NHS 65 - Philippines 67

[Doc Alan]

In July 1948 the UK National Health Service started ; 2 years previously the Philippines became independent.


Free health care for all – funded by taxation – was promised by UK Labour Health Minister Aneurin Bevan, and is largely true today. The Philippines is still aiming for universal health care – funded mainly through ( subsidised ) insurance.


Of course there are major differences between these two countries. Life expectancy at birth is almost a decade less in the Philippines than UK ( where it has increased by more than a decade since 1948 ). There are less resources – far fewer doctors ; smaller proportion of GDP ( 4% and 10% ), and 3% spending per person on health care in the Philippines, compared to UK.


Frequencies and types of illnesses vary between the two countries – yet now both have a predominance of " non-communicable " diseases, like cancers and heart conditions ( 3/5 deaths in Philippines ; 9/10 in UK ). An ageing population and advances in medical / surgical treatment are " double-edged swords " – costs keep rising.


There are major consequences of smoking, obesity and alcohol abuse for BOTH countries.


I’m not a GP ( my parents were ) and worked in hospitals both in UK and Malaysia. It’s not for me alone to defend health care workers and health services – we should ALL have a vested interest in how resources are used.


It would be interesting to know what members think is good about the UK health service – and how Philippines health care might be improved.


A recent topic concerned paying for " health tourism " ( although estimated cost of non-paying foreigners is less than 1% of total NHS spending ).


If health care was only freely available for those who fall ill through no fault of their own, costs would be dramatically less ! More is spend on screening / prevention in UK compared to Philippines. Many illnesses and some accidents are the results of " lifestyle choices ". But is it fair – or even possible - to make smokers, obese individuals, and abusers of alcohol pay more ?


A few examples of " services " which might be considered to require additional payment are cosmetic breast surgery; gastric band operations for weight loss ; sex change operations ; tattoo removal ; and IVF ( in vitro fertilisation ) treatment. Dental services could be cheaper ( or free ) when required. Could ( would ) you be prepared to pay more in taxation / insurance for health services ?



The private sector is already involved in UK health care to a limited extent – probably improving standards ; unlikely ever to fully replace " core " health services like A and E, coronary care, intensive care and cancer treatment. Are UK doctors and nurses paid too much or a fair amount ; do we need more; are they respected and trusted as much now ? Is the NHS safer with a Labour, Conservative, or other government ? Is it good ( as in England ) to devolve more health spending and responsibility to GP ( commissioning groups ) ?



Health care is a complicated and emotive topic. I don’t envy those having to make decisions - whether politicians ( mostly short term ) ; involved in rationing ( such as National Institute for Health and Care Excellence ) ; or looking after individual patients ( most of whom, in my opinion, are dedicated and caring ).


I wish all members, their families and friends, the best possible health for the future !

[imagine]

i would like to see the cause of waiting times to be seen, to be a priority sorted out, both for hospitals and local gp, other than that the nhs is a great thing for us to have,

i see often when i visit my gp surgery, a notice displayed of lost time for the gps and nurse appointments that patients have not turned up and not cancelled their appointments,
i would think that hospital appointments to see specialist suffer the same, their time is precious , perhaps like the dentist ,a charge for missed appointments should be introduced

[stevewool]

all i can say is it cannot carry on the way its going, i see some sort of insurance we all must take out per year just like the household insurance, just my thoughts

[Doc Alan]

Thank you Stewart and Steve for your responses and suggestions .


We call missed appointments “ DNA’s “ – did not attends ! Some kind of sanction – perhaps charging as some dentists do, or delaying re-appointment – is a good idea. It could be difficult to implement in the NHS and raises problems of actually ensuring the payment, or even deteriorating health before the new appointment. To be fair, also, patients don’t mind being kept waiting if an explanation is forthcoming ( doctor dealing with an emergency ), but long waits with no explanation are discourteous and inefficient.


As for insurance, it can’t be ruled out for the future. Personally I’m against it – predominantly insurance-based schemes, in the US for example, mean that health care accounts for almost twice the GDP ( 18% ) that the UK spends … for no better health.



Our BRITISH NHS does have problems – it’s being asked to do too much with too few clinical staff, and needs better integration with social care.



I await with interest to see how the new “ Chief Inspector “ of hospitals in England – Prof Sir Mike Richards – manages to recruit a "small army" of doctors, nurses, patients and carers to carry out inspections and ratings. This follows the publication of an independent review led by NHS medical director Sir Bruce Keogh. One problem will be recruiting suitable junior and senior doctors and nurses, who are already hard worked, as the intention is to inspect every department in every hospital.


While accepting a link between the Government of the day and health services, I don’t intend to take political sides. It’s likely that the current English Health Secretary is a “ caretaker “ who will not stay in that post after the next election. Those best placed to make decisions about health care are health care professionals who are in the job for enough years to have experience, before running out of ideas.


Furthermore, unless and until Scotland becomes independent – we have a UK Health Service, and the purpose of this thread was to compare it with that in the Philippines.

[Michael Parnham]

I also feel that self inflicted illness and injury should be paid for by those responsible!

[Michael Parnham]

With reference to Philippines, the Catholic church should pay for treatment of the people who can't afford to pay, after all the people of the Philippines give far more to the church than what it would cost to help cure the poor!

[imagine]

the catholic church must be a very rich organisation

[andy222]

This is a good post Doc there is so much to say about what has been said in the media recently. There has been a lot of talk about the lack of nurses and this maybe true. No body has mentioned health care assistance. They are the ones who give the basic care that patients need. I know from experience that there are not enough. Or should I say they are the ones who the NHS needs. I worked at a hospital the other night 1 Nurse and 2 health care assistants there were 23 patients on the ward. No wonder there are mistakes and patients neglected. I blame hospital excecutives in the NHS and politicians. Without the tools you cant do the job. As for the philippines it will never change it is too american orientated. Just my opinion and from experience.

[imagine]

too many chiefs and not enough indians

[Arthur Little]

too many chiefs and not enough indians

... that's certainly the case in BOTH the NHS and public sectors.

[Doc Alan]

Thanks Arthur, Michael and Stewart for your further thoughts.


The Catholic Church in the Philippines may be rich but may also be losing its power. It had to fight against the Reproductive Health Law for over a decade, and it seems that a majority of Filipinos don’t agree with its stance on contraception.


Making people pay – in addition to their taxes - for " self-inflicted " illnesses / injuries could be resisted, hard to implement. Many illnesses, including cancers and heart disease, have contributory " lifestyle choices ", such as smoking, excess alcohol and food intake, with lack of exercise. Of course there are indirect ways of payment, such as mimimum pricing for alcohol, increasing cost of cigarettes ( and plain packaging ), and " fat taxes " on unhealthy foods.


Andy’s post on healthcare assistants ( HCAs ) is interesting. HCAs provide vital and fundamental care patients, and people in the social care system. There are two proposals being considered ( in England ) :-
• Minimum training standards for HCAs in health and social care. This would improve safety, and allow progression up the career ladder ( for those who wished ).
• Student nurses should spend a minimum period of time ( 3 months up to a year ) doing work usually done by HCAs – “ hands-on caring experience “ to avoid the “ too posh to wash “ accusation that comes with the present academic training.