Monday, August 31, 2009

Health Care Stories: London, UK III

Harry gives us his point-by-point assessment of Britain's National Health Service.

I don't have any stories for you but i can tell you a few things...

1) The NHS does mean that anybody can book a GP appointment, or receive a heart-bypass, or whatever, for 'free' (it's everybody else's expense!)

2) This does mean that, since it's funded from general taxation, that it becomes a political issue

3) So everybody gets heathcare based on need, but the NHS can only supply healthcare based on politician's assessment of need and consequent funding. (supply has to be pre-planned top-down)

4) A body called NICE (National Institute for Health and Clinical Excellence) does a cost/benefit on drugs. Those that cost too much are banned from the NHS. You either get free treatment in the NHS for the approved drugs, or, if you want to pay for life-saving drugs, you have to go completely private. The NHS wont contribute at all, you can't top-up your healthcare. Equality is apparently more important than saving lives!

5) There used to be long waiting lists caused by the necessary 'rationing'. There is no market incentive for supply to increase. These have been greatly reduced due to massive taxpayer investment.

6) 1.3m people work for the NHS, vs 29m employed in the whole country. It creates a client state, with voters owing their living to government. They will vote for a pay increase at the expense of taxpayers!

However, some 'good' points...

1) There is no disincentive to pack in your job and set up in business for fear of losing your family's insurance cover. So labour flexibility is perhaps improved.

2) There is no bureaucracy from having to process insurance claims. It doesn't exist.

3) The focus at all levels is on health of the patient, not on whether they can pay (i.e. very altruistic culture where commercial realities don't exist)

The NHS persists, because no politician has ever been brave enough to propose an alternative system. The debate has always been around the level of investment (we want more doctors, nurses, etc., or we need to cut bureaucracy and make it efficient, etc.). Any time a politician talks about the NHS, it generates an emotive response. It has contributed to people feeling that the state is maternal and good. We have surrendered our self-reliance, largely, and voters seem to expect help from 'the government'.

The NHS could be reformed with market incentives to improve the situation a lot. It still forces taxpayers to foot the bill, but that is less of an issue than having people die because there is no market to drive up efficiency.

London, UK

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