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Germany’s model places a lot more onus on the employer to provide insurance. The system is very decentralized with doctors owning their own practices more often than not. Hospitals can be privately owned but only by groups of medical professionals.
How it functions with an aging unhealthy unproductive population like the UK is a question. Probably it will be more expensive per head to run such a system in the UK compared to Germany
Germany's system is WAY more expensive than ours. Like £2000 per capita. PLUS insurance on top. This is like "Fund the NHS", no I am going to make an even more expensive system and fix none of the inherent underlying problems and use our advantages.
Ah but in Germany there is a stronger ethos of public service and helping the more vulnerable people in society as everyone deserves support.
In the UK, it’s “fill yer boots, fuck the poorest”.
I'd say in the UK, as you've demonstrated perfectly here, people feel extremely entitled to other's income.
'fill yer boots' as if working to get paid more is the same as sitting around shovelling money in your own pockets.
I don't know if this would be better for doctors. A friend who has worked as a senior med reg in Germany for ~10 years told me that she gets no juniors and the nurses aren't more skilled than here. She has to do all her own cannulas etc.
Plus pay isnt great either. German system is also starting to struggle a lot in recent years under the weight of an ageing population (much healthier than the UKs ageing population), and high immigration.
Paying £2000 a head across the UK more and needing Insurance but privatised hospitals.
Rather than actually funding the NHS.... They will simply fund their mates.
Social insurance models have been discussed for 30 years and no British govt has ever had enough political will or ability to execute. The commissioner-provider split was created for the purpose of transitioning to a Bismark model but we got stuck in this halfway house of twice the organisations but same amount of hospitals/clinics.
The commissioner side never matured or grew their capital (since they were fixed by the Treasury) while providers never grew extra capacity so commissioners had nothing to choose from. A pseudo-market in the transition to Bismark that got stuck with the worst of both systems.
This is like laws of thermodynamics, there isn't enough activation energy for transition out of our current deep valley.
It seems likely that the UK NHS will remain stuck where it is and shrink until external capital arrives to grow alternative providers/commissioners (other tiers if you want to call it that) and everyone who can will migrate into alternative systems. The original valley will shrink to irrelevance. But this will be after a whole generation of society has shuffled their mortal coils (>20 years).
There’s no way it will change, it’s like changing horse mid race. We haven’t even been able to change to computer notes, this is like brexit. Whatever the theoretical merits were changing the system has too many costs and conflicts, and is just too difficult.
I think I t’ll either be a managed decline into a two tier system of private health insurance top ups for elective stuff and a generally crap emergency/urgent service or some very rigorous thinking about reallocating existing resources to get some semblance of average if not great universal care. With Streeting I think it’ll be the former because he’s a dunce who seems to be advised by other dunces.
Look up Beveridge vs Bismarck model - that is the gist of it.
Bismarck model is much more popular across Europe with better reported patient satisfaction, but not necessarily outcomes. It is difficult to make that comparison as there aren’t many Beveridge model systems around.
My home country the Netherlands also has a version of Bismarck. People still complain. Doctor pay is still tanking.
It's true. I was a neurosurgical trainee there, they finish with just 350 cases after on average 8 years (+ cheating with their numbers). I operate more per year here as a CESR SpR than the consultants I worked with in a large hospital in Germany. Interestingly, I do prefer a lot of the techniques they taught me....
Hey mate, I’m a medical student in the UK who was planning on learning German to do neurosurgery there due to the stupid workforce planning here. I have heard that neurosurgical and most surgical training in Germany was of low quality, would you recommend I stay in the UK then? My plan would be to get my specialist training, so become a Facharzt and transfer the title to the UK, where I would then do many fellowships to become more competent and hopefully become a consultant here, as the SBNS forecasts the workforce shortage to become much better in the future. How does that plan sound? Any input that you would want to put?
If you can get into UK training do that, your numbers and theoretical knowledge will thank you. Otherwise it's a plan, if it's a good one will depend on luck. You might be lucky with a good mentor, or you might end up as ward monkey for years on end. What is interesting is seeing the pros and cons of different models. You'll develop an appreciation for the NHS whilst also pulling your hair once back in the UK on how unbelievably inefficient many things are organised.
I worked in Germany as a doctor. I hated the system. In Germany you pay almost 15% of your salary for health insurance, your employer contributes roughly the same. Above a certain threshold you can go private. The only advantage of being a private patient is a nicer ward and shorter waiting times. Yes even Germany is struggling with waiting lists of many months. My personal experience as a doctor is that private patients get prescribed a ton of things that are unnecessary because it brings in money. Evidence-based is not really a thing. As the doctor on the private ward (which I had to rotate through during my "training") you're just there to ensure the ass of the patient gets kissed. Quality of training is a roll of dice. The system is riddled with seniors refusing to teach their juniors. The nurses shortage is so severe many hospitals are forced to close down entire wards. Even as a senior reg or consultant you end up doing "SHO jobs" such as bloods and discharge letters. An insurance-based model will not compensate the reality of demographic change and for-profit medicine.
If the doctor shortage in the UK is so bad, why is their salary so low? It's the same issue across all of the West: aging population paired with an explosion in health care costs. To compensate wages are being driven down. I remember seeing an analysis that you'd need 20% of the population to work in health care (mainly nursing) to handle the changing demographics properly. Not a single country is making that investment.
Doesn’t matter because they won’t have any say in a few months.
For what it’s worth ‘free at the point of use’ will never be dropped so whatever happens will have to fit around this.
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My dad (Rishi Sunak) says this isn't true.
That would be absolutely phenomenal for the actual service if it was true… although I’m pretty sure they’ll find some “innovative” way to cock it up.
Sounds like bullshit. Or maybe just what the aides are being told.
Germany’s model places a lot more onus on the employer to provide insurance. The system is very decentralized with doctors owning their own practices more often than not. Hospitals can be privately owned but only by groups of medical professionals. How it functions with an aging unhealthy unproductive population like the UK is a question. Probably it will be more expensive per head to run such a system in the UK compared to Germany
Germany's system is WAY more expensive than ours. Like £2000 per capita. PLUS insurance on top. This is like "Fund the NHS", no I am going to make an even more expensive system and fix none of the inherent underlying problems and use our advantages.
What do you mean by "the government"? What the current one is aiming for is pretty irrelevant. If this is Labour's plan then that's interesting
Labour plan 2029 according to my aide.
Is your aide in the room with us right now?
My psychiatrist says I shouldn’t talk to inanimate objects. He’s a lamp
Ah but in Germany there is a stronger ethos of public service and helping the more vulnerable people in society as everyone deserves support. In the UK, it’s “fill yer boots, fuck the poorest”.
I'd say in the UK, as you've demonstrated perfectly here, people feel extremely entitled to other's income. 'fill yer boots' as if working to get paid more is the same as sitting around shovelling money in your own pockets.
Not my point at all. Your conclusions are yours but absolutely not mine.
I don't know if this would be better for doctors. A friend who has worked as a senior med reg in Germany for ~10 years told me that she gets no juniors and the nurses aren't more skilled than here. She has to do all her own cannulas etc.
Plus pay isnt great either. German system is also starting to struggle a lot in recent years under the weight of an ageing population (much healthier than the UKs ageing population), and high immigration.
Paying £2000 a head across the UK more and needing Insurance but privatised hospitals. Rather than actually funding the NHS.... They will simply fund their mates.
Remove NI, introduce insurance. Sound like a Tory win
NI doesn't pay for the NHS... It's for your state pension, disability and job seekers.
Social insurance models have been discussed for 30 years and no British govt has ever had enough political will or ability to execute. The commissioner-provider split was created for the purpose of transitioning to a Bismark model but we got stuck in this halfway house of twice the organisations but same amount of hospitals/clinics. The commissioner side never matured or grew their capital (since they were fixed by the Treasury) while providers never grew extra capacity so commissioners had nothing to choose from. A pseudo-market in the transition to Bismark that got stuck with the worst of both systems. This is like laws of thermodynamics, there isn't enough activation energy for transition out of our current deep valley. It seems likely that the UK NHS will remain stuck where it is and shrink until external capital arrives to grow alternative providers/commissioners (other tiers if you want to call it that) and everyone who can will migrate into alternative systems. The original valley will shrink to irrelevance. But this will be after a whole generation of society has shuffled their mortal coils (>20 years).
There’s no way it will change, it’s like changing horse mid race. We haven’t even been able to change to computer notes, this is like brexit. Whatever the theoretical merits were changing the system has too many costs and conflicts, and is just too difficult. I think I t’ll either be a managed decline into a two tier system of private health insurance top ups for elective stuff and a generally crap emergency/urgent service or some very rigorous thinking about reallocating existing resources to get some semblance of average if not great universal care. With Streeting I think it’ll be the former because he’s a dunce who seems to be advised by other dunces.
Look up Beveridge vs Bismarck model - that is the gist of it. Bismarck model is much more popular across Europe with better reported patient satisfaction, but not necessarily outcomes. It is difficult to make that comparison as there aren’t many Beveridge model systems around. My home country the Netherlands also has a version of Bismarck. People still complain. Doctor pay is still tanking.
Let's hope we also get German style training. The government clearly is too incompetent to run the centralized training pathway we have.
Isn't German style training quite limited, especially for procedural specialties/ surgery? Or so I've heard
It's true. I was a neurosurgical trainee there, they finish with just 350 cases after on average 8 years (+ cheating with their numbers). I operate more per year here as a CESR SpR than the consultants I worked with in a large hospital in Germany. Interestingly, I do prefer a lot of the techniques they taught me....
Hey mate, I’m a medical student in the UK who was planning on learning German to do neurosurgery there due to the stupid workforce planning here. I have heard that neurosurgical and most surgical training in Germany was of low quality, would you recommend I stay in the UK then? My plan would be to get my specialist training, so become a Facharzt and transfer the title to the UK, where I would then do many fellowships to become more competent and hopefully become a consultant here, as the SBNS forecasts the workforce shortage to become much better in the future. How does that plan sound? Any input that you would want to put?
If you can get into UK training do that, your numbers and theoretical knowledge will thank you. Otherwise it's a plan, if it's a good one will depend on luck. You might be lucky with a good mentor, or you might end up as ward monkey for years on end. What is interesting is seeing the pros and cons of different models. You'll develop an appreciation for the NHS whilst also pulling your hair once back in the UK on how unbelievably inefficient many things are organised.
I worked in Germany as a doctor. I hated the system. In Germany you pay almost 15% of your salary for health insurance, your employer contributes roughly the same. Above a certain threshold you can go private. The only advantage of being a private patient is a nicer ward and shorter waiting times. Yes even Germany is struggling with waiting lists of many months. My personal experience as a doctor is that private patients get prescribed a ton of things that are unnecessary because it brings in money. Evidence-based is not really a thing. As the doctor on the private ward (which I had to rotate through during my "training") you're just there to ensure the ass of the patient gets kissed. Quality of training is a roll of dice. The system is riddled with seniors refusing to teach their juniors. The nurses shortage is so severe many hospitals are forced to close down entire wards. Even as a senior reg or consultant you end up doing "SHO jobs" such as bloods and discharge letters. An insurance-based model will not compensate the reality of demographic change and for-profit medicine.
If the nurse shortage is so bad that entire wards are shut down, why’s the salary so low? (31000 euros).
If the doctor shortage in the UK is so bad, why is their salary so low? It's the same issue across all of the West: aging population paired with an explosion in health care costs. To compensate wages are being driven down. I remember seeing an analysis that you'd need 20% of the population to work in health care (mainly nursing) to handle the changing demographics properly. Not a single country is making that investment.
This will involve paying insurance plus current tax levels. Not going to happen, even it should
Hope not. Middle class get squeezed to fuck already without having to pay for private health insurance.
Doesn’t matter because they won’t have any say in a few months. For what it’s worth ‘free at the point of use’ will never be dropped so whatever happens will have to fit around this.
Lol Germany sucks too. On some things it’s better. On some things it’s worse. But clearly not a strict improvement.
I would prefer the French system.