I’m in Belfast, Northern Ireland, UK for my spring break week, teaching a course to MA finance students at Queen’s University. It’s something I’ve done every year for twelve years, but it almost didn’t happen this year. The UK’s National Health Service almost kept me out.

As I’ve mentioned here before, I'm awaiting a kidney transplant. I started hemodialysis (mechanical blood filtering) three weeks ago, on the standard schedule of three sessions of a week, three-plus hours per session. To travel within the US now (e.g. to Las Vegas for the APEE meetings in April), I first have to reserve a session at a local dialysis clinic in the destination city. Not really a problem: the US is filled with for-profit clinics that are happy to accommodate extra clients. My health insurer has a handy web engine for locating, near any destination, the closest clinics that it certifies and will pay for “in-network”. There’s also a handy clinic finder at www.dialysisfinder.com.

The UK’s National Health Service, however, isn’t for-profit. It has waiting lists for many of its services to UK citizens, possibly including dialysis. So what incentive does it have to take on foreign travelers as clients? My initial inquiries were coldly received. I’m not sure why the dialysis clinic at Belfast City Hospital did finally find me a space in their late shift (7-11pm), but presumably the inquiries from my contacts at Queen’s didn’t hurt. (By the way, the NHS is charging me handsomely.) Why aren’t there also for-profit clinics here that would serve travelers, you ask? They’re illegal in the UK.

CORRECTION: That last sentence was in error; private dialysis clinics (and private hospitals more generally -- thanks to reader Andrew McGuinness for the correction) are not illegal in the UK, merely rare (private dialysis made up about 5% of the market in the UK, versus 77% in the US, according to Fig. 1 of this study). Since the NHS charges less, the private clinics' clients appear to be mostly people who switch to NHS service once they get off the NHS waiting list. There are two private dialysis clinics in London, according to this list, dated 2000; at that time there apparently weren't any others in the UK.

On the NHS rationing front, the front page of The Sunday Times yesterday carried the following headline: “Doctors call premature babies ‘bed blockers’”. Reads the text of the article:

As the NHS faces an increasing financial crisis, with beds being closed and jobs axed, it says these very premature babies are ‘blocking’ much-needed intensive care cots, sometimes forcing healthier infants to be transported by ambulance to other hospitals. ...

The statement reflects a growing view among child specialists that babies born under 25 weeks should be denied intensive care and allowed to die.

Why not let parents spend their own funds (including private insurance) to build additional facilities for saving premature babies? The possibility is not even mentioned in the article. That would be illegal in the UK. CORRECTION: Not illegal; private insurance is merely rare.