The UK has changed beyond recognition since the birth of the NHS in 1948. The population has grown, people are living longer, and prior to Brexit, immigration has added to the increased numbers all looking for world class health services in the UK. However, you don’t need to look hard to see the cracks evidenced by national and medical trade press headlines:
A report by The Health Foundation highlighted that
the challenges facing the NHS are not short-term. The health service faces another five years of austerity. If quality and access to care are not to suffer we need concerted action at a national level to improve productivity year-in, year-out. Rapid progress to resolve the problems in social care, which is so intertwined with the NHS, is also needed. Most critically, we need urgent action to tackle the gap between the need for skilled staff and the supply of suitably trained workers.
The Health Foundation went on to say that increases in funding are not keeping up with rises in demand for healthcare and health care costs; and the NHS is failing to deliver the productivity gains necessary to address the shortfall. The cost of providing health care is growing faster (by 2.2% in 2014/15) than funding increases (2% in 2014/15). Overall, the productivity of acute hospitals increased by only 0.3% between 2009/10 and 2014/15 – an average rate of 0.1% per year. The NHS in England needs to make 2-3% of efficiency savings each year between 2015/16 and 2020/21 to close the projected £22bn gap between the resources available and funding pressures.
Are there any alternatives?
The French, German, Dutch, and Swiss health systems are all of special interest. All have flirted in recent years with elements of price-based consumer choice, albeit within a framework of strictly regulated competition.
Although Britain spends less on health than its European neighbours, the set up of health care systems in France and Germany is unencumbered by the division between private and public sector that exists in the UK.
While UK health care is firmly split into NHS and private sector care – with one being paid for by the state and the latter being funded from people’s savings or medical insurance – the European model keeps the boundaries flexible.
As well as spending more on health, both France and Germany impose ring-fenced health taxes, while encouraging people to take out ‘top-up’ private medical insurance.
A patient is free to choose to be treated in either a public sector or private hospital, with the service being paid for either through taxes, or privately, or a mixture of both.
The Dutch healthcare system is fairly simple, everyone is required to purchase insurance from highly-regulated private providers. They describe it as “private health insurance with social conditions”. Insurers are tightly regulated for quality, provision of basic services, and to prevent discrimination, as they are required to accept everyone in their coverage area at a flat rate, no matter what their health status. To prevent loss of profitability from chronically-ill patients, they have a risk equalisation system so that rather than losing profits from recruiting sicker patients, insurance companies are compensated for providing service to those patients who need it most. And if a citizen wants to change companies, or buy additional insurance they are free to. It’s a system that encourages competition, but is regulated to prevent the companies from selecting only healthy patients, or otherwise abusing the system to prevent health care provision to sick people. The incentives are designed to provide excellent care to as many people as possible, cheaply and efficiently no matter what their health status, rather than the US system in which the incentives are to deny care and only sign on the healthy. The government even runs a website allowing patients to comparison shop among the different insurance companies and hospitals based upon their ratings for quality, outcomes and performance indicators.
In Switzerland the difference is that, everybody has health insurance. It is compulsory. You can choose which health insurer to go for, whereas in Britain you are effectively compelled to take out a government policy. The health insurers, in their turn, have contracts with doctors and hospitals. So there is choice and competition at two levels: between insurers and between health care providers.
What about those who can’t pay? They are compulsorily covered too. If they have not enough money to pay a premium, it is paid for them. But most people pay for their own health insurance.
Healthinsight is an initiative to gather the opinions of the Great British public and our medical professions so we can try and start a public debate about the healthcare system we need for the next 70 years – we would like to know what you think.