First of all, I want to stress that this story is not to be used to advocate a private healthcare system. The story reveals behavioral economics that would be true in both private and public funded systems.
My mother is a retired physics teacher. She now spends her time buying and developing property so she can rent them out. She has also obtained a dog that she walks regularly, tends to an allotment and gets involved at the women’s’ institute. She gets more tired now that when she was working. However, this is her nature. At some point, my mother started getting headaches and nosebleeds and rang me for advice. My advice was to see the GP but I wanted my mother to get the most out of her appointment and we both agreed that collecting data was a good idea. So she got a blood pressure monitor and I set up a shared drive for her to upload the data. We’re both mathematical and we understood probability theory well enough to know that multiple blood pressure readings over a period of time would give a better picture of a one-off reading at the doctors. Once we got the data I produced probability distributions and calculated the probability of a reading being a certain level. My mother was definitely hypertensive.
She then went to the doctor who didn’t want to see the data. He then did a blood pressure reading which had a systolic of 180 and told her that she was fine. Luckily, she knew the ranges and told him that she thought that it was hypertensive. He paused for a second and then instantly agreed. He still didn’t want to see the data and it took the effort of multiple visits armed with data and guidelines on hypertension before he started taking steps to manage it. If my mother didn’t have me doing this he would have sent her home with painkillers and her hypertension would have been left untreated.
Another tale is my brother who had raised paraprotein levels when he was in his 20s. However, his GP didn’t order an FBC when the blood was initially taken. When I told my brother to ask for the FBC results his GP replied saying that he didn’t need an FBC doing. Concerned for time, I contacted a doctor I knew in Harley Street who saw my brother at short notice, ordered a selection of tests and made quick referrals to specialists.
This shows us that if a patient has connections, or is educated, or has an advocate that is educated they will have a lower chance of receiving substandard care. This shouldn’t be a shock to most people. This is why charities and politicians express the desire to widen the access to education for poor people. It gives numerous advantages in different aspects of life. Considering this it’s not surprising that a report found that patients from lower socioeconomic groups got less out of the NHS system in general [link]. This is basic economics so we can’t blame the NHS for this. However, there is an unhealthy zealot-like religious view of the NHS in the UK, and people perpetuate the myth that the poor get the same healthcare as the rich. They seem to think that the NHS has magical powers and can defy economics. This is either delusion or political propaganda. The sad thing is that I have seen people (some who actually work in the NHS) proclaim that the NHS provides the same care to rich and poor. With the NHS you are only excluding one barrier and that is payment at the point of delivery. Ok, that’s a fairly big barrier but there are other barriers and trade-offs that come into play with this. Whether we are better off in a private system or not is outside the scope of this post, however, in order to improve and solve problems we need to acknowledge them first.
A more positive thing to take from this is that remote monitoring has the ability to reduce this inequality. Technology in general; does this. The internet has made knowledge that would only be available at universities, available to anyone with an internet connection. In the future, inexpensive remote monitoring with statistics packages and parameters coded into the software, will give patients in low socioeconomic backgrounds the privilege that my mother had today.
I help clinicians get to grips with coding and tech, I also code for a financial tech firm