Feature

Private health care: just what the doctor ordered?

Does private medicine help or hinder the NHS? Here, Lorrayne Holt and Lorna Roshier contribute opposing views, from their general studies essays, to the panacea-or-parasite debate.

The case for: everybody benefits

At first glance, private health care seems unfair as it allows patients who pay for treatment to ‘queue jump’ past others who have been on NHS waiting lists for much longer.

But when studied more closely, the effects of private health care can be seen to be beneficial - and as people who can afford to have private treatment do so, waiting lists will gradually reduce, shortening the amount of time people have to wait for NHS treatment.

In 1990 there were 700,000 people on NHS waiting lists. Some may have to wait years for treatment, which can be especially painful for parents who have to watch their children suffer. If they can reduce this suffering by having their children treated privately, who can blame them for so-called queue jumping?

When people turn to private health care, some pressure is taken off the NHS. Since private hospitals concentrate mainly on ‘cold surgery’, such as treatment of varicose veins, NHS waiting lists for these non-urgent conditions are reduced, which leaves the NHS able to deal with more chronic complaints, and emergencies such as heart attacks.

But private health care also offers its own unique contribution. For example, many types of cosmetic surgery are only available through private health care, and thousands of people receive such treatment annually.

Private hospitals and insurance companies have contributed to the nation’s health by donating equipment to NHS hospitals. This equipment is then used by both the public and private sectors. BUPA helped St Thomas’s Hospital in London buy a lithotripter (which uses sound waves to destroy kidney stones).

In 1987, NHS surgeons at St Bartholomew’s Hospital in London cleared more than 175 children from the waiting list for tonsil operations. They used facilities at the private Princess Grace Hospital, and operated throughout the four-day Easter holiday weekend as part of the government’s £25m drive to cut NHS waiting lists.

This exercise was very successful, since it reduced the children’s tonsils and adenoids waiting list at Bart’s by a third. The benefits to the children were obvious - some had been on the waiting list for over four years.

If the private and public sectors tried to co-operate more in ways that were mutually beneficial, private health care would not be seen as a service only for the very rich.

The private health sector has continued to expand in recent years; it is estimated that in September 1992 one in six of the population had some form of health insurance. An estimated 400,000 trade unionists and their families are now covered by group private health insurance schemes.

Private health care is no longer a luxury that only the very rich can afford. I think it is only a matter of time before more people realise the value of private care and how much everyone can benefit from it.

The case against: inequalities worsen

In theory, private health care appears to be the ideal solution to the problems of overcrowded hospitals and long patient (or should I say impatient?) waiting lists. But closer study shows the system to be problematic. Conservative policy has been to encourage employers to provide, and individuals to take out, private health care cover by offering tax concessions.

This seems to be somewhat hypocritical in view of Prime Minister John Major’s claim to be working towards a ‘classless society’. How can class divisions be overcome when those who are affluent can buy their operations, while those less well-off have to endure months or even years of pain waiting their turn on a seemingly endless list?

Private health care actually reinforces divisions in society. The General Household Survey of 1989, for example, showed that in the whole of Scotland only 4% of people were covered by private health insurance, compared with 16% in the outer-London commuter belt of England.

In 1982-83, 20% of inpatients in private care were professional workers, compared with only 1% of semi-skilled manual workers. There were no unskilled workers registered as private patients.

Elderly people are another group which does not have a large representation in private hospitals because insurance companies expect elderly people to pay a much higher premium for health cover. For instance, in 1988 the cost of BUPA cover for a 30-49 year old was £35 a month, but for anyone aged over 65 it was £80. Only 6% of the 65-74 year old age group is covered.

Chronically ill people are also unable to benefit from private health insurance unless they are prepared to pay well above the average costs. Both they and elderly people are too big an ‘insurance risk’; profits would be lost if their treatment cost more than the insurance they paid.

Private medicine does not offer accident and emergency services. If you are in a car accident, for example, it will be an NHS ambulance that takes you to an NHS hospital. Many private hospitals do not have facilities for emergency treatment.

Although it is claimed that private hospitals relieve the burden on the NHS, the fact that they use NHS laboratories and equipment is often overlooked, and many private health care companies use NHS hospital ‘pay beds’, so lengthening NHS waiting lists.

By creaming off some of the best NHS staff (all of whom are trained at the expense of the taxpayer), private hospitals again extend NHS waiting times. So instead of alleviating pressure on the NHS, the private sector could be making the problem worse.

Private health care is run as a business rather than a caring service, and as a result has little relevance to total health needs. Usually it offers no service outside consulting hours. If you have private insurance you can buy your operation ahead of NHS patients, but if you become seriously ill in the middle of the night, or if you get run over by a car, you still have to rely on the NHS. This means that private health care offers the best of both worlds, but at the expense (usually) of poorer people.

Even so, many private patients get a shock when they leave hospital. It has been proven that BUPA has at times charged a 400% mark-up on prescriptions; at one time its Roundhay Hospital in Leeds charged £129.38 for a tin of baby powder.

The evidence seems to be that private medicine may not be ‘just what the doctor ordered’.