Several years ago, I noticed a small lump on my right shoulder blade. Over time I noticed it was darkening slightly, so I decided it was worth getting examined by a dermatologist. My wife sees a dermatologist she really likes. This was after the Covid lock down had eased and I assumed it would take months to get in. I called and the dermatologist had an opening only a few days later. I did not have insurance at the time and asked if I could pay cash. He examined the lump and asked if there was anything else I needed him to look at. I told him I tend to have eczema from wintery dry skin. The dermatologist examined my skin and he wrote me a prescription for a steroid cream. My entire visit was only $86. I scheduled minor surgery for a month later, which cost around $560 including a pathology report and a free, post surgery follow-up visit. My dermatologist gives uninsured patients a cash discount similar to the Medicare price. He also throws in free services, like writing a prescription for eczema since I was already in his office.
Contrast my experience seeing a Dallas dermatologist with patients from the United Kingdom. In the UK there is very little cost-sharing or out-of-pocket payments for services covered by the National Health Service (NHS). This is from the BBC Scotland News:
A young woman with a severe skin condition spent almost four years on a waiting list to see an NHS dermatologist in person.
Charlotte Brown, 31, was first diagnosed with psoriasis in 2017 and referred for light therapy in 2019.
It wasn’t until September this year that she began treatment.
Hey, it may have taken four years to get an in-office consultation but at least it was free! I mean, it was free if you don’t consider exorbitant taxes that fund the NHS. The excuse for the delay used by the NHS is that dermatology hasn’t recovered since the Pandemic and resources are being rationed to screen for cancer. Here is another story from the UK.
In 2020, Karen McLeod noticed a growing lump on her forehead.
After getting referred by her GP to see a dermatologist, Karen was told the lump was a lipoma – a non-cancerous lump that is not typically removed by the NHS.
However, the lump continued to grow until it ran from her hairline down to the middle of her forehead.
Karen was told it was highly unlikely she could get the lipoma removed on the NHS as it would be considered a cosmetic procedure despite it having a “huge impact” on her daily life.
She felt she had no choice but to pay £800 at a private clinic in Glasgow to get the lump removed.
“I just feel I work hard, I pay my taxes like everybody else, and obviously that contributes to the NHS and it would be nice just to have a wee bit back,” she said.
My dermatologist suspected my lump was also benign, but he did not know for sure until he received the pathology report after the surgery. I was happy to pay cash for the peace of mind that I did not have aggressive melanoma growing in my back. Ms. McLeod will have to pay out-of-pocket to get her forehead lump surgically removed at a cost of about £800 ($1,000). My $560 surgery fee looks like a bargain now. Patients in the UK increasingly are turning to private clinics to get what they can’t get from the NHS:
Owners at the Ever Clinic say their service began as more cosmetic-focused, but they quickly pivoted resources as it became clear there was a high demand for minor surgery from patients who couldn’t get NHS treatment or faced years-long waits.
The most common treatments include removing lipomas, rhinophymas and moles – procedures which cost £800, £3495 and £275 respectively.
“Transparency is the critical thing,” Dr Convery said.
“Many of our patients have engaged with the NHS and have received some sort of attention but it’s just the timely delivery of that care that is not supportive of that patient’s need, and when we go to years waiting for that treatment it’s just not workable for the average individual.”