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    So I am a third year medical student and felt uncomfortabe asking this question to my peers.

    What does it mean if the nhs is privitised?
    What companies woud invest e.g. bupa or will ccgs have any input?
    Would people invest in shares in the health care?

    How will doctors work if we did privatise? Will we get paid more/less in the long haul? Can we get sued?

    Sorry for all the questions but I am very confused. I still don't know how a hospital runs e.g. in terms of finance

    I hope someone can help explain what is going on.

    Thank you,

    From a very confused medic

    This is a lot of questions; none of which really have simple answers.

    1. Privatisation can mean lots of different things - it really just means that health services are delivered by a private company, i.e. normally an entity that delivers a service in order to make a profit. This might mean that a private hospital sets up down the road and performs all the hip replacements in a region in exchange for £X,XXX per operation from the NHS. Or it could mean that NHS hospitals are sold to private companies who then charge patients directly (or their insurance companies) for treatment. There are already many examples of the former and many people fear that it is only a slippery slope between that and patients having to pay for healthcare.

    2. Any company might show an interest, although you'd accept those with an existing role in healthcare (e.g. BUPA) and other big conglomerates (e.g. Virgin) to get involved. One fear is that some big hospital chains from the US will try their hand at extracting profit from UK patients or taxpayers.

    3. This depends. Some companies are owned by shareholders, others aren't.

    4. There is no one answer to this question. In the US, where most healthcare services are privately run, doctors are paid in many different ways. Some of them receive a fixed salary and others get a smaller salary with some quite of bonus element or profit sharing. Some doctors collect payment directly from patients (or their insurance companies) and then in turn pay their hospital for their office space, operating theatres, tests ordered, etc.

    5. Doctors would probably earn more in a private system because there is a shortage of doctors in most specialties. Salaries would therefore have to go up in an open market so that hospitals could attract staff.

    6. You can get sued about as easily regardless of whether you work in a public or private system. In both systems you will pay indemnity fees to a company upfront who will defend you and pay compensation if you make a mistake that causes harm to a patient.

    Sorry long post. Your fault for asking a long question!

    The NHS is already privatised in many ways. Think about things that exist in a hospital:

    Doctors, nurses, HCAs are paid by the state. However, the chronic underfunding means we often have to rely on agency staff, who are working for private companies. Sometimes there are permanent rota spots given to private agencies. Porters and catering staff are often rented from private companies. Pharmacies are often run by Boots or similar particularly when compliance aids are involved. Older hospital buildings are generally owned by the hospital, but almost all new-builds are PFI i.e. rented from a private company. Sometimes hospitals don't even own their own CT or MRI scanners - also rented. Radiology services particularly out of hours are often out-sourced to e.g. Australia, India. Lots of secretarial work such as writing up clinic letters is also done in India. A lot of hospitals generally have at least one private ward patients have to pay to be on. Some services such as screening services are being offered to private corporations like Virgin and the running of one hospital was even given to Circle a few years ago, who first celebrated how easy running a hospital was before promptly collapsing and having to be bailed out by the NHS at huge expense.

    A lot of this is to do with making short-term savings without much thought for long-term outlook. PFI in particular can be a crushing fixed cost placed on trusts who are now being told to make 10-15% "efficiency savings" but the 20-30% of their budget is ring-fenced so the remaining services are in fact looking at a 25-30% cut. That's huge.

    We are looking at more privatisation in the future, Jeremy Hunt famously writing a book on the topic. As above, it could take many forms. The concern is that it will a) restrict free access to healthcare e.g. fees to see a GP and b) contracts will be given to JH's pals without fair assessment (lets not pretend corruption is not rife within the kind of corporations we're talking about) and c) you'll get the spiralling costs you get with private healthcare: at the moment doctors have at least some sense that they should not waste NHS resources, not request unnecessary scans or blood tests etc. But if its a private company paying and your neck is on the line (being sued is more likely if the patient is directly paying for their care) then they might just request all the tests to be safe. That's what happens in America, who do more than 6x more CT scans per head than us.

    The locum agency pay rates were much higher than NHS pay rates, suggesting that a private system would result in much higher doctor's pay. But it depends on the system they implement - whilst the government has introduced all the private stuff above in the name of the free market, for doctor's they removed the free market by introducing a pay cap. Its free market economics but only if you're a mate of the Health Secretary, some sceptics might say.
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