In this series of articles, medical students from across the country will discuss a range of topics from medical ethics to the NHS to public health to medical conditions to clinical governance.
The NHS was established in 1948 after the second world war, and provides free healthcare to all people ordinarily resident in the UK, apart from dental and optical treatment, which most people have to pay for, as well as prescription charges. Some treatment on the NHS is provided privately, though this is paid for by the NHS and still free at the point of use by patients.
However, private treatment outside of the NHS also exists, where patients, or their insurers pay for the treatment. Although the majority of healthcare is provided to patients in the UK on the NHS, the private healthcare market is worth almost £1.5 billion, with 70% of the treatment being funded by private health insurance. Is the existence of private healthcare ethical?
Private healthcare offers shorter waiting times or treatment that is not free on the NHS, greater choice of doctors, more convenient times for appointments and surgeries etc, which is better for patients, but some argue that it is unethical for the wealthy to be able to access better healthcare than others.
One of the biggest arguments against private healthcare is the inequality that comes with it – the wealthy are able to simply pay for treatment as and when they need, while those who cannot afford it have to face the long waiting lists, inconvenient times and locations, and crowded wards.
As doctors, the outcomes of the patient are arguably the most important factor when making any ethical decision. For each individual patient, if they have the means to access better healthcare, then surely it is ethical to do so. In other words, just because not all patients will be able to access one treatment, doesn’t mean it shouldn’t be denied to those who can.
One could go further to say that in fact, using private healthcare benefits those who access NHS care because it is one less patient that the NHS must deal with, and the private patient still pays towards the NHS in their taxes.
In addition, it can help to cope with the rising demand for resources, appointments, and beds in the NHS for the same reason. Indeed, one doctor even went so far as to say “if you care about the NHS, you should pay for private healthcare … you will help ease the burden on the NHS” (Dr Seth Rankin). Perhaps if you can afford private healthcare, perhaps you should leave the NHS for those who really need it.
Drawing Doctors Away from Working in the NHS?
However, there are huge arguments against this.
Firstly, although it seems that going privately may “ease the burden on the NHS”, one could argue that in fact paying for private healthcare means that you support the market – a market that draws doctors and other healthcare staff away from the NHS with the promise of vastly increased salaries, better hours and better working conditions.
The existence of private healthcare means that doctors who would otherwise be working for the NHS are no longer doing so. It is common for doctors to work both in the NHS and privately, to supplement their income – a BMA survey in 2009 suggested that about half of doctors in the UK did private work. The average NHS salary for a consultant is £117,700 per year, while consultants who work privately can earn in excess of £500,000, especially in high demand specialities, like orthopaedic surgery. Working privately therefore hugely benefits doctors and encourages them to spend less time in the NHS. Many doctors work part time both in the NHS and privately and some argue that this can detrimentally affect NHS patients too. The time that doctors spend working privately is time that they are unreachable should they be needed by their NHS work and vice versa, meaning that perhaps it can act as a distraction to their other work. In addition, working two jobs may have a conflict of interest. For example, an orthopaedic surgeon who works both in the NHS and privately probably obtains the majority of his/her income from private treatment. Most private patients are diagnosed on the NHS, and then only later seek private treatment – i.e. the patients on the list of the orthopaedic surgeon will be the same patients who might be thinking of private treatment.
Skipping the Queue?
One of the main reasons that patients choose to go privately is to skip the queue for treatment, but one of the NHS goals is to reduce waiting times. There is a direct conflict of interest between the surgeon and the NHS here – it is not in the surgeon’s interest to reduce waiting times if the long waiting times are what push patients to his/her private practice. Of course, any good doctor would practise solely with each individual patients’ best intentions in mind, but the conflict of interest is still there.
In addition, many argue that outcome from private healthcare are not better. Although private healthcare does offer faster treatment, generally at more convenient times and locations, the actual treatment at private practices is not necessarily better. Firstly, private hospitals are generally much smaller, and the vast majority don’t have ITU facilities should the patient need them.
If a patient becomes critically ill during private surgery, they are often transferred to NHS facilities, which also can put a further strain on the NHS.
A&E services are all provided by the NHS too – there is almost no emergency private provision – and private insurers often will not pay for treatment of chronic illnesses, meaning the NHS is a vital service to those living with persistent health conditions. Furthermore, because private practises are businesses as opposed to a government service, they must be focussed on not only the health outcomes of the patient, but how much money the patient is going to provide.
Treatments and scans are no longer necessary services, but commodities that can be bought and sold, and like all businesses, selling products is important for profit making. Follow up appointments, for example, may not always be necessary, but the patient still must pay for the time that they see the doctor for. Some argue that private practices place financial gain over health outcomes, putting profit over need.