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My experience suggests that 400eur would get you this exact level of treatment in European private practice, although I suspect medical reports by WhatsApp would make most doctors fall foul of relevant data safety laws.

My (extensive) experience of South East Asia is that they’ll run many tests which a European Dr wouldn’t order with a straight face but that you don’t care because it’s generally pretty cheap.

> medical reports by WhatsApp

At least it has end-to-end encryption.

Apart from in-person (which is inconvenient) what's the alternative? Email? SMS? Post?

Provided it's a "good news" follow-up, of course.

One alternative is to require patients to attend a followup visit to have the report read to them, inconveniencing the patient and wasting insurance/taxpayer dollars.

I’ve had a private hospital give me an online portal to receive results, with online registration requiring the jumping through of many hoops

Cleveland Clinic does this, and it's amazing. The first time I went in they gave me a little sheet of paper that had a code to sign up to their site with (myChart) and now I can get all of my test results, make appointments, and message my doctor all online.

I’ve got a few doctor’s offices/clinics that are in MyChart. It’s wildly convenient. The app and site are generally poorly designed, but work well enough that I’d rather have it than not.

The Universal Health Network of hospitals in Ontario have recently started using an online portal as well - the interface is a little intuitive but it's so much better than the alternative

> My experience suggests that 400eur would get you this exact level of treatment in European private practice

One of the problems is actually that you cannot tell what a certain level of treatment will cost.

They need to run more tests because you don't mess around with many tropical diseases that just are not a problem in Europe

I wish. I don't know how to get this service in Israel, for any amount of money.

It's not red tape. It's the millions of (occasionally even aggressive) hypocondriacs, careless people who book appointments and then don't show up, über-entitled tossers who compensate their low status in life by trying to boss around their legally-mandated healthcare providers, and the highly-functioning mentally ill.

These people will hog any system. In some countries they are discouraged by high fees (your 40 euros in Bali are cheap for you but very expensive for locals), but those fees will then become a barrier for a lot of people who really need the service.

I honestly don't know the answer, but there must be ways to create barriers that are porous enough to let the genuinely ill people in and the hoggers out.

It's not red tape. It's the millions of (occasionally even aggressive) hypocondriacs, careless people who book appointments and then don't show up

Allegedy 1-in-5 NHS GP appointments are no-shows, costing north of a billion squids/year. The total NHS budget is £125Bn so that's nearly 1%. Which doesn't seem like a great deal but when you add on all the other waste such as people filling prescriptions they don't need it's going to be pretty significant.

We need a system where you pay a deposit say £10 for an appointment, refunded in full if you show up on time, say £5 if you are late. Because it has a knock on effect on other patients.

In the US, doctors run perpetually late throughout the day, so I doubt a no-show would affect their operations one way or the other. The patient pays for being on time by waiting.

> We need a system where you pay a deposit say £10 for an appointment, refunded in full if you show up on time, say £5 if you are late.

For many people having to pay a £10 deposit to place a doctor's appointment would be the difference between seeing the doctor or not. Especially near the end of the month there are people for whom £10 is the difference between eating or not eating.

There's a very real possibility that a small cash deposit could increase the rate of no-shows.

Right now, a lot of British people feel quite protective of the NHS. They see it as a scarce and precious resource that should be used sparingly. Many people feel a real sense of guilt if they inadvertently miss an appointment, because they feel that they're taking something away from someone who might need it more.

Converting this reciprocal relationship to a transactional relationship is very risky. Many people who would otherwise make an effort to keep their appointments could take the attitude that they're just paying for a service; the lost deposit takes away any guilt about missing the appointment. £10 is a fraction of the actual cost of a missed GP appointment, so the NHS could make a substantial net loss.

I think a far more productive approach would be to use behavioural nudges. It wouldn't be difficult or expensive to give an SMS or automated voice reminder of an appointment. People who persistently miss NHS appointments could be offered support in keeping to their appointments, while being gently reminded of the costs to the NHS and the effects on other patients. I suspect that a bit of psychological carrot-and-stick would be far more effective and far less risky.

They see it as a scarce and precious resource that should be used sparingly

This is not even slightly true. £11Bn a year is spent on Type 2 diabetes, 80% of which is caused by obesity (source: Diabetes UK). A&E every Friday and Saturday night is full of drunks. People take the NHS for granted.

take the attitude that they're just paying for a service

Well SOMEONE is paying for it. Generally, the people who can't get GP appointments...

An interesting real-life example of failed economical incitements is a case here a kindergarten started to charge an extra cost for "late pickups", ie later than the what the contract stipulated.

The end result was that "late pickups" increased as the shame of being late was replaced with a transaction fee, signalling that late pickups where allowed by the rules.

At what point do we hold people accountable? If a $10 fully refunded deposit is an insurmountable challenge (which, at least in the US does not at all apply to "many" people.) what would work?

We can't just allow people who give no thought to others, who make bad choice after bad choice, the option to continue to ruin it for the rest of us. I'm sympathetic to low income folks, but surely a 10 dollar deposit you get back if you simply do what you say you're doing to do, is not too much to ask?

As a UK resident earning a comfortable wage, I personally wouldn't mind paying a bit more, and hope the NHS continues to be easily accessible. Money can solve many problems, but these kind of "solutions" only adversely affect those don't have enough of it. It isn't like managing such a system has zero overhead.

Glad to hear I'm not the last bleeding heart liberal round here! The solution is to increase taxes and properly fund the NHS.

The solution is to increase taxes and properly fund the NHS.

What would you say that involves? The current budget is £125Bn, so are we looking at £150Bn, £200Bn, £500Bn? Put a number out there and we'll have a national debate on what we are willing to do to finance that.

Noone seems to know what "properly fund" actually looks like, and noone has any appetite for tackling waste, such as missed appointments, or IT outsourcing contracts. £10Bn flushed down the toilet on NPfIT, when you say "save our NHS" you are really saying "save CSC's shareholders", do you realize that?

https://www.theguardian.com/society/2013/sep/18/nhs-records-...

Windfall tax on Accenture et al I say.

Aren't you tired of rehashing the NPfIT failure, literally decades since it started and even 4 years since the press last covered it? It's just become a talking-point, a right-wing meme. The new systems are not faring much better; it's just a set of hard problems from an organizational perspective.

Conflating IT mistakes (10bn over 20 years, 500m per year - peanuts, from a government perspective) with the entire NHS expenditure, is just misleading propaganda. This is why we can't have a civil debate on what the NHS should and should not provide: the fixation on cost-cutting and its opposite knee-jerk reactions stifle any attempt at reasoning about actual problems.

It's just become a talking-point, a right-wing meme. The new systems are not faring much better

That's a really weird thing to say: are you asserting that the "right wing" is complaining about billions in public money being funnelled into the pockets of capitalist shareholders? Or is "right wing" just your word for "anyone who disagrees with me"?

I'll grow tired of it when the government stops doing business with these companies, insources all the IT work, and hits them with a windfall tax to claw it all back. Is that what you call "right wing"?

OK, so only apply this system to someone once they miss an appointment then. At some point people have to take a little bit of responsibility. If you don't need an appointment anymore just call and cancel. Oh but what about those who can't top up their phones? What about what about what about...

This is 20% of appointments. I in no way believe that 12 million people in the UK can't afford a fully refundable £10 deposit.

I haven't seen a GP for years although, because of age, I probably ought to just to get a few things checked out. The last time I tried to make an appointment I gave up after encountering a phone that just wasn't being answered - except for the time I got a message saying they were busy and to call back later.

Anecdotally, in the UK this now normal. Apparently you have to beat the system by calling at a certain time and saying your problem is urgent. Obviously, all the people you are referring to know all about this; it's just suckers like me who have to suffer.

The NHS is free at the point of use in the UK - except for dentistry which is only free if you have a low income, etc.

Most folks (in my experience) go full on private and pay a monthly fee plus insurance. It isn't expensive (unless you need some major work doing) and the standard of dental care has improved many fold as a consequence.

You highlight an interesting problem with the NHS that quality is extremely variable based on your location.

For example I can book an appointment online at my GPs, so never have to phone anymore. I can normally get an appointment within a week.

Also a number of years ago I needed an MRI and CT scan. I had these 2 weeks after seeing my GP, whereas I know family members that live in a different area and have had to wait months for similar scans.

Edit: For some more data on UK NHS GPs see

* https://www.england.nhs.uk/statistics/statistical-work-areas...

* https://www.gp-patient.co.uk/

> Obviously, all the people you are referring to know all about this; it's just suckers like me who have to suffer.

Absolutely, but that's exactly why these barriers exist: because dealing with the hoggers sucks up all available resources. It's not like GPs sit around, their time is still allocated for the most part. In a context where central government keeps squeezing GPs (forcing them to work longer hours for less pay than before), they have no incentive to do anything but to deal with the high-maintenance types. Some sort of external shock is required.

I had a similar experience with my local GP surgery, in a working-class area in the North of England. Doctors kept rotating (they would hire kids and other practitioners with no experience, who would then leave very quickly after they realized what the workload was), it was impossible to get an appointment, and more often than not one would just be dismissed with paracetamol. Then people discovered the feedback tool at https://www.nhs.uk/service-search , and inundated the surgery with bad reviews. This seems to have kicked the right asses in gear, and now it's much better. Mind, I still have to log on Patient Access right after midnight to get a same-day appointment, but at least I don't get dismissed once there...

Dentistry's an odd one. In some parts of the country it certainly used to be essentially impossible to get an NHS dentist, and in others it's easy. There are multiple dental surgeries accepting new NHS patients in Oxford, for example, which is by no means a cheap place to operate.

Although NHS dental treatment isn't generally free for adults, it is pretty cheap. I've been lucky enough to find an NHS surgery everywhere I've lived and the standard of care has been generally excellent.

I have heard similar elsewhere, NHS dentistry used to be pretty awful when I was a kid - many people developed phobias that they never got over with obvious consequences.

Maybe the growth of private clinics has had a positive effect on standards overall, though I know a lot of NHS dentists do a bit of both.

I'm told by my dad that his (private) dentist as a kid also used to be awful; whereas my (NHS) dentist was great. Though I'm told that surgery went downhill when our dentist retired. Very hard to separate out what's going on.

And I think essentially all NHS dentists do private work as well these days. The one bit of private work I've had done was a rear filling: standard amalgam was covered on the NHS tariff, but a cosmetic 'upgrade' to a white composite one was private and at cost.

As a general principle, be wary of any practitioner who doesn't also do NHS work. The CPD and peer-review keep them on the straight and narrow.

I'm not sure about this since my dentist is a dental surgeon way above the grade of an average practitioner.

May be good advice in general but I don't think that not being part of the NHS should be seen as something negative.

Anecdotally, in the UK this now normal. Apparently you have to beat the system by calling at a certain time and saying your problem is urgent. Obviously, all the people you are referring to know all about this

This mirrors my experience and stories from friends. The GP system just isn't designed for people who work. The only GP I can actually see is a private one near work, which I pay for directly (not covered by insurance - fortunately I rarely need to go).

> Most folks (in my experience) go full on private and pay a monthly fee plus insurance.

I have private medical insurance paid for by my employer, but as far as I'm aware no one else I know has private insurance because despite its shortcomings the NHS gets the job done.

Yeah this is almost the same experience in India too. Specialists like orthopedics, ob-gyn, etc. are often walk-in or same day appointments, and finish everything for under $50-$100. The only drawback with the overall health system in India is that there is mind boggling inequality. Easy access to specialists is true in big cities in good neighborhoods, but hospitals and healthcare can truly be medieval in remote or poor villages.

There's also a massive variation in standards. You'd think price and quality are correlated but one does have to perform due diligence as private hospitals routinely overcharge and prescribe unnecessary tests/procedures.

A bigger problem is that the justice system in India is (almost?) dysfunctional so good luck suing a private hospital if things go wrong. Your only hope is that the media picks it up, which can force the government to take action, e.g. [1].

[1] http://www.thehindu.com/todays-paper/tp-national/haryana-pro...

We know that over-testing, over-diagnosis, and over-treatment causes harm, so while what you describe may have been useful for your partner it's harmful when applied to a population.

I'm too scared now to lookup difference in price for an ambulance (after calling 911/112)..

You don't need to look it up, just subtract $0 to know the difference: ambulances are free in most countries.

Oh having been in a few, i know the bill is 1000'ish euros in NL, sure insurance 'pays'. And i still have to pay my insurance, which goes up every year.

It's about 1000$ in Switzerland. But if it was emergency or an accident your health insurance will pay.

What you just described honestly sounds a lot like direct pay here in the states. If you google “direct pay doctors” in your city you will find some.

Doctors offering direct pay are cash only. They charge a small monthly fee. Here in Missouri it’s about $100/month. For that $100/month you get seen the same day!!! I haven’t been able to get seen by a doctor the same day since I was like 5 and that was 1980. Usually it’s a week or so before an appointment can be made. You also get an hour with the doctor. No rushing you in and out to increase turnover. Most things up to minor urgent care are included as well including stitches and lacerations. You only pay for materials used. Which is usually very cheap. A couple bucks for gauze. A couple for stitches. Medication and labs massively reduced from insurance rates. Flu shots are free. Etc

Direct pay providers are becoming more common as more and more doctors say “screw insurance and federal government red tape and regulations”. They are just absolutely done with the mess and pain of insurance and government regulations. Most even provide house calls! House calls! I haven’t seen a doctor do house calls since little house on the prairie!

Seriously if you are in the states look into it! The wife and I are more than likely moving to direct pay with a high dedeuctible catastrophic insurance plan this year and we will be saving over $500/month on our employee provided Cadillac insurance plan.

We get same day with our pediatrician, albeit we often end up waiting for along time.

I wonder if wait times and insurance pain points are the same for pediatricians vs normal general practice doctors?