- Associated Press - Sunday, December 25, 2011

LONDON — When David Evans needed a hernia operation, the 69-year-old farmer became so alarmed by the long wait that he used an ultrasound machine for pregnant sheep on himself, to make sure he wasn’t getting worse.

After repeated calls from him, his doctor and his local member of Parliament, a hospital performed the surgery, nearly a year after he asked for the operation.

Under government guidelines, he should have started getting treatment within 18 weeks.

“I was in quite a lot of pain,” Mr. Evans said of his ordeal in Cornwall in southwest England. “It really restricted what I could do around the farm since I couldn’t lift anything heavy.”

Across Britain, an increasing number of patients like Mr. Evans are facing more pain and longer waits because the National Health Service is being forced to trim $31 billion, or 20 billion pounds, from its budget by 2015.

The cuts are part of the most radical changes made since the system was founded more than 60 years ago.

Many hospitals are saving money by raising the threshold for who qualifies for treatment and extending waiting times for non-lifesaving surgeries.

In January, the government introduced a new health bill that could bring deeper cuts and competition from private providers.

The bill would ax more than 20,000 health jobs in the next two years and shut an undisclosed number of hospitals, possibly including the iconic St. Mary’s in London, where Alexander Fleming discovered penicillin.

The medical profession is outraged.

“The government is wrong to ask us to cut 20 billion pounds because the pressure on the entire service is rising and with the expense of new drugs and treatments. It’s impossible,” said Sir Richard Thompson, president of the Royal College of Physicians.

“We’ve seen waiting lists go up, signs that [hospitals and doctors] are trying to prevent patients from going to [the] hospital,” he said. “I think it’s immoral.”

All of the top medical organizations are opposed to the health bill. The British Medical Association warned more competition means providers could choose only to offer profitable services rather than what patients need.

Prime Minister David Cameron even had to halt the bill’s progress in April to conduct a six-week “listening exercise” to get input from hostile health professionals.

While the bill still has several hurdles to clear, the government plans to put the first major changes into effect in April.

“The [health service] must be more efficient to meet the pressures of an aging population and the rising costs of drugs and treatments,” said Health Secretary Andrew Lansley. “We are absolutely clear this does not mean cutting services. This means getting better value for every pound spent.”

Only about 11 percent of Britons pay for private health care, and experts suspect that figure will remain largely static given the country’s continuing economic crisis.

In Britain, everyone is entitled to free emergency treatment, including foreigners. Registering with a local doctor requires only proof of identification and residency. No insurance cards, paperwork or bills are needed.

In England, patients are charged a $12 prescription fee, which covers whatever medicines doctors prescribe, including those for blood pressure, cholesterol and birth control.

Such fees are waived for more than 50 percent of people who need prescriptions, as exemptions cover children, students, pregnant women, the elderly and patients with disabilities or chronic conditions like diabetes or epilepsy.

People on low incomes or who are unemployed are also exempt from the charges.

Across Europe, health budgets are coming under pressure from the new age of austerity.

In Spain, the Catalan government introduced a 10 percent budget cut earlier this year, which meant closing or reducing the opening times of 100 outpatient centers.

Increased health charges in Italy are now being passed along to patients, who must pay an extra $13 for a medical consultation and another $33 for non-emergency hospital treatment.

French officials are cutting some reimbursements for health services and raising taxes on cigarettes and soda to bring in more revenue.

Britain spends about $3,490 per person on health care, far less than the U.S. average of nearly $8,000. Norway spends more than $5,350, making it the country that spends the most in Europe.

In crisis-hit Europe, Britain’s health care system is suffering some of the most dramatic cuts, raising questions about the sustainability of socialized medicine.

A report in October from Britain’s health regulator found 20 percent of hospitals are breaking the law by failing to provide minimum standards of care to elderly patients.

Officials on unannounced visits found patients shouting or banging on bedrails to get a nurse’s attention. Some struggled to eat without assistance. At one hospital, inspectors found some patients had not been given water in more than 10 hours.

Another health watchdog accused hospitals of imposing minimum waiting times on patients for elective surgeries, suggesting officials hoped to cut costs as people either decided to pay for private treatment or died on the waiting list.

For basic services like a doctor’s appointment, most family physicians offer same-day services for patients requesting urgent care or non-emergency visits within 10 days.

People needing non-emergency procedures for cataracts, hip replacements and hernias are supposed to begin treatment within 18 weeks of being referred to specialists by their family doctors.

Patient advocates say that an increasing number of people are facing longer delays, although most get treatment within that period.

Sheep farmer Evans said he never considered going for private care since he could not afford it.

“The problem is there will be many more people like me who are suffering and are now being forced to wait quite a long time,” he said.

Some experts say ballooning health costs will ultimately force a reconsideration of Britain’s socialized medicine.

“At some point, we’ll have to look at what the boundaries are of what governments provide and what people will be paying for themselves,” said Mark Pearson, head of health at the Organization for Economic Cooperation and Development in Paris.

“At the moment, countries aren’t ready to have that discussion yet, but that breaking point will come one day.”

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