What is the best way to measure if NHS is cost-effective?
The blog called "Liberal Conspiracy" did this, and some of the replies are quite stunning! The gist of the article is that spending went up more quickly under Margaret Thatcher than it is planned to under David Cameron, even though the need is growing at a faster rate. The gist of the comments is that the world falls into two camps, those that want to defend NHS, and those that want to attack it. In truth, the demographics of England (many more people living to frail old age, rich enough to kill ourselves) is changing faster than NHS can change, so it is difficult to compare performance over time.
There is a sterling report by the Commonwealth fund from 2010, which does this, and demonstrates a number of interesting points brought out in the Tax Research UK blog on the subject from June 2011.
This detailed piece of research shows the NHS for what it is - an exceptionally cost-effective way to deliver heatlhcare to the nation, with the corresponding benefits of
A more recent study (reported in the Guardian August 7 2011) compares UK NHS to a larger number of health systems. The study was published in Journal of the Royal Society of Medicine, which is known for its impartiality.
The study demonstrates the importance of committed staff, as UK is able to deliver better care, for lower cost in terms of both £ per head of population (or US $ as the currency of comparison) and as a % of GDP. Obviously our health spend is higher than some countries, and people will go on about Japanese legendary long life.
Actually, I have a question to ask about the legendary long life of Japanese people on their diet of raw fish.
Last year, the oldest person in the world (who was thought to live in Japan) was found not to be. His son and daughter in law had been claiming his pension for the last 30 years after he'd died. Then the Japanese state pension authorities estimated that perhaps 1/3 of all pensioners were not actually alive. This number has to be big enough to change the average life expectancy? Maybe the Japanese don't live longer, they just pretend they do for pension purposes?
Anyway, this allows us to mimic what the government does and compare UK to USA. UK compares rather well to USA - with GDP spend on health at 9.3% (compared with USA at 15%), and better outcomes in terms of life expectancy at birth and healthy years.
This is an important argument. Those that pay the biggest taxes should have a choice what they are spent on, and if these same people decide that they want to spend their own money on private healthcare provision or private education provision, why should their money be allocated by some faceless bureaucrat, to help people who don't or won't look after themselves?
Healthcare is a necessity, just as education, enforcement, logistics are vital to any successful Western economy. It doesn't matter who spends the money (whether you pay for it yourself or whether government taxes you and then spends the money on your behalf), the money will leave your pocket and you will make use of healthcare.
Well in USA, 15% of every $ dollar $ of GDP goes on healthcare. Since we know that only about 70% of the population have access to healthcare, this means that healthcare per person receiving healthcare is exceptionally expensive. I've certainly heard of insurance premiums for a healthy 40-year-old non-smoking male around $8000 per year. That is money that has left your pocket.
In UK, 9.3% of every $ dollar (because we're comparing like with like) goes on healthcare. This is about $3000 per adult, more when they are old and less when they are a healthy 40-year-old. Obviously they take the money when you are working, because it comes out of taxes.
BUT I hear you cry - BUT my private health insurer only charges me a premium of £600-800 ($900 - 1300). Yes, but when you read the small print you find that private healthcare ONLY covers you for a few things, basically the cost of better hotel services. You usually only get private treatment (ie bumped up the waiting list) if the waiting list is longer than the NHS maximum, therefore for most things you will use NHS care. You go into an NHS hospital for your treatment, but convalesc in the private hospital which is little more than a hotel. The private insurer provides NO cover for emergency or for maternity at this price. Of course they can do it more cheaply. What is surprising, given that, is that so much of our money goes into private healthcare premiums - of the total 9.3% of GDP spend on health, 7.1% is from tax and 2.1% (I presume there's some rounding error) is private!
Of course NHS needs reform. How do you think it came to be so efficient and effective, if it were not always going through a process of review and reform. But as the saying goes "all improvement requires change, but not all change is an improvement" and this applies most strongly to top-down change in NHS.
TSRC works to empower individuals and teams at the front line, to make the changes needed in response to the changes in the environment around them (changes in needs, changes in technology and medical understanding, changes in expectations). We help to ensure that back office functions do what they are meant to do - support the front-office functions. We help your own staff to create value, to understand what about what they do creates value and how to do more, and we help you to design priorities and strategies that provide a firm foundation for health and care delivery. This applies whether you are NHS, public sector, CVS or for-profit.