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Access controls and waiting lists

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In making health care a largely "invisible cost" to the patient, health care seems to be effectively free to its consumers - there is no specific NHS tax or levy. To reduce cost and ensure that everyone is treated equitably there are a variety of "gatekeepers." The GP ( General Practitioners ) functions as a primary gatekeeper - without referral from a GP, it is often impossible to gain higher courses of treatment, such as an appointment with a consultant. These are argued to be necessary - Welshman Bevan noted in a 1948 speech in the House of Commons, "we shall never have all we need... expectations will always exceed capacity". On the other hand, the national health insurance systems in other countries (e.g. Germany) have dispensed with the need for referral; direct access to a specialist is possible there.

There has been concern about opportunistic "health tourists" travelling to Britain (mostly London) and using the NHS while paying nothing. British citizens have been known to travel to other European countries to take advantage of lower costs, and because of a fear of hospital-acquired superbugs and long waiting lists.

NHS access is therefore controlled by medical priority rather than price mechanism, leading to waiting lists for both consultations and surgery, up to months long, although the Labour government of 1997-onwards made it one of its key targets to reduce waiting lists. In 1997, the waiting time for a non-urgent operation could be two years, there were ambitions to reduce it to 18 weeks despite opposition from doctors. It is contested that this system is fairer - if a medical complaint is acute and life-threatening, a patient will reach the front of the queue quickly.

The NHS measures medical need in terms of quality-adjusted life years (QALYs), a method of quantifying the benefit of medical intervention. It is argued that this method of allocating healthcare means some patients must lose out in order for others to gain, and that QALY is a crude method of making life and death decisions.


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