern health services are huge, but unlike the NHS in the UK, the French don't seem to have accepted the need to cut costs and prevent their service being a bottomless pit.

[nomoss]

[quote user="Daft Doctor"]I agree yccmb, I am astonished at the 'waste' in the system here in France, dressed up as 'good care'. My wife had a knee op, she had 2 appointments with the surgeon before the op, a separate appointment with the anaesthetist before the op (even though she's a completely healthy 43 year old), and since the op she's already been twice to see the surgeon and needs to go again in 2 months. .......................... [/quote]

I'm not sure that is an example of waste dressed up as good care. I think it is more due to the people involved in the op milking the system. Perhaps because they feel they are underpaid?

I was at the hospital for an appointment, and had a painful wrist due to a fall. As it was hurting more than I thought it should after the several days since the fall, I asked the doctor I was seeing about it.

He phoned another doctor in the same area, who sent me downstairs for x-rays. After I collected these and returned, he looked at them and said there was no breakage.

I was surprised when the bills arrived that this second doctor had charged for two consultations, although I did see him twice for a couple of minutes each time.

 

 

[idun]

Don't get me started about the NHS and waste Daft Doctor! My hackles are up already. And yes, I know all about waste in France on all levels.

And 45€ (296FF in old money), that is a little less than £30, because we should never use current exchange rates to judge, french people live on the basis of that intial exchange rate between the euro and the french franc, and that was the amount that was 10virgule something french francs to the £ on average.

Would a surgeon really have seen someone for £30 in the UK. All Doctors pay in the UK is a lot and I doubt that they would have done that for less than a one being in the front of that figure. A GP wouldn't never mind a surgeon. And seeing a surgeon once after an op, well how much would that bill be in the UK???? that I really would like to know.

[Daft Doctor]

The point idun is that the NHS, by having the medical staff on fairly fixed remuneration, independant of how many people they see, tests they do, etc, nails down a significant cost for the service.  There is no perverse incentive in the NHS to do what is not necessary, and the patients by and large appreciate this.  In France, it is by contrast in some ways a license to spend, spend, spend.  There is a direct financial incentive (or need) to bring patients back unnecessarily, to have open-ended ordinances for multiple e.g. physiotherapy sessions, to investigate everything to the hilt, to prescribe multiple items which the pharmacist must dispense only in full packs, etc, etc. 

The standard of care in France overall is no better or worse than in the NHS I'm sure, though having said that some of the medical practices and customs here seem a bit archaeic, almost as if the service is a bit insular in certain areas.  I know someone here for instance who has a child with definite Attention Defecit Hyperactivity Disorder (ADHD), a well recognised illness in the UK and for which regular treatment can be a godsend for both child and the parents.  Not only did the parents have great difficulty getting the French to even acknowledge that the condition exists, but even then they'd only allow the poor child (and therefore poor parents) to take medication for it on schooldays, because 'that's the only days he/she needs to concentrate'. Oh really??

Whatever the rates are here in France for a consultation, if it means that to earn a crust the GP or specialist must bring people back multiple times is plain wrong.  That behaviour becomes entrenched in expectation and 'the norm'.  It creates a medical dependance culture which is very difficult I would argue to change, something that will IMHO haunt the French in the decades to come. 

   

[NormanH]

This is exactly what I was trying to say on another thread recently:

http://services.completefrance.com/forums/completefrance/cs/forums/2996073/ShowPost.aspx

The system creates a pressure to consume rather than to ration.

This can be seen acutely in the 'Urgences' at the local clinique. At the public hospital there is little encouragement  to be seen by a specialist, as they  are salariedbut  the clinique actively seeks tests it can charge for and, as it is run by a consortium of consultants, it tries to use the Urgences as a place where they can prospect for patients. When you leave you will almost certainly have had a series of costly tests and an appointment with one of the consortium.

There is also a lot of duplication. If one is passed up the line to a consultant  in another place the same battery of tests is often done a second or third time

I also agree that certain things are less recognised in France.

People with ME have problems being accepted as being ill, and I had something called Sarcodosis, treated in the UK by a Consultant Generalist, that is a Consultant who instead of dealing with one organ such as the heart deals with illnesses (such as Diabetes) than can affect several parts of the body.

I couldn't even begin to explain this to my French Doctor who just said it was Medecine Interne  a medical problem.

I was just looking earlier at ADD for a friend whose son seems to me to possibly suffer from it.

I did find a Wiki page..

https://fr.wikipedia.org/wiki/Trouble_du_d%C3%A9ficit_de_l%27attention_avec_ou_sans_hyperactivit%C3%A9#Facteurs_g.C3.A9n.C3.A9tiques

[YCCMB]

It's interesting to compare and contrast, perhaps, the costs of UK private medical treatment - and, indeed, the number of "consultations" compared to France.

My husband has just undergone heart surgery for the second time in a Central London hospital. After a 5 hour operation, having seen the consultant once, several weeks prior to the op., and never having had a separate consultation with the anaesthetist or anyone else involved, he was discharged the following day with the surgeon telling him he'd quite like to see him in 3 months time. He was in hospital for exactly 24 hours. He will have a brief follow up to check his blood each month, with an NHS nurse, and he will go to her.

In France, a friend had a similar operation. In hospital for several weeks, followed by 3 weeks in a special facility for recuperation.

The cost of my husband's surgery and hospital stay - and again I stress that this was in Central London - was just over £11K. I shudder to think how much it would have cost if he had also had the 3 weeks R&R.

[suein56]

[quote user="You can call me Betty"]

My husband has just undergone heart surgery ... and never having had a separate consultation with the anaesthetist or anyone else involved, he was discharged the following day ... [/quote]

I am delighted to hear all went well for your OH as heart surgery can be traumatic for all concerned, however competant the surgeon. It.was good to hear he was up and about, even out of hospital, so quickly. It was more or less the same for my OH's heart surgery in 2001 in the UK.

Even so as I can have quite bizarre reactions to some anaesthesia I would be reassured to speak to an anaesthetist before my op.

But not all French situations are the same as the husband of a friend of mine, who lived in central Paris before retirement, had an emergency 8 hour heart operation in 2003 which meant he spent 5 days in Pompidou after the op; where they got him up, sitting in a chair, then starting to move about very quickly. Following that he then had a couple of weeks of re-education to really get him going again. No rest and recuperation for him, as he said the exercises and workouts under supervision were really hard work. The explanation was that they needed to test to the max all the work done on him.

Now,10 years later, it would be interesting to find out if that timetable has been speeded up, or not.

Sue

[idun]

How do you know how much your husband's op cost Betty?  NHS or not? 

Out of curiosity I asked how much my medication I collected from the chemists cost and they said that they didn't know and were shocked that I had asked. But after most of my adult life time 'knowing' such things, I rather wanted to know.

[NormanH]

It's interesting to compare and contrast, perhaps, the costs of UK

private medical treatment - and, indeed, the number of "consultations"

compared to France.

The trap of cliniques in France is that although they are private and exist to make a profit they have access to the funds of the standard system.

So they give you all the profitable tests they can justify even if they are not essential knowing that these will be paid out of public money.

They even employ people in the office to look at each patient and see what opportunities can be found.

I had three operations over 2 years.

In each case apart from the surgeon I had blood tests, consultation with a cardiologist, a chest Xray  and then armed with the results of these a consultation with the anaesthetist.

All these are of course partners in the consortium who own the clinic.

I can see the logic, and as I have problems in each of those areas I was relieved at the degree of attention given to me, but I am not duped into thinking that the only motivation is patient care.

If this were a private clinic paid from PHI I am sure that the costs would be forced down.

I am not qualified to judge what is waste and what is good practice.

I do see that when the private sector is allowed  access to public money it is less economical with that  than it would be with its own funds.

[YCCMB]

No, Idun, it was private, which is how I know the cost 'cos I saw the bill. The point I was rather clumsily making was that I think it's probably a fairer comparison with France insofar as it involves private top-up insurance, just like the French system, and all aspects of the care are itemised and billed including hospital accommodation and each aspect of the care received. Funny you should mention asking the chamist about the cost of medication because ours does sometimes point out that it's cheaper to buy some OTC medicines rather than have them on prescription. And, conversely, I've had prescriptions for things which I could have bought myself because my GP has pointed out that they're cheaper on prescription.

I also had the experience many years ago of my son having an MRI scan done privately and the hospital made the point of asking whether it was covered by our private insurance because if not, it would cost £1K!!!

[basquesteve]

UK to stop issuing S1's to early retirees from April 2014?

A great idea stops the riffraff/drapple must keep up the standards eh