It seems from a country with a universal system that access to healthcare seems to take up a good amount of the limited time they have at home away from work. That’s either finding an insurance policy or finding a doctor or hospital that your insurance company will pay for and then begging the company to approve the right treatments.
I thought it might be of interest to explain how somebody joins the scheme and accesses healthcare in England.
There are two numbers personal to you for use. The first is your NHS number for accessing healthcare. Remember the NHS is part of a wider National Insurance scheme for workers so you will need your NI number too when you have to start making contributions to the cost.
JOINING THE SCHEME AND PAYING YOUR “PREMIUMS”
The commonest route is quite simple: get born to a mother who is resident in the UK. The hospital will notify your birth, nowadays on-line, and get your personal number for your hospital records. If the hospital is not on line or you were born at home, the number is issued when your parents register your birth.
Details of your birth and any operations or treatment you had before birth will be copied from your mother’s records to your hospital records. One of the first things when you get home from hospital is to register with your first GP. Your mum will probably do this for you when she takes you to the heath centre to get weighed by the community nurse. You may have seen her before when she came to see mum at home for her post-natal visit to make sure you were feeding OK and talk about any problems. The staff at the doctor’s will start your medical records, probaby with a letter from the hospital or the midwives who delivered you. GP’s office will record your medical history “from cradle to grave”. Your mum also gets a nice book to record your weight and development goals, your vaccinations etc as a family record and to show in case of emergencies or worries.
The next significant point will be about 3 months before your 16th birthday. You will be sent your National Insurance Contribution number. This is for your contribution record and shows your entitlement to sickness benefits, unemployment benefits and a retirement pension. You are exempt from paying if you are in full time education but have to remember to tell the DHSS. When you work, even vacation jobs, you give your employer this number. If you earn more than £166 a week. you pay 12% of your earnings, up to £962 a week (for 2019-20) the rate drops to 2% of your earnings over £962 a week. Remember NIC is due on each week’s income, income tax is based on your earnings for the whole financial year starting in April.
(Note: National Insurance Contributions are simply a form of payroll tax on employers and employees. Taxes in the UK are not generally “hypothocated”, that is solely collected and only used for a particular purpose. All the money goes into one pot so expenditure on health and the other benefits are met from general taxation too.)
As far as you the employee is concerned, you just see these as deductions from your basic salary, you employer does all the calculations and the money to the Revenue. Similarly most employees pay “Pay As You Go” income tax calculated and by their employers. A lot fewer have to submit a tax return in the UK.
The next challenge will be to find a new GP when you eventually move away from home. In towns, there’s usually one within walking distance. Drop in during working hours (they are now open some evenings) and see the receptionist. Give them your old and new addreses, you old GP’s surgery and your NHS number which you will have forgotten but will not be a problem, they can look it up. They may explicity ask if you agree to your anonomysed records being made availabe for research purposes or not. They will arrange to have your records transferred and probably an appointment with your new GP to have a check-up. You can change GP surgery or ask to see a different doctor at any time.
People From Abroad
Just to make it absolutely clear, everybody in the country is entitled to free emergency and urgent care. If you have a heart attack at Heathrow Airport in transit from New York to Moscow; you will be transported to hospital and treated free, including the days you need to recovery from an angioplasty. What’s excluded is “medical tourism”. You cannot, for example, enter on a 6 month visitor’s visa and give birth in an NHS hospital free. On the other hand, if you went into labour two months early, you would not be charged. (Note that the babies would not be British citizens automatically). There is also a list of medical care like the detection and treatment of TB or HIV and some family planning services.
Visitors (less than 6 months).
People from a number of other countries with which the NHS has “reciprocal arrangements” have full access to NHS services free. The UK bills the other country. The countries involved are mainly in the European Economic Area but include Australia and New Zealand.
People from other countries are entitled to access emergency provision. So you would be treated for a badly dislocated ankle but not get the follow-up physiotherapy and rehabilitation services. These visitors would need to have health travel insurance, particularaly to pay for repatriation if needed.
Some new arrivals, or newly discovered to have illegally entered the country are also entitled to full and free access. These include refugees, asylum seekers and people suspected to be the victims of people trafficing or modern slavery.
People settling in the country longer than 6 months
Anyone wanting to stay in the country longer than 6 months will need a residency permit or a work visa. People come for extended periods for a variety of reasons. It could be for education, to join a partner or to work. (An important point to note here is that somebody from a non-EU country in order to marry or enter a civil partnership may not have the right to work. Under the terms of their visa they cannot be a “burden on public funds”,) People can be asked to pay an “NHS Supplement” in the cost of their visa, to give them full NHS access. They pay in advance fees for each year the visa runs. This charge is currently £300 for students and £400 for others.
NHS numbers (and NIC numbers for workers) are issued with the visa together with a biometric identity card confirming their immigrations status and right to access full NHS services. When they move, they register with a GP in the same way as any other person. Those “with temporary leave to remain” like the aforementioned asylum seeker and trafficing victims also get these cards.
Private Medicine
I mentioned that “medical tourists” are not welcome on the NHS. On the other hand they are more than welcome to come for treatment or to give birth in one of the many private clinics and hospitals — or indeed as “paying patients” in one of the world class hospitals like Great Ormond’s Street Hospital for Sick Children. If you visit London and go to Marble Arch, you may notice a large number of people in Arab dress and that there are “shisha bars” with customers smoking hookas outside along the joining Edgware Road. There because smoking is illegal inside and there because the area has a large number of luxury short-let apartments. These are ideal for private patients going to the nearby Harley Street medical area of London or the private hospitals nearby. Patients from the Middle East bring family members with them to support them — join the dots.
The UK has big non-NHS medical provision. Anyone can choose to “go private” and pay for their treatment. You would certainly get better “hotel facilities” — you would probably have a room to yourself or share with one other rather than being in an NHS bay or “Nightingale” long ward. (Caveat, quite a few private hospitals conduct elective procedures for NHS patients, I’ll go into this in part 2) They will also fit elective procedures round your timetable.
You can play with your friendly plastic debit card or take out “private insurance”. I should add that the cost of procedures in these private hospitals is a lot less than the equivalent in the US. In some cases, less than a US patient’s co-pays. The doctors may well work in the NHS at other times. The costs to run the hospitals are also lower as they do not have Emergency Rooms or Intensive Care Units. They leave those to the NHS. The NHS hospitals themselves sometimes provide private facilities. The private Lindow Maternity Wing is popular for posh private births, including Royals, and is attached to the NHS St Mary’s Hospital, Paddington (further along the Edgware Road from Marble Arch!).
The backup and often a lot of initially tests being provided by the NHS means that in turn the costs of private health insurance are much lower than in the USA. I got a quote for a fake 45 year old male non-smoker on a price comparison site. The “full” policies started at under £95 (US$120) a month.
Many organisations give private health coverage as part of employee benefits, especially for senior staff to enable them to schedule procedures at the best time. The largest insurance companies also run their own private hospitals. Other private hospital are run or were started by charities for members of groups like the Masons, senior service personel and there are still hospitals run by Jewish foundations.
POSTSCRIPT
You will realise that, despite the complications of the rules about those from abroad, it really is quite simple. The vast majority only have any paperwork to fill out when they change GP. About the only time they are aware of NIC charges are when they have a tut at what has been taken in tax and National Insurance. Medical provision is just part of what you pay government to do, like providing police and fire services.
So in this diary I have focussed on the time saving that not having to shop around for the “best” insurance policy means. Not that the British don’t have other paperwork to do, well these days they use the price comparison sites to get the best prices for insurance, landline, broadband and cellphones, household gas and electricity.
In part 2 I’ll go into how getting healthcare is substatially different from the model used by most Americans.