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How far would you go for healthcare?
By Hannah Ricci
How far would you go to get the medical treatment you or your family needed? Frustrated with the limitations of the NHS and the expense of private healthcare, 70,000 people travelled overseas to receive medical treatment in 2007, according to official government figures, and this is expected to burgeon to almost 200,000 by the end of the decade.
Whether a trip to Poland for fertility treatment, to Hungary for dental work, or even moving across the border to Scotland to get access to life-saving drugs, more and more patients are pushing the boundaries to seek the medical treatment they need.
While the development of more life-saving drugs is a positive step forward, not being able to access many of these drugs on the NHS is a growing frustration for the people whose lives they are intended to save.
The term 'postcode lottery' couldn't be more apt when it comes to the availability of life-extending treatment. "There are 15 cancer drugs available on the NHS in Scotland that aren't available in England," explains Charlie MacEwan, communications director at Western Provident Association (WPA), a not-for-profit health insurer.
The Government's drug rationing body, the National Institute for Clinical Excellence (NICE) is responsible for approving drugs and deciding which ones from an increasingly expensive list should be available on the NHS. Many cancer drugs, such as the breast cancer drug Avastin, and Erbitux, which is used to treat bowel cancer, are denied on the NHS even though they have been proven effective. This is because NICE is either taking its time to approve them or because it deems them not to be 'cost-effective.'
However, once approved, the decision to fund such drugs lies with individual primary care trusts (PCTs), which means a patient's ability to access these drugs depends on where in the country they live.
Topping up the NHS
This controversial issue has been brought to light by an increasing number of cases, including that of 57-year-old Debbie Hirst from Cornwall. Her breast cancer had spread, and the NHS would not provide her with Avastin, which is licensed and widely used in the US and Europe to halt the growth of tumours.
The drug costs £60,000 and Debbie's oncologist told her that she could fund it herself, so she started saving and decided to put her house on the market. However, in December when Debbie had raised £10,000, the Department of Health told her GP that if she paid for Avastin she would have to pay for all her cancer treatment, which she could not afford.
The Government is adamant that patients cannot dip in and out of the NHS. It says the rules are black and white - you either go all NHS and it is free, or you go all private and pay for everything. The Government says that allowing patients to top-up the NHS would lead to a 'two-tier' system, because it would lead to patients in the same NHS ward receiving different drugs based solely on their ability to pay.
With more life saving drugs in the pipeline that the NHS is unlikely to fund, this distressing situation is likely to be experienced by increasing numbers of patients who could stretch themselves to pay for additional life-extending drugs, but not the entire cost of private care.
This issue is highly contentious because legal experts say that there is nothing in the law to bar patients from buying their own drugs and having them administered by the NHS. Think tank Doctors for Reform has also pointed out, in a report published in 2007, that top-up payments are routine in the NHS, and range from dentistry and audiology, physiotherapy to diagnostics.
A helping hand
The policy, called Mycancerdrugs, is provided by WPA and requires customers to pay an annual premium equal to their age in years, so £60 at age 60 for example. If policyholders develop cancer, they will have access to £50,000 of treatment with licensed drugs that are often not obtainable through the NHS.
There are a number of caveats to the policy. These include if you have had or currently have cancer and if either of your parents, brothers or sisters have developed or died from cancer under the age of 60. There is an initial 90-day deferment period and it is only available to the under-65s.
Due to the contentious topping-up issue, which those who claim under the policy may face when trying to get the NHS to administer drugs, WPA has sought legal advice from Nigel Giffin QC, who also insists there is nothing in law to bar this.
Medical tourism
Diagnostics, scans, fertility treatment, cosmetic surgery, ophthalmology and cardiology are all part of long list of treatments available in private clinics on the continent for a fraction of the price of private treatment in the UK.
However, referring to healthcare as being cheaper overseas can be misleading, says Alison Hope, managing partner of StatMedica, which provides access to private healthcare in Poland. "This can imply a substandard service, but patients have access to top specialists so the healthcare is simply better value for money."
Of course, travelling into the unknown to receive treatment is not a decision to be taken lightly. It is advised to seek English-speaking clinics and those that arrange for you to meet, or a least talk to the consultant, before you arrange the treatment. Personal recommendations are also a good guide.
The feasibility of travelling abroad also depends upon the type of treatment and whether you will need to make any follow-up visits. You'll need to research journey times and cost, because while private elective surgery such as hip and knee replacement in Australia is around half the cost of in the UK, the cost and convenience of travelling such a long distance could make you think twice. You'll also need to know whether you will be fit to fly after your treatment and the cost of insurance.
It's important to get the total cost of your treatment in writing before you travel, and confirmation of what is included in this cost. The Foreign Office advises patients to be clear about who is responsible for the cost of extras, such as additional medical or emergency treatment, in case of complications; medicines and dressing, and any extended stay for any friends or family accompanying you. Also find out if medical repatriation to the UK; correctional treatment in the UK, and follow-up treatment are covered.
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