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Healthcare provision.
Feb. 8th, 2013 11:40 amLike I should I expect most people, I've been watching with undisguised dismay the outcome of the inquiry into Mid Staffs NHS trust. In case you've not been keeping apprised of this, the short version is that at least 1200 avoidable deaths can be attributed to medical negligence at the hospital. What's more, at least five other hospitals are now being investigated under similar circumstances with at least another 3,000 additional deaths under consideration. That is, for sake of comparison, about 1500 more people than died in the World trade Centre attacks in 2001. If Osama bin Laden had infiltrated the NHS instead he could hardly have done a better job. What's more he'd still be alive, as the inquiry concluded nobody was to blame and nobody will be prosecuted, punished or even named.
To put the figures into perspective, in one single Staffordshire hospital more people died from medical negligence than in the entire Dutch healthcare system in the same year. When you get results like that, it starts being worth suggesting that maybe those Nederlanders know something we don't.
The details of the deaths make for depressing reading: nurses refused to bring patients water, reducing people to drinking from the vases containing flowers brought by their relatives. There are stories of people starving to death, and incontinents lying uncleaned in their beds.
I dunno about you, but I missed the bit in the Olympic opening ceremony with the pensioners starving to death in their own poo. Maybe I was making a cup of tea during that bit or something.
The problem is that any suggestion that there may be problems with the NHS immediately gets you labelled some sort of psychopath who wants to privatise the healthcare system and leave poor people to die like what happens in wicked America. Nigel Lawson once observed that the NHS had assumed the status of a new national religion, and he had a point. Criticise the good works and expect to find people queuing up outside demanding to find out if you weigh as much as a duck.
Anyway, despite this I got me to considering healthcare systems and how they work. The first thing to do when considering these things is to look at which ones work. It's difficult to get this sort of information as there are few comparitive studies which rank national systems. The most famous one is an World Health Organisation study from 2000, and going digging there is also an ACHI study from 2007 and one by the Economist intelligence unit from a couple of years ago which I have seen but don't have a link for. You can believe me or not as it pleases you regarding what I say about it.
Looking at these, there are some countries who names keep coming up as providing the best healthcare systems by outcomes in the world - France, Austria, Switzerland, Australia, Canada, Singapore, a few others. The UK doesn't tend to come into the list of top systems at all. The WHO ranked the UK 18th, and we didn't make the top ten in the EIU study either. As such it's instructive to look at what other, better placed, systems do.
In a broad brush sense, there are four structural models which can be said to be used by most national healthcare systems. These are:
1) The Beveridge system, as used in the UK.
This model involves the Government owning and operating the entire health care system, with all costs paid from general taxation and with no costs at point of use.
2) The Bismark model, used by places like France, Germany Switzerland and Holland.
This model involves healthcare being paid for by compulsory private healthcare strictly regulated and controlled by the government, with the government making insurance provision for the poor and unemployed.
3) The Douglas model, as used in Canada, Australia and South Korea.
This model involves most medical care being privately provided but paid for by general taxation from the government.
4) No effective public healthcare, as used in the United States, Somalia, and Chad.
If you can pay for your healthcare, good for you! Sucks to be you if you can't.
From looking at the studies, a few consistent features appear, these being:
1) That of the countries which regularly appear in the top ten best healthcare systems in the world, every single one of them spends more per capita on healthcare than the UK. That's unequivocal. Ranging from the marginally more, like Australia which spends maybe 1-2% more per capita on healthcare, to the significantly more, such as France which spends about 10% more per capita (it's worth noting that France seems to be regarded as the best healthcare system in the world fairly consistently). All of them spend more than the UK does.
It's worth noting that expenditure cannot be the only factor in improved outcomes - the US spends about 90% more per capita than the UK and whilst the NHS ranks about 18th globally on outcomes, the US comes in at 37th. So what other factors are there?
2) Of the ten best healthcare systems in large developed nations at least comparable to the UK, only one (Italy) uses the Beveridge structural model. The others are all either Bismark or Douglas models. What's more, the very best - France, Austria, Switzerland, Japan, Holland all use the Bismark model. For all the people who fear privatisation of the NHS, it's worth considering that the very best healthcare systems in the world all appear to be private operations and it's not like France is noted for being run by die-hard capitalists.
Chatting to the she-David, she observed that the great fear of private healthcare is that it stops being free at point of use, which is a legitimate fear, so I'd point out that all of the above listed systems ensure that their healthcare is insurance based and guarantee insurance coverage to the unemployed and poor.
3) All the best systems rely upon private provision of insurance and medical care, but they also rely upon strict government regulation and price controls.
Speaking as a die-hard market capitalist I've got to admit that I recoil from price controls, but I can't deny that in this case the evidence completely contradicts my ideological position. The best healthcare systems are based on having heavily regulated and price-controlled structures.
So, the conclusions we can draw from that are that:
1) If the UK wants a better healthcare system, it's gonna have to pay for it.
2) The funding structure used does not produce the best possible outcomes. I'd suggest that the problem is one of the government being both provider and regulator - player and referee. For why that's a problem, imagine if Manchester United employed, paid for, and regulated all the referees in the Premier League, and then ask yourself why nobody has been named or will face any punishment or sanctions for the deaths of 1200 people in Mid Staffordshire, or why the banks regulating themselves didn't work out so well.
3) Whilst the separation of provision and regulation appears necessary, regulation - strict regulation - and legally enforced price controls on the cost of procedures seems to be an essential part of the package.
So there you go. Ideologically speaking, I object to spending more on public services and price controls, but I've got to admit that I'd put that aside in return for fewer people dying in their own poo. The question is whether you have any ideological attachment to or dislike of the system of healthcare provision in the UK, and whether you'd be prepared to put that aside for the same goal. I'm looking at you, 'No private healthcare' people.
But hey, I might be wrong. What do you think?
To put the figures into perspective, in one single Staffordshire hospital more people died from medical negligence than in the entire Dutch healthcare system in the same year. When you get results like that, it starts being worth suggesting that maybe those Nederlanders know something we don't.
The details of the deaths make for depressing reading: nurses refused to bring patients water, reducing people to drinking from the vases containing flowers brought by their relatives. There are stories of people starving to death, and incontinents lying uncleaned in their beds.
I dunno about you, but I missed the bit in the Olympic opening ceremony with the pensioners starving to death in their own poo. Maybe I was making a cup of tea during that bit or something.
The problem is that any suggestion that there may be problems with the NHS immediately gets you labelled some sort of psychopath who wants to privatise the healthcare system and leave poor people to die like what happens in wicked America. Nigel Lawson once observed that the NHS had assumed the status of a new national religion, and he had a point. Criticise the good works and expect to find people queuing up outside demanding to find out if you weigh as much as a duck.
Anyway, despite this I got me to considering healthcare systems and how they work. The first thing to do when considering these things is to look at which ones work. It's difficult to get this sort of information as there are few comparitive studies which rank national systems. The most famous one is an World Health Organisation study from 2000, and going digging there is also an ACHI study from 2007 and one by the Economist intelligence unit from a couple of years ago which I have seen but don't have a link for. You can believe me or not as it pleases you regarding what I say about it.
Looking at these, there are some countries who names keep coming up as providing the best healthcare systems by outcomes in the world - France, Austria, Switzerland, Australia, Canada, Singapore, a few others. The UK doesn't tend to come into the list of top systems at all. The WHO ranked the UK 18th, and we didn't make the top ten in the EIU study either. As such it's instructive to look at what other, better placed, systems do.
In a broad brush sense, there are four structural models which can be said to be used by most national healthcare systems. These are:
1) The Beveridge system, as used in the UK.
This model involves the Government owning and operating the entire health care system, with all costs paid from general taxation and with no costs at point of use.
2) The Bismark model, used by places like France, Germany Switzerland and Holland.
This model involves healthcare being paid for by compulsory private healthcare strictly regulated and controlled by the government, with the government making insurance provision for the poor and unemployed.
3) The Douglas model, as used in Canada, Australia and South Korea.
This model involves most medical care being privately provided but paid for by general taxation from the government.
4) No effective public healthcare, as used in the United States, Somalia, and Chad.
If you can pay for your healthcare, good for you! Sucks to be you if you can't.
From looking at the studies, a few consistent features appear, these being:
1) That of the countries which regularly appear in the top ten best healthcare systems in the world, every single one of them spends more per capita on healthcare than the UK. That's unequivocal. Ranging from the marginally more, like Australia which spends maybe 1-2% more per capita on healthcare, to the significantly more, such as France which spends about 10% more per capita (it's worth noting that France seems to be regarded as the best healthcare system in the world fairly consistently). All of them spend more than the UK does.
It's worth noting that expenditure cannot be the only factor in improved outcomes - the US spends about 90% more per capita than the UK and whilst the NHS ranks about 18th globally on outcomes, the US comes in at 37th. So what other factors are there?
2) Of the ten best healthcare systems in large developed nations at least comparable to the UK, only one (Italy) uses the Beveridge structural model. The others are all either Bismark or Douglas models. What's more, the very best - France, Austria, Switzerland, Japan, Holland all use the Bismark model. For all the people who fear privatisation of the NHS, it's worth considering that the very best healthcare systems in the world all appear to be private operations and it's not like France is noted for being run by die-hard capitalists.
Chatting to the she-David, she observed that the great fear of private healthcare is that it stops being free at point of use, which is a legitimate fear, so I'd point out that all of the above listed systems ensure that their healthcare is insurance based and guarantee insurance coverage to the unemployed and poor.
3) All the best systems rely upon private provision of insurance and medical care, but they also rely upon strict government regulation and price controls.
Speaking as a die-hard market capitalist I've got to admit that I recoil from price controls, but I can't deny that in this case the evidence completely contradicts my ideological position. The best healthcare systems are based on having heavily regulated and price-controlled structures.
So, the conclusions we can draw from that are that:
1) If the UK wants a better healthcare system, it's gonna have to pay for it.
2) The funding structure used does not produce the best possible outcomes. I'd suggest that the problem is one of the government being both provider and regulator - player and referee. For why that's a problem, imagine if Manchester United employed, paid for, and regulated all the referees in the Premier League, and then ask yourself why nobody has been named or will face any punishment or sanctions for the deaths of 1200 people in Mid Staffordshire, or why the banks regulating themselves didn't work out so well.
3) Whilst the separation of provision and regulation appears necessary, regulation - strict regulation - and legally enforced price controls on the cost of procedures seems to be an essential part of the package.
So there you go. Ideologically speaking, I object to spending more on public services and price controls, but I've got to admit that I'd put that aside in return for fewer people dying in their own poo. The question is whether you have any ideological attachment to or dislike of the system of healthcare provision in the UK, and whether you'd be prepared to put that aside for the same goal. I'm looking at you, 'No private healthcare' people.
But hey, I might be wrong. What do you think?
