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Методические рекомендации для студентов ii курса по теме Медицинское обcлуживание в Великобритании
Annotation of the text.
Introduction of key words:
TheNationalHealthService- Национальная система здравоохранения;
Insured persons- застрахованные люди;
To afford to pay-позволитьоплатить;
A form of charity- вид благотворительности;
A range of home and clinic service – ряддомашнихиклиническихуслуг;
Prevention-предотвращение, профилактика;
Freetochoose- свободны выбирать;
Accept private patients- принимать частных пациентов;
Thegreatmajority– подавляющее большинство.
Primary reading of the text
The National Health Service in Great Britain
The National Health Service was established throughout the United Kingdom on the 5th July, 1948. The National Health Service made it possible that the benefits once available only to insured persons or those who could afford to pay for them, or as a form of charity, became available to everyone. The Service consists of 3 main parts:
The General Practitioner (including dental) Service,
The Hospital and Specialist Service,
and a Local Health Authority Service (comprising a range of home and clinic service for prevention, treatment and care).
The public is free to use the Service, or any independent part of it, as it pleases. The patient is free to choose his doctor, and to change to another if he wishes to do so. The doctor may accept private patients while taking part in the Service. About 97 per cent of the whole population of Great Britain is using the Service. The great majority of specialists and practitioners are involved with the Service.
Discussing the contents of the text:
When was the National Health Service established?
How many parts does the Service consist of? What are they?
Are patients free to choose a doctor?
What part of population uses The Service?
4. Let’s discuss the contents of the text.
The text is entitled … .
The title of the text is … .
The headline of the text I have read is … .
The author of the text is … .
The article opens with the description of ...
The author starts by telling the reader that … .
Much is said about … .
According to the text … .
In conclusion the author says that … .
Text 2.
1. Description of the National Health Service
The National Health Service is under the control of the Minister of Health, who is advised by a central health services council made up of 41 persons, 35 of whom are appointed by the Minister himself, selected from the various groups dealing with the care of the sick. The NHS is administered by the civil servants of Whitehall-this is important to remember-and it is divided into three sections. The first one is the hospital services, the second is the medical practice services and the third is public health.
The hospital services control all the hospitals in Great Britain with the exception of a very few denominational hospitals. The whole country is divided into 14 regions arranged around one or more medical schools and administered by the regional hospital boards. These regional boards, 25% of whose membership are physicians, are responsible for all consultans’ and registars’ appointments in the hospital. Each hospital in turn is controlled by a hospital management committee. The 36 teaching hospitals are under the control of boards of governors which are independent of the regional hospital boards. Each hospital must submit in September its budget for the year commencing the following March and must return to the Treasury any unspent money. This makes planning extremely difficult and complicated and invariably results in the complete expenditure of all funds in order to avoid a smaller allocation the following year.
To the second section of the medical practices committee belong to the general practice of medicine which includes the general practitioner, the dentist, the oculist and the druggist. The section controlled by 163 local executive councils, which succeeded the national insurance committees, is responsible for personal medical services. There are at present in GB about 19,000 physicians for a population of 45 millions which is a proportion of one physician per 2,300 people.
In the third section of the public health service we find the health centres, the various clinics for pre-natal care, for school children, for vaccination, for immunization, for tuberculosis and for rehabilitation.
At the present time it should be pointed out that the medical services are not entirely free since the patient has to make a weekly contribution to the national insurance system and has to pay a certain fraction of the cost of the prescriptions, dentures, glasses, trusses and other medical accessories. About 95% of the medical profession receive their income through governments cheques. Almost all the hospitals and sanatoria belong to the government and the whole NHS is ultimately controlled by civil servants of the Ministry of Health. It is estimated that about 92-95% of the population in England is now under the NHS.
2. Cost of the National Health Service
The individual weekly contribution to the national insurance system varies between 35 cents for an unemployed person under 18 to $1.25 for a worker whose employer pays half of its amount. Less than 10% of the total contributions to the national insurance system or about $100 million went to the division of the NHS in the years 1950-1951. Since the total cost of the NHS in those years was 1.2 billion dollars, it means that 92% of the total cost oh NHS had to come from the general taxation moneys. This represents about 3.5% of the total government revenue, about 22% of the expenses of the national insurance system and about $27.00 per head of population.
One of the cornerstones of the NHS was intended to be the creation of health centres throughout the country. At the present time, because of the lack of money and the enormous cost of the other services, it has only been possible to build one or two. Each of these centres which would provide general medical, dental and public health services for a population of about 20,000 persons under the local health branch of the NHS would cost about $450,000. Such a centre would include six general practitioners, two dentists and one or two health officers. On this basis, greater London alone would need about 450 such centres.
3. Free services and contributory services
The vast majority of NHS services are free at the point of use.
This term, which is commonly used, means that people generally do not pay anything for their doctor visits, nursing services, surgical procedures or appliances, consumables such as medications and bandages, plasters, medical tests, and investigations, x-rays, CT or MRI scans etc. Hospital inpatient and outpatient services are free, both medical and mental health services. This is because these services are all pre-paid from taxation.
Because the NHS is not funded by contributory insurance scheme in the ordinary sense and most patients pay nothing for their treatment there is thus no billing to the treated person nor to any insurer or sickness fund as is common in many other countries. This saves hugely on administration costs which might otherwise involve complex consumable tracking and usage procedures at the patient level and concomitant invoicing, reconciliation and bad debt processing.
Eligibility for free NHS services is based on having "permanent residence status" (a birthright for some or granted by the Home Office for those who have immigrated). The person must be registered with a general practitioner and have an NHS card and number. This will include overseas students with a visa to study at a recognized institution for 6 months or more, but not visitors on a tourist visa for example.
Citizens of the EU holding a valid European Health Insurance Card and persons from certain other countries with which the UK has reciprocal arrangements concerning health care can likewise get emergency treatment without charge.
In England, from 15 January 2007, anyone who is working outside the UK as a missionary for an organization with its principal place of business in the UK is fully exempt from NHS charges for services that would normally be provided free of charge to those resident in the UK. This is regardless of whether they derive a salary or wage from the organization, or receive any type of funding or assistance from the organisation for the purposes of working overseas. This is in recognition of the fact that most missionaries would be unable to afford private health care and those working in developing countries should not effectively be penalized for their contribution to development and other work.
Those who are not "ordinarily resident" who do not fall into the above category (including British citizens who may have paid National Insurance contributions in the past) are liable to charges for services.
There are some other categories of people who are exempt from the residence requirements such as specific government workers and those in the armed forces stationed overseas.
Prescription charges
As of April 2009 the prescription charge for medicines was £7.20(which contrasts with Scotland at £4.00 and Wales and Northern Ireland where they are free). People over sixty, children under sixteen (or under nineteen if in full time education), patients with certain medical conditions, and those with low incomes, are exempt from paying. Those who require repeated prescriptions may purchase a single-charge pre-payment certificate which allows unlimited prescriptions during its period of validity. The charge is the same regardless of the actual cost of the medicine, but higher charges apply to medical appliances. For more details of prescription charges, see Prescription drugs.
The high and rising costs of some medicines, especially some types of cancer treatment, means that prescriptions can present a heavy burden to the PCTs, whose limited budgets include responsibility for the difference between medicine costs and the fixed prescription charge. This has led to disputes whether some expensive drugs (e.g. Herceptin) should be prescribed by the NHS.
The good points of the NHS
The main part of medical research in England depends on the Medical Research Council which is a government body, free of political influence. The characteristics of medical research in England are that the greatest part of the funds available come from one central body which is the MRC, that most of the work done under its grants is of good to superior quality and there is a minimum of useless duplication.
Medical care costs very little to the individual and there is no question that the public is satisfied.
The previously full time physicians in the hospitals receive a better income than before and are given the importance they deserve. Many of them are happy about the change.
The out-patient departments are given greater importance and better organization.
The most competent section of the medical profession, professors, consultants, and top research workers are given more importance than formerly in the advisory committees, in the organization and the development of the service.
It appears that that the British doctors have a reasonable income and are much happier in comparison with the rest of English society.
Weak points of the NHS
One of the most important failures of the NHS lies in its artificial administrative division into the three branches of the hospital services, general medical services, and public health, without any integration at any level. There is very little relationship between the consultant in the hospitals, the general practitioner and the public health officer. This often leads to misunderstanding and mutual ignorance. In the end it is the patient who suffers in this artificial no man’s land between the three divisions.
Animal experimentation is under the control of the civil servants of the Home Office, who sometimes has little or no knowledge of hospital problems, medical care or of medical research. Any experimentation involving the use of animal requires a written application to the Home Office. Permission is usually given without difficulty but still there are exceptions.
The private charitable and the voluntary welfare associations have been chocked and replaced by the cold, slow and impersonal machinery of the various government bodies.
Since the actual number of young physicians prepared for consultants’ posts is too great there is strong competition for these, as well as competition between consultants for the special awards, with all the unwelcome features attendant on these struggles.
Because of the number of certificates required and the impersonal character of hospital care, professional secrecy and discretion are in many instances things of the past.
Surgeons are paid by operating sessions and receive the same payment whether they do one appendectomy per operating session or four gastrectomies.
In the care of the aged, tuberculous patients, the chronically sick, the infirm and the patients with infected tonsils the situation is so bad that there is a waiting period of non-urgent cases of 6 months to 2 years before admission to the hospital and during that time the patient becomes a burden on the general practitioner.
In summary, the main weaknesses of the NHS consist of:
The lack of unity between the three divisions of general practice, public health, hospital services and consultants;
The excessive demands for services of the general practitioners which render them unable to give the necessary time to cases which deserve close attention;
The isolation of the general practitioners from hospitals, the long waiting list in all hospitals for non-urgent cases, and the lack of facilities for the aged and chronically sick patients.
Health Care Around the World: Great Britain
WRITTEN BY: JASON SHAFRIN - APR• 23•08
Great Britain represents all that is good and bad with centralized, single-payer health care systems. Health care spending is fairly low (7.5% of GDP) and very equitable. Long wait lists for treatment, however are endemic and rationing pervades the system. Patients have little choice of provider and little access to specialists.
Percent Insured.
100%
Funding. Great Britain has a single payer system funded by general revenues. With any centralized system, avoiding deficits is difficult. In 2006, Great Britain had a £700 million deficit despite the fact that health care spending increased by £43 billion over five years.
Private Insurance. 10% of Britons have private health insurance. Private health insurance replicates the coverage provided by the NHS, but gives patients access to higher quality care, and reduced waiting times.
Physician Compensation. Unlike in the case of other single payer systems such as Norway, most physicians and nurses are mostly government employees. In 2004, the NHS negotiated lower salaries for doctors in exchange for reduced work hours. Few physicians are available at night or on weekends. Because of low compensation, there is a significant shortage of specialists.
Physician Choice. Patients have very little physician choice. However, under the experimental London Patient Choice Project, patients waiting more than six months for treatment will be offered a choice of four different treatment providers.
Copayment/Deductibles. There are no deductibles and almost no copayments except for small copayments for prescription drugs, as well as for optical and dental care.
Waiting Times. Waiting lists are a huge problem in Great Britain. Some examples: 750,000 are on waiting lists for hospital admission; 40% of cancer patients are never able to see an oncologist; there is explicit rationing for services such as kidney dialysis, open heart surgery and care for the terminally ill. Further, minimum waiting times have been instituted to reduce costs. “A top-flight hospital like Suffolk Est PCT was ordered to impose a minimum waiting time of at least 122 days before patients could be treated or the hospital would lose a portion of its funding.”
Benefits Covered. The NHS system offers comprehensive coverage. Because of rationing, care might not be as easy to get as advertised. Terminally ill patients may be denied treatment. David Cameron has proposed that the NHS refuse treatment to smokers or the obese (see 7 Sept 2007 post).
Text 3.
Healthcare in the UK
Introduction
The UK lies in mainland Europe and is made up of Great Britain (England, Scotland and Wales), Northern Ireland and some smaller local islands. The United Kingdom is surrounded by the North Sea, the Atlantic Ocean, the Irish Sea, and the English Channel.
The National Health Service (NHS) of the United Kingdom
Funded through taxation, the NHS provides low-cost, and sometimes free, medical care to all its residents. Services that require a fee include dental treatments, medical prescriptions, eye tests, and spectacles. These charges are not applicable to children, people in receipt of unemployment benefit and pregnant women. The NHS general practitioners, along with hospital care consultations are practically free for all the residents of the UK. Hospitals and other medical facilities that provide free services are available in most parts of the country. However, there are only few dentists that offer NHS services.
Overseas visitors from non-European Union countries qualify for free emergency treatment at all NHS hospitals. However, they are required to pay for other medical services and in-patient treatments. The United Kingdom also has a reciprocal healthcare arrangement with a number of other countries including Australia and New Zealand, as well as a number of Eastern European countries. Nationals from these countries are, generally speaking, exempt from healthcare payments.
However, all other non-British residents have to pay for their medical and hospital treatments, unless their employer provides them with sufficient medical insurance.
If you are confused as to whether you qualify for the health service or not, try to visit the website of the Department of Health in the United Kingdom. It provides you with the detailed rules and procedures, along with documentation on access to UK hospitals and general healthcare, as well as other important healthcare information.
Visitors and expatriates are recommended to take out private health insurance before they arrive. |
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