My (extensive) experience of South East Asia is that they’ll run many tests which a European Dr wouldn’t order with a straight face but that you don’t care because it’s generally pretty cheap.

At least it has end-to-end encryption.

Apart from in-person (which is inconvenient) what's the alternative? Email? SMS? Post?

Provided it's a "good news" follow-up, of course.

One of the problems is actually that you cannot tell what a certain level of treatment will cost.

These people will hog any system. In some countries they are discouraged by high fees (your 40 euros in Bali are cheap for you but very expensive for locals), but those fees will then become a barrier for a lot of people who really need the service.

I honestly don't know the answer, but there must be ways to create barriers that are porous enough to let the genuinely ill people in and the hoggers out.

Allegedy 1-in-5 NHS GP appointments are no-shows, costing north of a billion squids/year. The total NHS budget is £125Bn so that's nearly 1%. Which doesn't seem like a great deal but when you add on all the other waste such as people filling prescriptions they don't need it's going to be pretty significant.

We need a system where you pay a deposit say £10 for an appointment, refunded in full if you show up on time, say £5 if you are late. Because it has a knock on effect on other patients.

For many people having to pay a £10 deposit to place a doctor's appointment would be the difference between seeing the doctor or not. Especially near the end of the month there are people for whom £10 is the difference between eating or not eating.

Right now, a lot of British people feel quite protective of the NHS. They see it as a scarce and precious resource that should be used sparingly. Many people feel a real sense of guilt if they inadvertently miss an appointment, because they feel that they're taking something away from someone who might need it more.

Converting this reciprocal relationship to a transactional relationship is very risky. Many people who would otherwise make an effort to keep their appointments could take the attitude that they're just paying for a service; the lost deposit takes away any guilt about missing the appointment. £10 is a fraction of the actual cost of a missed GP appointment, so the NHS could make a substantial net loss.

I think a far more productive approach would be to use behavioural nudges. It wouldn't be difficult or expensive to give an SMS or automated voice reminder of an appointment. People who persistently miss NHS appointments could be offered support in keeping to their appointments, while being gently reminded of the costs to the NHS and the effects on other patients. I suspect that a bit of psychological carrot-and-stick would be far more effective and far less risky.

This is not even slightly true. £11Bn a year is spent on Type 2 diabetes, 80% of which is caused by obesity (source: Diabetes UK). A&E every Friday and Saturday night is full of drunks. People take the NHS for granted.

take the attitude that they're just paying for a service

Well SOMEONE is paying for it. Generally, the people who can't get GP appointments...

The end result was that "late pickups" increased as the shame of being late was replaced with a transaction fee, signalling that late pickups where allowed by the rules.

We can't just allow people who give no thought to others, who make bad choice after bad choice, the option to continue to ruin it for the rest of us. I'm sympathetic to low income folks, but surely a 10 dollar deposit you get back if you simply do what you say you're doing to do, is not too much to ask?

What would you say that involves? The current budget is £125Bn, so are we looking at £150Bn, £200Bn, £500Bn? Put a number out there and we'll have a national debate on what we are willing to do to finance that.

Noone seems to know what "properly fund" actually looks like, and noone has any appetite for tackling waste, such as missed appointments, or IT outsourcing contracts. £10Bn flushed down the toilet on NPfIT, when you say "save our NHS" you are really saying "save CSC's shareholders", do you realize that?

https://www.theguardian.com/society/2013/sep/18/nhs-records-...

Windfall tax on Accenture et al I say.

Conflating IT mistakes (10bn over 20 years, 500m per year - peanuts, from a government perspective) with the entire NHS expenditure, is just misleading propaganda. This is why we can't have a civil debate on what the NHS should and should not provide: the fixation on cost-cutting and its opposite knee-jerk reactions stifle any attempt at reasoning about actual problems.

That's a really weird thing to say: are you asserting that the "right wing" is complaining about billions in public money being funnelled into the pockets of capitalist shareholders? Or is "right wing" just your word for "anyone who disagrees with me"?

I'll grow tired of it when the government stops doing business with these companies, insources all the IT work, and hits them with a windfall tax to claw it all back. Is that what you call "right wing"?

This is 20% of appointments. I in no way believe that 12 million people in the UK can't afford a fully refundable £10 deposit.

Anecdotally, in the UK this now normal. Apparently you have to beat the system by calling at a certain time and saying your problem is urgent. Obviously, all the people you are referring to know all about this; it's just suckers like me who have to suffer.

The NHS is free at the point of use in the UK - except for dentistry which is only free if you have a low income, etc.

Most folks (in my experience) go full on private and pay a monthly fee plus insurance. It isn't expensive (unless you need some major work doing) and the standard of dental care has improved many fold as a consequence.

For example I can book an appointment online at my GPs, so never have to phone anymore. I can normally get an appointment within a week.

Also a number of years ago I needed an MRI and CT scan. I had these 2 weeks after seeing my GP, whereas I know family members that live in a different area and have had to wait months for similar scans.

Edit: For some more data on UK NHS GPs see

* https://www.england.nhs.uk/statistics/statistical-work-areas...

* https://www.gp-patient.co.uk/

Absolutely, but that's exactly why these barriers exist: because dealing with the hoggers sucks up all available resources. It's not like GPs sit around, their time is still allocated for the most part. In a context where central government keeps squeezing GPs (forcing them to work longer hours for less pay than before), they have no incentive to do anything but to deal with the high-maintenance types. Some sort of external shock is required.

I had a similar experience with my local GP surgery, in a working-class area in the North of England. Doctors kept rotating (they would hire kids and other practitioners with no experience, who would then leave very quickly after they realized what the workload was), it was impossible to get an appointment, and more often than not one would just be dismissed with paracetamol. Then people discovered the feedback tool at https://www.nhs.uk/service-search , and inundated the surgery with bad reviews. This seems to have kicked the right asses in gear, and now it's much better. Mind, I still have to log on Patient Access right after midnight to get a same-day appointment, but at least I don't get dismissed once there...

Although NHS dental treatment isn't generally free for adults, it is pretty cheap. I've been lucky enough to find an NHS surgery everywhere I've lived and the standard of care has been generally excellent.

Maybe the growth of private clinics has had a positive effect on standards overall, though I know a lot of NHS dentists do a bit of both.

And I think essentially all NHS dentists do private work as well these days. The one bit of private work I've had done was a rear filling: standard amalgam was covered on the NHS tariff, but a cosmetic 'upgrade' to a white composite one was private and at cost.

May be good advice in general but I don't think that not being part of the NHS should be seen as something negative.

This mirrors my experience and stories from friends. The GP system just isn't designed for people who work. The only GP I can actually see is a private one near work, which I pay for directly (not covered by insurance - fortunately I rarely need to go).

I have private medical insurance paid for by my employer, but as far as I'm aware no one else I know has private insurance because despite its shortcomings the NHS gets the job done.

A bigger problem is that the justice system in India is (almost?) dysfunctional so good luck suing a private hospital if things go wrong. Your only hope is that the media picks it up, which can force the government to take action, e.g. [1].

[1] http://www.thehindu.com/todays-paper/tp-national/haryana-pro...

Doctors offering direct pay are cash only. They charge a small monthly fee. Here in Missouri it’s about $100/month. For that $100/month you get seen the same day!!! I haven’t been able to get seen by a doctor the same day since I was like 5 and that was 1980. Usually it’s a week or so before an appointment can be made. You also get an hour with the doctor. No rushing you in and out to increase turnover. Most things up to minor urgent care are included as well including stitches and lacerations. You only pay for materials used. Which is usually very cheap. A couple bucks for gauze. A couple for stitches. Medication and labs massively reduced from insurance rates. Flu shots are free. Etc

Direct pay providers are becoming more common as more and more doctors say “screw insurance and federal government red tape and regulations”. They are just absolutely done with the mess and pain of insurance and government regulations. Most even provide house calls! House calls! I haven’t seen a doctor do house calls since little house on the prairie!

Seriously if you are in the states look into it! The wife and I are more than likely moving to direct pay with a high dedeuctible catastrophic insurance plan this year and we will be saving over $500/month on our employee provided Cadillac insurance plan.