A comparison of UK and German healthcare provision

Arnie Pye

Arnie Pye

Senior Member (Voting Rights)
This article is not detailed, but I thought some of the numbers given were quite startling :

Title : Why aren't European hospitals facing a 'winter flu crisis' like the NHS?

Link : http://www.itv.com/news/2018-01-31/...tals-facing-a-winter-flu-crisis-like-the-nhs/

Europeans who know Britain well are often slightly bemused by our unconditional love of the NHS, even more so when they hear us insist that it is somehow the 'envy of the world'.

Because, to put it brutally, it isn’t.

Of course they recognise that the NHS is a fine system, that delivers great health outcomes in a pretty efficient and cost effective way.

But they don’t envy it, for the simple reason that they have their own health systems which do much the same, sometimes (whisper it if you dare) even slightly better.

And, crucially, they also do it in a way that is funded almost entirely by the tax-payer and is free at the point of delivery.

Most European voters would tolerate nothing less.

So why don’t the French or the Dutch or the Danish or the German health systems live in the same state of 'perma-crisis' as the NHS?

Why is health policy not the perennial number one political issue, dominating the life of every Government whether of left or right?

This is what I went to Germany to find out.
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The UK now spends around 9.9% of GDP on health, very slightly below the EU average.

Germany spends 11.1% or so, not a massive gap.
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Germany manages to provide 8.1 hospital beds for every thousand of its citizens, compared to 2.6 in the UK.

It employs 4.1 doctors per thousand people compared to 2.8 in the UK, and there’s a similar sized gap in the numbers of nurses.

Little wonder that they don’t run into the capacity problems that so afflict the NHS.
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Although I don't have a link, I have read articles in the past about NHS provision that make no sense to me whatsoever. New hospitals will get built to replace old and out-dated ones, and in the process the numbers of beds will be reduced by half. And the government of the day will spin this like mad as an "improvement".
 
One problem in Germany is that nurses are not allowed to do anything. Nurses in hospitals are not even allowed to draw blood, it's ridiculous. Nurses in doctor's offices (who are called "doctors' helpers") are allowed to draw blood but not to do much more, they merely do the paper stuff and if you ask a question you're told to please ask the doctor. I read here from the US and UK where nurses even do appointments or make homevisits. That would be very helpful.
 
And that is perhaps the point: for decades we have looked westwards across the Atlantic at the way the Americans organise their health care, and felt a smug satisfaction that we don’t allow the inequalities and excesses of the US system.

But closer to hand, just across the Channel, a number of countries with a similar social system and spending similar amounts of money seem to be managing health care rather well.
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I think it boils down to the NHS in the UK becoming focused on economics rather than health. It's a socialist system seeking to incorporate capitalist principles, and it's getting the worst parts of both ideologies.
 
I think the difference between 9.9 and 11.1% of GDP is massive in terms of that additional amount of money that helps smooth a system.

I think the NHS has another issue which is around doctors pay. I think the UK is one of the highest paying places for doctors yet the funding doesn't follow. It comes back to doctors not wanting the NHS and Nye Bevin having to 'pave the way with gold' to get them to agree.

I suspect there are issues with the medical schools and nursing colleges as as well in that we don't train enough staff to keep the system running. Hence the need to bring in so many foreign doctors and nurses.
 
Adrian said:
I think the difference between 9.9 and 11.1% of GDP is massive in terms of that additional amount of money that helps smooth a system.
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Yes, I agree. I thought the dismissal of the difference between 9.9 and 11.1% was very dubious. It's as if the reporter was saying that a few billion pounds here or there isn't important.

Adrian said:
I think the NHS has another issue which is around doctors pay. I think the UK is one of the highest paying places for doctors yet the funding doesn't follow.
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Doctor's pay rocketed in or around 2004 when Labour wanted to give GPs a new contract. I can't remember what the government hoped to get out of the new contract. But doctors were laughing all the way to the bank.

http://news.bbc.co.uk/1/hi/health/6314301.stm

Regarding nurses, they used to be paid bursaries while they trained. But these were abolished a couple of years ago in favour of loans. So nurses end up starting their careers many thousands in debt but don't earn anything like the salaries that other trained graduates get to pay the loans off.

At the time the nurses bursaries were abolished the government trumpeted this as a brilliant idea because it would allow this to happen :

Replacing bursaries with loans would free up about £800m a year to create additional nursing roles by 2020 and help more students enter the profession, according to the Department of Health.
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Source : https://www.theguardian.com/society...t-nurses-will-end-in-2017-government-confirms

But as any idiot could have forecast (except the government) this is what happened instead :

Applications by students in England to nursing and midwifery courses at British universities have fallen by 23% after the government abolished NHS bursaries, figures show.

Nursing leaders said the sudden slump revealed by the latest university application data was inevitable given that student nurses now faced paying annual tuition fees of more than £9,000.
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Source: https://www.theguardian.com/educati...lications-slump-after-nhs-bursaries-abolished
 
An interesting fact came to light when I surfed around this. In Germany anyone is entitled to book to see any physician. There is no need to see a GP before a specialist. GPs see patients for slots of an average of 7minutes - even less than the UK. I suspect that as said above, GPs in Germany mostly do what practice nurses do in the UK - check a blood pressure and print out a repeat prescription. In the UK a large number of GP visits are a waste of time because they are requests to see a specialist that need not happen.

UK doctors are paid more than they need to be - and one effect of that is that they retire at 60 because they already have enough pension and cannot stick it any longer. German specialists get paid about £85,000 a year it seems. In the UK the equivalent figure may be nearer £100,000 but I am not sure how comparable these are. GPs are I think paid more in the UK but less in Germany.

What the NHS needs is more staff, just to make it humanly possible to deliver the work needed.
 
Jonathan Edwards said:
An interesting fact came to light when I surfed around this. In Germany anyone is entitled to book to see any physician. There is no need to see a GP before a specialist.
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I've read that the same is true of the French healthcare system as well. Patients don't need permission from a GP to go and visit a lung specialist or an arthritis specialist or a gastroenterologist etc. I would love that system.

What I do find annoying in the UK is, on the very rare occasion I have paid to see a doctor privately, I usually still have to get permission from a GP before the specialist will see me. Although it hasn't happened to me personally, I've read of GPs preventing people from seeing a specialist privately (by refusing to refer) because they don't think the patient needs to see anyone.

Another feature of UK private medicine that annoys me is that the doctors I've seen haven't always felt it was essential to report to anyone what the recommendations or findings were, and some have written to the GP who referred me, but not me - and I'm paying the damn bill!

Jonathan Edwards said:
What the NHS needs is more staff, just to make it humanly possible to deliver the work needed.
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That is very true. But the government seems to think that GPs are convenient servants who will do anything the government wants, whether it is part of their contract or not. I'd get pissed off under those circumstances too, if I was in their shoes.

I think the problems in the NHS are accelerating. The more staff leave, the greater the workload for the ones who remain, and the more then decide to leave. I really think the NHS is circling the drain, but I hope I'm wrong. I won't be able to afford healthcare if it goes, and I hate the politicians who are letting this happen, and in fact appear to be engineering this whole debacle.
 
Arnie Pye said:
I've read that the same is true of the French healthcare system as well. Patients don't need permission from a GP to go and visit a lung specialist or an arthritis specialist or a gastroenterologist etc. I would love that system.
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In theory this is true but I know that I'll be seen much quicker if referred by my GP than if I made a first appointment myself. Repeat appointments (even if requested by me might be a different thing).

There are many differences though between the French and UK systems. While nominally a 'national health service' both funding and provision are a public/private mix. The majority of funding is via taxation at source (earnings) but compare to the UK is hypothecated - money taken from your wages via the appropriate 'caisse' goes to the health service and nowhere else. What isn't covered by this contribution (typically around 75% is covered - it varies) must be covered by a privately provided health insurance top-up (mutuelle) which you pay for yourself. There's also a non-refundable personal contribution of €1 for every €23 GP appointment (paid up front).

On the provision side your GP is self-employed (when discussing an upcoming strike of GP's my own took great offence at me referring to the health minister as his boss). Most tests ordered are carried out by private clinics and typically the response time is within days rather than weeks. Hospitals are another mix. Some work to fixed fees (conventioned) while others can charge what they want.

As for ME/CFS my GP knew so little about it that he asked if the only other patient he had could phone me for a little chat and advice.

Overall the standard of care is excellent but very expensive to administer and as I understand it likely to become more and more unaffordable.
 
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Jonathan Edwards said:
An interesting fact came to light when I surfed around this. In Germany anyone is entitled to book to see any physician. There is no need to see a GP before a specialist.
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The system is quite complicated and depends on the insurance (privat or state insurance) and kind of speciality. I can book appointments for some specialities but need referrals from a GP for most.

A huge difference to the UK is that we can chose our GP in Germany. On the other hand the good GPs are often booked and don't take on new patients (or only patients with private insurance, same with specialists). I had a private insurance for the first 30 years and it was a huge difference.

So, I think we can chose more but the downside is that also doctors can chose their patients to some extend. Also without a referral no one writes a report to my GP. And I have no central place with my results and history and no GP with a real oversight.
 
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Doctor shopping is easy in Germany, so it's easy to just change from one you don't like. And I've never had a problem being referred to a specialist, or just going to see one without a referral. When I had an operation they kept me in hospital for more nights than they needed to because they get paid for every extra night they hang onto a patient. I actually sneaked out, spent the night at home and sneaked back the next day, nobody was that bothered. Oh yes, it's a wonderful system here in Germany. Unless you've got ME of course, then it's a f***ing nightmare.
 
TiredSam said:
Doctor shopping is easy in Germany, so it's easy to just change from one you don't like.
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Hm...Maybe GP shopping is easy, no matter if you have a private or "state" insurance. In all other cases my experience was it's pretty difficult. Well, I never tried to invent some symptoms in order to get a referral to a specialist, maybe that would have worked.
 
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