After discovering she was pregnant, my wife made the seemingly sensible choice of taking out comprehensive private medical insurance. Unfortunately, what we failed to notice at the time was that the actual BIRTH of the child wasn’t in fact covered by said insurance.
Poland (our current home) has its own public health service much like the NHS, but the two suffer similar strains. By contrast, its private hospitals are highly regarded in Europe; they are predominantly aimed at and used by wealthy natives and expats, even attracting medical-tourists from more expensive countries. Since my wife was now accustomed to the staff and facilities at such a private hospital, we decided to stick with it and, a few days ago, were cordially invited to come in and choose which “birth package” we wanted to pay a ruinous amount for.
Similar wholly private institutions exist in the UK, such as the London Bridge Hospital, but I’d never had the need or the urge or the money to go to them. This was my first inside job, and, I’m happy to admit, it's a nice -looking hospital, and it doesn’t have that Dettol-mixed-with-urine smell. I got a smile rather than a glare from the receptionist, even an offer of a cup of tea. (Naturally, I had ten, to be sure I got my money’s worth.)
Despite this, I found myself powerless to shake a growing sense of unease. I felt like I was in some kind of Stepford Wives utopia, expecting at any minute that the serene faces of the nurses might melt away to reveal red-eyed robots underneath, that the surgery doors might blow open to uncover a dark sorting room where the rich and beautiful are invited through a waterfall into a soothing garden, and the ugly or feckless are simply tossed into a fiery pit. I knew beforehand, of course, that modern medical care is as much a business as any other industry, but I didn’t expect to be so shocked at what I found.
'Sir, Should your wife feel at any time that she would like pain relief, we’ll be happy to automatically upgrade you to a superior package…'
Those birth packages: the first of the three was called the “basic” package. For the equivalent of £1,200 it gets you a private bed and a dedicated midwife and some aftercare, but – get this – no anaesthetic. None. Not even gas and air. “But don’t worry,” the consultant smiled sweetly, “should your wife feel at any time that she would like pain relief, we’ll be happy to automatically upgrade you to a superior package… though a small administrative fee will apply, of course.”
Of course.
I began to sweat. I suddenly felt like I was on Ryanair and, smash it as I might, my cabin bag wouldn’t fit into the bloody metal cage they put near the gate. I imagined a poor woman in the pain of labour, desperate for relief but knowing that she can’t give in because they’ll put her on a birth package that she can’t afford, and chuck in a penalty charge on top.
The second package was called the “standard” package, and we were told it’s the one that most people go for. Unsurprising – just look at the name. Imagine the poor husband who plumps for the “basic” deal now; the withering look from his wife that says, “You’ve just elected to give me and your child below standard healthcare.”
For around £1,600, the standard package does get you pain relief, as well as the intermittent supervision of a doctor. Then it was back on Ryanair again as the consultant reeled off a list of “optional extras” (though she stopped short of offering smokeless cigarettes.) For an extra £280 you can have a doctor there the whole time. For £100 we were told we could upgrade to a family room, which would allow the partner to stay overnight after birth. The consultant’s face came up to look me bang in the eye and ask if I’d be interested, and again the guilt was crushing. What kind of man could refuse such a thing? What kind of callous bastard would abandon his wife after such an ordeal, would turn down the chance to be with his child on the very first night of his or her life?
I tried to compose myself as she moved on to the final package, but fortunately it was too ridiculous to feel anything but amusement. It was called – I shit you not – the “prestige birth” package.
The prestige birth package (about £3000) gets you literally anything you want. On arrival you are whisked away to – again, not a joke – a “VIP birth room.” There is full-service catering. You can request any doctor you want to be there every second of the way; by the sound of it, they don’t even have to be a gynaecologist – if you like the podiatrist and you want him there, you got it. And, crucially, if you decide you feel like a caesarean today, they’ll convey you directly to surgery, no questions asked. There, the mother-to-be can sit back and enjoy a cool glass of chardonnay, while Morgan Freeman, with his oh-so-soothing voice, scrubs up, ready to conduct the procedure.
Jokes aside, I understand free-market capitalism, the benefits of choice, the importance of women feeling comfortable when they give birth. I recognise that, to anyone earning British wages, these amounts might sound fairly reasonable really. But I couldn’t escape the feeling that it was all very, very sad. Do we really need “prestige” to distinguish ourselves from the pack, even when undergoing something so unifyingly human as childbirth?
Is this what all hospitals will be like in a post-NHS future? A tiered system where the Have Nots, with their non-existent anaesthetic, look on miserably as the Haves are golf-carted into the lobster restaurant?
Jeremy Hunt and the notion of a privatised NHS are barely out of the news these days. Is this, I wondered, what all hospitals will be like in a post-NHS future? A place where a bruised ego can end up costing you as much as a bruised rib? A tiered system where the Have Nots, with their non-existent anaesthetic, look on miserably as the Haves are golf-carted into the lobster restaurant?
This was my first real glimpse of the patient as a customer, and I’m not sure I liked it. My dad is an old-school doctor, from the days when, rich or poor, patients wilfully submitted to his expertise, rather than dictated to him. In the years after his retirement he wrote a book to express his sadness at the much-documented “consumerisation” of medical care. Rationality and expert advice, it seemed to him, were no longer-valued, replaced by a “the customer is always right” ethos. I forgot to mention (as did the hospital) that there was also a charge for us to even see the consultant to choose the birth package. In England, I’ve cheerfully waited for hours in NHS hospitals, content that the doctors and nurses are doing their best. But here, when there was a 20 minute delay, I felt annoyed; I felt like complaining. I had paid, and therefore I was thinking like a customer owed a service, rather than a patient seeking help.
There are a hundred arguments for and against this new approach, but, in closing, suffice to say: as I sat there watching the consultant deferring to my wife, an economist, about whether she would like a caesarean or not, I felt uncomfortable. The customer may always be right, but does the customer always know what is right? I began to imagine a future where anyone with enough money can go into the doctor and ask for a heart transplant because their current one “feels like it’s getting on a bit.” A world where hospitals are like restaurants and patients can nip in and order whatever they want, going away happy so long as they get good service. And it scared me.
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