Paying For Health

Signatures of President Barack Obama, Vice President Joe Biden and Speaker Nancy Pelosi on the American Health Insurance Reform Bill 23 March 2010
American Health Insurance Reform Bill 2010-03-23 – photo by Chuck Kennedy; public domain

Paying for Services in England

The new Chairman of the British Medical Association, Dr Farah Jameel, has campaigned that GPs should drop “non-core services” from their NHS surgeries. Now what might these be, and which patients are likely to be affected?

I have started keeping a record of how much my (aging) friends and I are having to pay for health services in this beautiful land of England, proudly boasting of a NATIONAL HEALTH SERVICE since 1948.

I am now about the same age as that of the NHS. My grandfather and great-grandfather climbed out of the slums of the East End of London by becoming insurance agents. My father believed in private health insurance too.

When I was 21 he strongly recommended that I take over paying for the BUPA cover he had protected us with during our childhood. I refused, convinced that the NHS would cover me for life. Now I am not so sure.


Since the beginning of the NHS, patients have had to pay dental charges, except for:

  • Children
  • Full-time students
  • Pregnant and nursing mothers
  • Those receiving income support

By the 1990s there were as many as 400 different fees. These were then simplified, into the three categories of charges we still have today:

  1. Maintenance check-up (current fee £23.50)
  2. Treatment (fillings, root canal treatment, current fee £65.50)
  3. Advanced treatment (crowns, bridges dentures etc £232)

Force Majeure

The first large fee I paid personally was for three bridges – yes, three (genetic problem). But the shrewd dentist gave me about three years’ warning, so I had time to save up. This raises the question as to whether private dental insurance is worth it.

The next dental crisis to strike our family was when our daughter could not get an appointment with any dentist within reach of her home in London. Though a nursing mother eligible for free dental care, she had to go private to get treatment for an abscess. 

Income, Not Need

Now, as pensioners with incomes just above the rate that would allow us free NHS treatment, my husband and I face increasing costs of visits to the dentist. Basically this is because his teeth are crumbling at the rate of a crisis every three months. (At £65.50 a time).

My complaint here is not the principle of paying for something but the fact that there is no taper on eligibility. You either get NHS dentistry for free, or you have to pay in full. But what about those who are, say, just about £100 pm above the income support level, and yet having to pay more than this each month? This is for dentistry and some of the other charges detailed below. There ought to be some system of tapered help for those with multiple conditions, all of which now require fee payments.


Here at least the eye test is free for the over-60s. But the glasses are not and can cost at least £230 depending on the frame. Again it is wise to have savings for this, unless you are in the category of low income and can get into the NHS voucher scheme (HC3).

Seniors are likely to need cataract operations which are free of charge under the NHS. Then new glasses will be required. But for those who are candidates for multi-focals, the operation for lens replacement for astigmatism is only offered privately (cost: £3,500 per eye). But no glasses are required thereafter.

Hip And Knee Surgery

Older people often suffer from joint problems. But the waiting lists for NHS treatments can leave them waiting in pain for too long. This is especially so now during covid times. To avoid waiting by going private can cost some £12,500 for a hip replacement and around £4,500 for a knee operation.

Urgent: In Pain, Can’t Wait

Increasingly people are faced with an urgent condition and feel the need to pay privately. Our granddaughter had a painful ingrown toenail that was crippling her. It cost £200 to get it seen to quickly. This ailment may not be life-threatening. But sometimes getting a test or X-ray done more quickly at least saves months of pain.

Is Private Health Insurance Worth It?

Supposing I had accepted my father’s offer and kept up my BUPA membership. A rough guesstimate at today’s prices (discounting inflation) is that by the time I retired I might have paid some £44,520. That assumes I were to pay as a singleton for 10 years, and then as a couple for 30 years.

Depending on what level of cover I had picked, this would have allowed me to skip waiting lists, and get vital tests and scans, and quicker appointments with consultants than is available on the NHS. But I could also do the same if I had opted to save this money year by year (self-insurance) and thus had a pot to use for such eventualities.

Job-Related Health Plans

Many people who are enrolled for private health insurance get this as a perk from their work. But then they find this benefit is taxed. There is a big advantage to the private insurance industry of such subscribers, as they are mostly young with few health conditions. The older you get, the more difficult it is to sign on for private health insurance.

The Uswitch site for getting quotes for such insurance asks searching questions about a previous history of heart conditions or strokes, and with cancer. Also as soon as I ticked mental health, most quotations vanished off the options. So insurance companies win every time by eliminating the most risky.

The private health sector was worth £6.42bn in 2011, of which 2.8% came from overseas subscribers, 15% from self pay at point of treatment, 26% from NHS buying services and 56% from private medical cover, 11% of the UK population having such cover.

Services That Are Dropped
1. Syringing Ears

Our GP practice has just dropped the service of the nurse syringing wax from blocked ears. This is an annoying condition which tends to afflict seniors. It can make a person deaf and thus cut them off from social interaction. This appears to be a decision across Kent made in the last few months.

The result is that waiting lists for all private providers of this service (Specsavers included) have lengthened to months. It costs £70 to get it done privately and it may need to be done every four months or so.

2. Podiatry

Similarly podiatry may be very necessary for the infirm who cannot cut their own toenails due to poor vision, bad posture or arthritis. Is this a core or a non-core service for the increasingly infirm? I can imagine some accountant totting up the columns in the new Integrated Care Systems and triumphantly noting all the little non-life-saving services that can be lopped off the NHS.

What Else Could the NHS Be For?

But is the NHS only for life-saving? What about some quality of life? In some EU countries the public health system offers massage for back problems. The rationale is that prevention of pain and improvement of posture are a better cost-saving than pills. But in the UK the NHS prefers pharmaceutical solutions.

So as the Integrated Care systems are phased in, being paid for by the rise in NI contributions, we must all watch for what is being included or excluded in our area. With Dr Jameel at the helm of the BMA, it may become a postcode lottery of what is on offer. So this is where some citizen vigilance comes in.