Text 2. The National health Service

The NHS (National Health Service is commonly referred to by this abbreviation) is generally regarded as the jewel in the crown of the welfare state. Interestingly, it is very ‘un-British’ in the uniformity and comprehensiveness of its organization. When it was set up it did not, as was done in so many other areas of British public life, accommodate itself to what had already come into existence. Instead of entering into a partnership with the hundreds of existing hospitals run by charities, it simply took most of them over. The system is organized centrally and there is little interaction with the private sector. For instance, there is no working together with health insurance companies and so there is no choice for the public regarding which health insurance scheme they join. Medical insurance is organized by the government and is compulsory.

However, in another respect the NHS is very typically British. This is in its avoidance of bureaucracy The system, from the public’s point of view, is beautifully simple. There are no forms to fill in and no payments to be made which are later refunded. All that anybody has to do to be assured the full benefits of the system is to register with a local NHS doctor. Most doctors in the country are General Practitioners (GPs) and they are at the heart of the system. A visit to the GP is the first step towards getting any kind of treatment. The GP then arranges for whatever tests, surgery, specialist consultation or medicine are considered necessary. Only if it is an emergency or if the patient is away from home can treatment be obtained in some other way.

As in most other European countries, the exceptions to free medical care are teeth and eyes. Even here, large numbers of people (for example, children) do not have to pay and patients pay less than the real cost of dental treatment because it is subsidized.

The modern difficulties of the NHS are the same as those faced by equivalent systems in other countries. The potential of medical treatment has increased so dramatically, and the number of old people needing medical care has grown so large, that costs have rocketed. The NHS employs well over a million people, making it the largest single employer in the country. Medical practitioners frequently have to decide which patients should get the limited resources available and which will have to wait, possibly to die as a result.

In the last quarter of the XX^th century, the British government has implemented reforms in an attempt to make the NHS more cost-efficient. One of these is that hospitals have to use external companies for duties such as cooking and cleaning if the cost is lower this way. Another is that hospitals can ‘opt out’ of local authority control and become self-governing ‘trusts’ (i.e. registered charities). Similarly, GPs who have more than a certain number of patients on their books can choose to control their own budgets. Together these two reforms mean that some GPs now ‘shop around’ for the best-value treatment for their patients among various hospitals.

These changes have led to fears that commercial considerations will take precedence over medical ones and that the NHS system is being broken down in favour of private health care. And certainly, although pride and confidence in the NHS is still fairly strong, it is decreasing. There has been steady rise in the number of people paying for private medical insurance in addition to the state insurance contribution which, by law, all employed people must pay.

In fact, though, Britain’s health system can already claim cost-efficiency. The country spends less money per person on health care than any other country in the western world. One possible reason for this is the way that GPs are paid. The money which they get from the government does not depend on the number of consultations they perform. Instead, it depends on the number of registered patients they have – they get a ‘capitation’ allowance for each one. Therefore, they have no incentive to arrange more consultations than are necessary. It is in their interest that their patients remain as healthy as possible, so that they can have more patients on their books. The other possible reason is the British ‘stiff upper lip’. In general, people do not like to make a big drama out of being ill. If the doctor tells them that there is nothing to worry about, they are likely to accept this diagnosis. Partly as a result of this, British GPs prescribe significantly less medicine for their patients than doctors in other countries in Europe do.

When it was set up, the NHS was intended to take the financial hardship out of sickness – to offer people medical insurance ‘from the womb to the tomb’. In this respect, despite the introduction of charges for some kinds of treatment, it can still claim to be largely successful.

Exercise 1. Answer the following questions:

1. How can you comment upon the following seemingly controversial statements: ‘The NHS… is very ‘un-British’’ and ‘The NHS is very typically British’?

2. How do you understand the statement ‘GPs are at the heart of the NHS’?

3. Dwell upon the difficulties the NHS faces nowadays.

4. Describe the reforms of the NHS and the results they led to.

5. Describe the way GPs are paid in Britain.

Exercise 2. Find English equivalents for the following words and word combinations:

Благодійні лікарні, компанії зі страхування здоров’я, медична страховка, зареєструватися у місцевого лікаря з Національної Служби Охорони Здоров’я, терапевт, лікування, домовитися про..., організувати здачу аналізів, операції, спеціальні консультації, безкоштовне медичне обслуговування, лікування зубів, виходити з-під контролю місцевої влади, приватне медичне обслуговування, проводити консультації, зареєстрований пацієнт, діагноз, прописувати ліки.

Exercise 3. Translate into English:

Пацієнти в Британії можуть вибирати з цілої низки приватних, державних та благодійних лікарень.

Пацієнт в Великій Британії може отримати безкоштовне медичне обслуговування. Виключенням є лікування зубів та очей. Але і тут сплачувати доводиться менше фактичної вартості, бо ці види медичного обслуговування субсидуються державою.

Терапевти в Великій Британії отримують зарплату залежно від кількості зареєстрованих у них пацієнтів. Як наслідок, вони зацікавлені в розширенні своєї клієнтури та підвищенні якості обслуговування.

Британці не люблять скаржитися на захворювання, тому їм прописують набагато менше ліків, ніж пацієнтам в інших країнах Європи.

Реформи НСОЗ дозволили лікарням виходити з-під контролю місцевої влади та займатися самоврядуванням. Крім цього, терапевти отримали можливість самостійно контролювати свій власний бюджет та більш ефективно організовувати консультації, операції та різні тести.