1A - 1C6 Flashcards
How many people does PMI cover in the UK?
7 million
When was the NHS set up?
1948
National Insurance Act 1911
David Lloyd George created a comprehensive scheme to provide national insurance for a range of risks for working people.
National Insurance Scheme eligibility
All manual and low-paid non-manual employees for less than four pence.
NHS Act 1946
Established by Minister of Health Bevan – effected in 1948.
NHS concept
Healthcare free at point of use for every citizen.
How are GPs contracted?
Continue to be self-employed, but have a contract with the NHS and paid per patient (although some are now salaried members of GP practices)
NHS projected costs
1944 – £132/y
1946 – £110m/y
1947 – £179m
1949 – actual cost was much higher at £248m and this grew to £384m in 1950/51
NHS charges imposed
IN1 951, charges on spectacles, dental treatment and prescriptions.
How was NHS made equitable?
Priority given to emergencies and those with the greatest medical need.
How many people work for the NHS?
Around 1.6m (full-time 1.4m) of which 1.3m are in England – GPs, dentists, optometrists excluded
NHS funding pressures
- Effects of an ageing society
- Medical developments
- Drug costs
- NHS funding has to grow above inflation each year
Ways of improving NHS productivity
- More day surgery
- Improved medicines
- Closing inefficient wards
NHS devolvement
Each country is separately funded and managed, setting its own budgets
NHS cost 21/22
£159bn
NHS cost for COVID-19
£22.4b
NHS charges
- Prescriptions
- Eye care
- Dentistry (although some exempt based on age or income)
- Other services such as treating road accident victims and personal injuries where a third party is to blame
- Patient telephone calls
- Hospital parking
- Vaccinations
- Insurance claims forms
NICE
National Institute for Health and Care Excellence – recommends which treatments the NHS should and should not provide
Advantage of NICE
Better treatment for all (no postcode lottery – where the best treatment depends on where you live)
Disadvantage of NICE
Acts to restrict certain health treatments, especially where the economic cost is too great or the
treatment does not provide good value for money
Health and Social Care Act 2012
Outlines how the NHS is structured
Secretary of state and Department of Health and Social Care
Provide strategic leadership
GP-Led clinical commissioning groups
Responsible for commissioning services from
local hospitals, meaning that decision-making is close to patients –
manage around 80% of the NHS budget
HealthWatch and local health boards
Exist within local councils as a forum for local commissioners
Trusts and foundation trusts
Trusts can become foundation trusts through independent regulation (these have more local autonomy)
Public Health England
Exists to provide national leadership in support of public health
NHS England and NHS Improvement
Independent body responsible for health in
England
When did Department of Health and social care stop publishing waiting list times?
2009
Median wait for NHS hospital admission (as of Apr 22)
12.6 weeks
Standard government waiting time
18 weeks
NHS constitution waiting list rights for non-urgent conditions
Right to start consultant-led treatment within a max of 18 weeks
NHS constitution waiting list rights for suspected cancer
Maximum of two weeks
NHS constitution rights when cancer is diagnosed
Maximum wait of 31 days from diagnosis to the first definitive treatment for all cancers
Contracting with privately run treatment centres
Privately run treatment centres contract with the NHS to provide a specified number of
treatments a year at a fixed price – This takes some pressure off the NHS & centres are not likely to be
disrupted by emergencies, which can affect general hospitals
What happens where NHS patients cannot get key treatments within a fixed timescale?
They may choose to
be treated at another hospital and this may include private and overseas hospitals. The
NHS e-Referral service allows patients to book an appointment with a specialist and to
pick from a choice of hospitals.
What % of income can NHS earn from private patients?
Up to 49%
NHS principles
- NHS provides a comprehensive service to all.
- Access based on clinical need, not on an individual’s ability to pay.
- NHS aspires to the highest standards of excellence and professionalism.
- NHS aspires to put patients at the heart of everything it does.
- NHS works across organisational boundaries
- Committed to providing best value for taxpayers’ money
- NHS is accountable to the public, communities and patients that it serves.
What are six reasons the private sector is different to the public sector?
- Waiting lists and choice of time
- Choice of facilities
- Choice of specialist
- Exclusive technology
- No ICU
- No A&E
Advantages of choosing facilities
– No need to share a room
– Fewer HCAIs
HCAI
Healthcare-associated infections
Emergencies
Sudden or unexpected illnesses or injuries that need immediate hospital attention
Comp/alternative med
Therapies outside of ‘traditional’ medicine
Cosmetic surgery
Non-essential surgery to change appearance (usually excluded from PMI unless direct consequence from treatment)
Surgicentres/specialist hospitals
Independent sector treatment centres
Advantages of PMI
- Waiting lists and admission times
- Choice of consultant
- Choice of facilities (private room) (cleaner hospitals )
- Exclusive treatments
What was the NHS private hospital income in 2016/17?
£620m
Routine PMI exclusions
- Pregnancy
- Chronic
- Long-term disability or psychiatric illness
- Comp-med
- Cosmetic surgery
Provident insurers
– Non-profit making organisations
– No shareholders
– All surpluses part of reserves (not subject to corp tax)
– Cannot attract tax relief from losses
Provident Associations governance
Governed by FSA 2012 and 2016 and subject to insurance company solvency rules including Solvency II
MGA
Managing general agent – insurance agent or broker granted underwriting authority by an insurer or Lloyd’s syndicate.
Advantages of MGAs
- Market its own products and use brand to access potential customers
- Underwriter can gain access to insurance market without risking reputation
- Economies of sclae for underwriter (if underwriting more than one scheme)
Purpose of wellbeing providers
- Reduced sickness absence
- Improved employee health
- Better mgment of long-term conditions
- Greater fitness levels
- Better MI for employees
- Caring employer image
- Minimising employees’ costs
