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More on British medical care

Basic medical help is free in the UK, we have already talked about that. You don’t need any identification to walk into a hospital emergency room or an NHS Walk-in Centre to get assistance. You may even be able to arrange an appointment with a local doctor when you need it, on availability basis.

If you live in the UK, though, you are expected to be registered with a GP (which means “general practitioner” and conversationally universally used in the abbreviated form). The idea is very similar to the primary care physician concept: Not only is your GP a doctor who knows you well and who possibly has been your physician for many years, but (s)he also guards the strings of the purse that holds the public money that might be spent on your treatment, having an important say on whether you need any, and what.

So, a Brit with a medical problem is likely to go see his/her GP for an initial consultation, and then, if needed, be referred to a specialist. The physicians’ pay – whether GPs, or specialists within NHS, – is mostly the function of the size of the practice, and the margin earnings rate for each additional visit is puny enough so that there is little incentive to see the patient more than minimally necessary. Plus, no doubt, every GP is incentivized to expend as little money as possible on treatments.

It is a known fact that waiting for an NHS specialist to see you can take weeks. Which is where the concept of Private Medical Insurance comes in.

The idea is that for a monthly premium, those willing can obtain speedier access to medical care – beyond the basic one available through NHS. When you need to see a specialist, or require a serious medical procedure, you call your insurance company, obtain an authorization, find a nearby physician who accepts private insurance, and – because such visit would pay the doctor a lot more – get to see one within just a few days, at worst.

But – there is a catch. You need to have a referral when you call. And the referral can be issued only by – did you guess it? – your NHS GP. Without it, your insurance company will not even process your request. In other words, no matter what your situation is, you may still need to wait an X number of days before even being able to use your private insurance… Of course, your GP has no reason or incentive to deny you a referral for something that will not be paid for via NHS, but you can’t just phone your GP and ask for a referral (or, maybe, you can if you really know him/her for years, but that’s not a luxury we possess) – you need to come in for an examination, which you may not be able to schedule for a week or two…

Sounds exactly like an HMO, doesn’t it? Only with a ludicrous provision of a doctor who’s got nothing to do with the HMO, being its gatekeeper… To be honest, on a certain level, it makes sense to have at least some line of defense against unnecessary medical care, and, in the absence of any other mechanism, the GPs are it.

Dumb foreigners that we are, we have not really bothered to check exactly how our private insurance worked (although I first mentioned it more than half a year ago). You know, the basic care is free, this insurance is only for extraordinary treatment, and we don’t really expect to use it. Meanwhile, I have been paying the monthly premiums for a year and a half now (ok, I don’t exactly pay, but I could pocket some extra money if I chose to, – same difference!)

And only a few weeks ago, it dawned on me that without even being registered with a GP, we would have no ability to ever use this additional insurance, even if we needed it.

And what do you know? Registering takes quite some time all by itself. You fill out applications, attach utility bills to prove your residence (How exactly can one prove that a certain 7-year-old child lives at this particular address? By presenting a letter from school that shows both the address and the name of the child. What do you do for a 3-year-old, I wonder…), make an appointment for an initial examination – likely, in about three weeks or so, – and finally receive a card from a central NHS office confirming your registration. After which, you are ready to go to see that specialist…

Our examinations are in a couple of weeks. Not that we ever plan to use the stupid private insurance.